http://www.psychiatrygrandrounds.com Cutting-edge presentations on clinical neurosciences, behavior, and mental health Sun, 28 Jan 2007 10:00:00 PST Generated the old fashioned way en-us Copyright 2007, 2008, 2009 Ian A Cook MD editor@psychiatrygrandrounds.com (editor) wm@psychiatrygrandrounds.com UCLA Semel Institute; Ian A Cook MD, Course Dir. UCLA Semel Institute; Ian A Cook MD, Course Dir. No Psychiatry, Psychiatry Grand Rounds, CME, Mind, Brain, Behavior, Mental Health, psychology, psychopharmacology, therapy Podcast Summary Edition - PsychiatryGrandRounds.com Summaries, interviews, and discussion with leaders in Psychiatry, Neurobiology, Human Behavior, Mental Health, Social Sciences, and Health Care Policy. comments@psychiatrygrandrounds.com Ian A Cook, MD, Course Director Psychiatry Grand Rounds http://www.psychiatrygrandrounds.com/images/iTunes.jpg http://www.psychiatrygrandrounds.com/ 144 144 no Medicine Ian A Cook MD editor@psychiatrygrandrounds.com (editor) Ian A Cook MD Launching our podcast summaries - PsychiatryGrandRounds.com As a complement to our weekly in-person and webcast presentations of Psychiatry Grand Rounds from UCLA's Semel Institute for Neuroscience and Human Behavior, we're now offering summaries via podcasting. Please share your comments with us via email to comments@psychiatrygrandrounds.com http://psychiatrygrandrounds.com/podcast/PsychiatryGR200700.m4a Tue, 02 Jan 2007 22:00:00 PST 1:41 psychiatry, grand rounds, mental health, introduction, UCLA no editor@psychiatrygrandrounds.com Stephen C Scheiber MD & Ian A Cook MD Update on ABPN Board Certification Stephen Scheiber MD updated us on the current trends in assuring quality via ABPN board certification. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200701.m4a Tue, 09 Jan 2007 22:00:01 PST 2:06 board certification, ABPN, professional, competence, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Robert Kern PhD & Ian A Cook MD Addressing the disability of schizophrenia through new approaches to learning Dr Robert Kern described work addressing the disability associated with schizophrenia and psychotic illnesses using "errorless learning." This technique circumvents the cognitive deficits in learning, memory, and executive function that commonly contribute to functional disability. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200702.m4a Tue, 23 Jan 2007 22:00:00 PST 3:12 schizophrenia, psychosis, learning, disability, function, executive, frontal lobe, rehabilitation, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Anthony Lehman MD MSPH & Ian A Cook MD Biological and psychotherapeutic treatments for schizophrenia supported by evidence Dr Lehman updated us on the latest scientific evidence supporting the use of specific biological and psychotherapeutic treatments for patients with schizophrenia and other psychotic disorders (Philip May Memorial Lecture). http://psychiatrygrandrounds.com/podcast/PsychiatryGR200703.m4a Tue, 30 Jan 2007 22:00:00 PST 2:32 no evidence, schizophrenia, psychosis, psychiatry, grand rounds, mental health, UCLA editor@psychiatrygrandrounds.com Marc A Schuckit MD & Ian A Cook MD Genetic and environmental factors contributng to alcoholism Dr Schuckit described data on the contributions of genetics and the environment to the development of alcoholism. The study of intermediate endophenotypes may help clarify the pathophysiology of alcoholism and identify patient groups that may benefit from different treatments. Research also suggests new possible avenues for prevention. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200704.m4a Tue, 06 Feb 2007 22:00:00 PST 3:31 no alcoholism, alcoholic, genetics, endophenotype, psychiatry, grand rounds, mental health, UCLA editor@psychiatrygrandrounds.com Stephen Marder MD & Ian A Cook MD Lessons from CATIE and CUtLASS Trials Dr Marder identified key findings and lessons from the CATIE and CUtLASS trials, two large-scale clinical trials in schizophrenia which were supported by the NIMH in the US and the NHS in the UK, respectively. These projects compared clinical outcomes with older and newer antipsychotic medications in treating schizophrenia. Findings call into question what advantages the newer agents may have over older medications. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200705.m4a Tue, 13 Feb 2007 22:00:00 PST 4:37 alcoholism, alcoholic, genetics, endophenotype, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Michelle Craske PhD & Ian A Cook MD Advances from Translational Research Dr Craske described new fundamental research in learning, memory, attention, and reactivity, and how these advances may be translated into improvements in our cognitive and behavioral treatments for anxiety disorders. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200706.m4a Tue, 27 Feb 2007 22:00:00 PST 2:24 anxiety, cognitive, behavior, behavioral, cbt, psychotherapy, psychology, learning, memory, attention, psychiatry, grand rounds, mental health, UCLA no Gary Sachs MD & Ian A Cook MD Key findings to improve care for Bipolar Disorder Dr Sachs updated us on the design and practical findings from the NIMH's STEP-BD project, "Systematic Treatment Enhancement Program for Bipolar Disorder." http://psychiatrygrandrounds.com/podcast/PsychiatryGR200707.m4a Tue, 06 Mar 2007 22:00:01 PST 2:43 bipolar disorder, manic depression, STEP-BD, NIMH, psychiatry, grand rounds, mental health, UCLA no Andrew F Leuchter MD, Carole Klove RN JD, & Ian A Cook MD Introducing the new UCLA Guidelines on COI The potential for conflicts of interest to exist has led many Universities to promulgate guidelines and rules to clarify what sorts of behaviors and activities are permissible and which may be construed as unprofessional and corrosive to the relationship of trust between physician and patient. Drs. Andrew Leuchter and Carole Klove address this important topic in this week’s Psychiatry Grand Rounds program, http://psychiatrygrandrounds.com/podcast/PsychiatryGR200708.m4a Tue, 13 Mar 2007 22:00:00 PST 2:49 bipolar disorder, manic depression, STEP-BD, NIMH, psychiatry, grand rounds, mental health, UCLA no Peter S Jensen MD & Ian A Cook MD Lessons from the MTA Trial (Multimodal Treatment of ADHD) The NIH conducted the Multimodal Treatment of ADHD, or MTA, Trial to examine outcomes in Attention Deficit Hyperactivity Disorder for children treated by experts with medications, therapy, or the combination, or who received care as usual. Dr. Peter Jensen discussed over a decade of findings from the MTA trial in this week’s Psychiatry Grand Rounds program, http://psychiatrygrandrounds.com/podcast/PsychiatryGR200709.m4a Tue, 20 Mar 2007 22:00:01 PST 2:32 ADD, ADHD, Attention Deficit Hyperactive Disorder, MTA, NIMH, psychiatry, grand rounds, mental health, UCLA no Alexander Bystritsky MD PhD & Ian A Cook MD Practical algorithms in treatment resistant anxiety disorders, and research for new interventions A large proportion of patients with anxiety disorders respond well to treatment with SSRI medications and/or Cognitive Behavioral Therapy, but a subset of individuals have treatment-resistant forms of their illness. Dr. Bystritsky is a Professor of Psychiatry at the David Geffen School of Medicine at UCLA and is Director of the Anxiety Disorders Program at the Semel Institute. He updated us on current treatment algorithms and some new interventions for anxiety disorders. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200710.m4a Tue, 27 Mar 2007 22:00:22 PST 2:32 no Anxiety, social anxiety, phobia, obsessive compulsive disorder, OCD, panic, psychiatry, grand rounds, mental health, UCLA Mary-Frances O'Connor PhD & Ian A Cook MD Neuroimaging, autonomic, endocrine, and immunologic studies, and their treatment implications The similarities and differences among grief, bereavement, and major depression have constituted an area of considerable attention and debate for many years. Advances in neuroimaging are allowing new work to delineate better these experiences by examining the physiology associated with each. Dr. Mary Frances O'Connor has made this the focus of her research. Dr. O'Connor is a post-doctoral fellow here at UCLA and is the Friends of the Semel Institute Fellow this year. In this week's Psychiatry Grand Rounds program, Dr. O'Connor updates us on current research in this area its clinical implications. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200711.m4a Tue, 03 Apr 2007 22:00:00 PST 3:06 Grief, bereavement, loss, mourning, depression, Friends of the Semel Institute, psychiatry, grand rounds, mental health, UCLA no Rita Charon MD PhD & Ian A Cook MD Listening and writing about the interior lives of our patients and ourselves Physicians and other healthcare professionals have a special privilege in knowing our patients in ways outside the ordinary. Patients share with us their stories of struggles with illness, and from this, we are able to know them from a unique perspective. These glimpses of the interior life of our patients invariably impacts on our own lives, yet this is not often acknowledged. Writing about experiences with patients is one way to gain a deeper understanding of these interactions, and a leader in this nascent field of narrative medicine is Dr. Rita Charon. An Internist and Professor of Clinical Medicine, Dr. Charon is Director of the Program in Narrative Medicine at the College of Physicians and Surgeons of Columbia University. Her Psychiatry Grand Rounds program "Narrative Psychiatry: Storied Approaches to Patient Care" introduces us to her approach and suggests ways in which practitioners might adopt some of these techniques into their own practices. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200712.m4a Tue, 10 Apr 2007 22:01:01 PST 2:34 no Literature, medicine, narrative, stories, psychiatry, grand rounds, mental health, UCLA Helen Lavretsky MD & Ian A Cook MD Update on the management of late-life depression While major depression is a common psychiatric disorder at any age, depression in late life has some unique features, including differences in the presenting signs and symptoms and in the response to treatment, in comparison with other age groups. The demographic trends associated with aging of the Baby Boom generation suggest that a staggering number of older Americans will develop depression in the coming decades; one of the clear implications is that practitioners will need to be adept at managing depression in older adults. Updating us on new treatment approaches in late-life depression is Dr. Helen Lavretsky. Dr. Lavretsky is an Associate Professor of Psychiatry at the David Geffen School of Medicine at UCLA and a Research Scientist at the Semel Institute. Her Psychiatry Grand Rounds program reviews the setting of late-life depression and presents important new data on the clinical management of depression in older adults. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200713.m4a Tue, 10 Apr 2007 22:02:02 PST 2:00 Depression, late-life, aging, elderly, MDD, psychiatry, grand rounds, mental health, UCLA no Murray B Stein MD MPH & Ian A Cook MD Perspectives on genetics and endophenotypes in anxiety disorders Our understanding of anxiety has come a long way from clinical descriptions advanced over the past two centuries. Some advances have come from theories that specific brain regions function together in a neural circuit, and that this circuit may function differently in people with anxiety disorders. The processing of information in such circuits is influenced by a number of so-called susceptibility genes. These genes may lead to what is called a phenotype, such as exhibiting enhanced brain reactivity when seeing a picture of someone who looks frightened. These intermediate phenotypes or "phenes," may identify subsets of individuals within the diagnostic categories in the anxiety disorders. One of the critical thinkers in this area is Dr. Murray Stein. Dr. Stein is a Professor of Psychiatry and of Family and Preventive Medicine at the University of California, San Diego. His Psychiatry Grand Rounds program reviews for us the conceptual approach for understanding complex human behaviors by looking at constituents parts that may have a more clearly-defined neurobiological basis. This has implications for the heritability of anxiety disorders, for understanding the interaction between genes and environment, and for developing new targets for treatments. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200714.m4a Tue, 17 Apr 2007 22:01:01 PST 2:33 Anxiety, phenotype, endophenotype, psychiatry, grand rounds, mental health, UCLA no James J Hudziak MD & Ian A Cook MD Review of genetic and environmental factors and resilience vs vulnerability to mental illness In previous decades, the relative roles of genetic and environmental factors were sometimes framed as a debate of "nature vs nurture." Contemporary perspectives find that both sets of factors are important contributors to mental health and illness, and that they interact. Dramatic structural and functional changes occur in the brain as children mature and these changes are influenced by both genes and environment. These changes in turn influence each person's vulnerability or resilience to psychopathology. Many adult psychiatric patients have their first onset of illness in childhood or adolescence, making this of importance not only to child psychiatrists and psychologists, but to mental health practitioners more broadly. This approach is sometimes phrased as "what is inherited is the manner of reaction to a given environment." Important contributions in this area have been made by Dr. James Hudziak. Dr. Hudziak is Director of the Child Psychiatry and Behavioral Genetics program at the University of Vermont. His Psychiatry Grand Rounds program reviews for us this new approach to studying interactions of genes and environment across a wide range of psychiatric illnesses. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200715.m4a Tue, 24 Apr 2007 22:01:01 PST 2:19 Gene, genetics, environment, children, child psychiatry, child psychopathology, psychiatry, grand rounds, mental health, UCLA Susan Bookheimer PhD & Ian A Cook MD New research examining the complexities of Autism Spectrum Disorders Humans are social creatures, and social communications and behaviors help define us. Autism spectrum disorders are marked by problems with social behaviors and by dysregulation in the systems in the brain that support these behaviors. Autism spectrum disorders are defined by three features: 1) delayed language development, 2) poor social skills such as difficulties with joint attention and referencing, and 3) repetitive behaviors, such as hand flapping or rocking. Genetic factors account for much of the prevalence of autism, with perhaps a dozen genes exerting a joint effect. Ultimately, multiple brain systems appear to be involved with autism, and one way to unravel the complexity of the autism spectrum is to use neuroimaging to delineate phenotypes. Imitation of expressions, interest in faces, eye contact, and detecting the emotional content of speech from tone of voice all are areas of study that illuminate the differences between children with autism and typically-developing children. Dr. Susan Bookheimer leads research in this area at UCLA. Dr. Bookheimer is with the Center for Cognitive Neurosciences at UCLA where she is a Professor in the Department of Psychiatry and Biobehavioral Sciences. Her Psychiatry Grand Rounds program reviews for us some new research that uses neuroimaging to understand the neurobiology of autism spectrum disorders. http://psychiatrygrandrounds.com/podcast/PsychiatryGR200716.m4a Tue, 01 May 2007 22:00:10 PST 3:30 Autism, Autism spectrum disorders, fMRI, neuroimaging, communications, social behavior, children, child psychiatry, child psychopathology, psychiatry, grand rounds, mental health, UCLA no Michael Gitlin MD & Ian A Cook MD New research examining the difference between symptomatic and functional outcomes Bipolar disorder or manic depression has a profound effect on the lives of individuals who have this illness. The classic symptoms of mood swings with euphoric highs and devastating lows are but part of the picture. The disability experienced can be marked and can impact on individual relationships, function in the family, and occupational achievements. Updating us on new research findings is Dr. Michael Gitlin. Dr. Gitlin is the Director of the UCLA Mood Disorders Clinic and Director of the Division of Adult Psychiatry at the David Geffen School of Medicine, where he is also Professor of Psychiatry and a Research Scientist at the Semel Institute. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2008-101.m4a Wed, 10 Sep 2008 16:00:01 PST 2:23 Bipolar, Manic, Depression, Manic depression, treatment, function, outcome, psychiatry, grand rounds, mental health, UCLA no Jeanne Miranda PhD & Ian A Cook MD Data on the impact of healthcare disparities among ethnic minorities The role of ethnicity in psychiatric illnesses is gaining attention at the national level and is a topic particularly appropriate to examine in Los Angeles, arguably the most ethnically-diverse region in our country. Ethnic and racial differences may exert influences which can impact on the development, course, and treatment for psychiatric disorders. Access to care is an important part of this picture, and a topic which is particularly germane in election-year discussions of public policy. Our Grand Rounds presentation on this important area is being made by Dr. Jeanne Miranda. Dr. Miranda is Assistant Director of the UCLA Health Services Research Center and is a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA and the Semel Institute. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2008-102.m4a Tue, 16 Sep 2008 16:00:01 PST 2:15 Ethnicity, ethnic, minority, minorities, race, racial, disparity, insurance, healthcare, medicare, medicaid, medi-cal, treatment, function, outcome, psychiatry, grand rounds, mental health, UCLA no Robert M Bilder PhD & Ian A Cook MD Update on a Phenomics-based approach to Psychiatry Our understanding of mental illness is frequently organized around our diagnostic framework, particularly as codified by the Diagnostic and Statistical Manual from the American Psychiatric Association. Heterogeneity within any given diagnostic category has added challenges to efforts to link genes to diagnosis. These thwarted efforts have focused new attention on the characterization and refinement of endophenotypes, namely, quantitatively-measurable traits believed to be intermediate between disease phenotypes and the biological processes that underlie them. This update on new advances in phenomics is presented by Dr. Robert Bilder. Dr. Bilder is Director of the Consortium for Neuropsychiatric Phenomics and is Chief of Medical Psychology and Neuropsychology and a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA and the Semel Institute. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2008-103.m4a Tue, 07 Oct 2008 16:00:01 PST 3:30 phenomics, cognitive phenomics, endophenotype, diagnosis, treatment, function, outcome, psychiatry, grand rounds, mental health, UCLA no Ronald M Harper PhD & Ian A Cook MD Impact of sleep-disordered breathing on brain structure and function Many psychiatric disorders include sleep dysregulation among their formal diagnostic criteria or associated symptoms. Patients may experience sleep disturbances from medical conditions such as obstructive sleep apnea, a problem frequently caused by obesity. Difficulties with breathing during sleep have been associated with daytime impairments in cross-sectional studies and with increased mortality rates in longitudinal studies, and but the mechanistic pathways linking these phenomena are still being elucidated. As these relationships become clearer, so too does the importance of accurate diagnosis and appropriate intervention. In this Grand Rounds program, Dr. Ronald Harper presents new research into the neurobiology of sleep disorders and their health consequences. Dr. Harper is the Distinguished Professor of Neurobiology at the David Geffen School of Medicine at UCLA and the UCLA Brain Research Institute. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2008-104.m4a Tue, 14 Oct 2008 16:00:01 PST 4:26 sleep, apnea, obstructive sleep apnea, breathing, mood disorder, substance abuse, autonomic, mood, cognition, diagnosis, treatment, function, outcome, psychiatry, grand rounds, mental health, UCLA no Madhukar H Trivedi MD & Ian A Cook MD Management of Depression, new questions after STAR*D Depression is among the most common and disabling psychiatric disorders, in large measure because it frequently takes a considerable amount of time for individual patients to recover fully. The NIMH funded the STAR*D Project to examine a sequence of treatments and expand the evidence base for what to do when the first treatment doesn’t lead to remission. Over four thousand outpatients with depression and a variety of medical and psychiatric co-occurring disorders enrolled in that study; these “real world” treatment-seeking patients participated in up to 4 different levels of treatment, with measurement-based care to guide dose adjustments and the objective of achieving remission. The pipeline of hundreds of reports from this massive project will continue to inform us for a number of years to come, but already we have learned much about the strengths and shortcomings of our current strategies to manage depression. Speaking to us on the next steps after STAR*D is an internationally-known depression researchers and one of the prime movers behind the STAR*D project, Dr. Madhukar Trivedi. Dr Trivedi is Director of the Mood Disorders Program at the University of Texas Southwestern Medical Center in Dallas, where he is also the Betty Jo Hay Distinguished Chair in Mental Health, and the Lydia Bryant Test Professor in Psychiatric Research. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2008-105.m4a Tue, 21 Oct 2008 16:00:01 PST 3:44 depression, clinical depression, major depression, mood disorder, STAR*D, sequenced, mood, diagnosis, treatment, function, outcome, psychiatry, grand rounds, mental health, UCLA no Kay Jamison PhD & Ian A Cook MD Self disclosure and public and professional reaction Personal experiences with illness have often played pivotal roles in the lives of health practitioners, steering youngsters to pursue a career in the healing professions or renewing the humanity of someone who has been in practice for years. Narratives about these experiences can be found in private diaries, in published memoires, and in Hollywood film scripts. On the other hand, self-disclosure by mental health practitioners has long been debated in many circles, tracing back to dicta about the importance of the therapist being able to serve as a “blank screen.” Considerable time is spent in many psychiatry residency programs in supervising trainees on when, why, and how much self disclosure might be appropriate to introduce into the therapeutic setting. Against that historical background, our Grand Rounds speaker, Dr. Kay Jamison, had established herself as an expert in Bipolar Disorder for many, many years before she went public with her autobiographical descriptions of her own experiences with that illness. Kay Redfield Jamison, has published extensively in the area of mood disorders, both in the scientific literature and in books accessible to interested members of the public. She is Professor of Psychiatry and Behavioral Sciences at The Johns Hopkins University School of Medicine, Baltimore and has returned to UCLA to participate in our day-long conference, “Mood Disorders in the 21st Century,” a Symposium from the UCLA Integrative Study Center for Mood Disorders. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2008-106.m4a Tue, 28 Oct 2008 16:00:01 PST 3:15 depression, manic depression, mania, bipolar, narrative, self disclosure, mood disorder, mood, outcome, psychiatry, grand rounds, mental health, UCLA no Gary W Small MD & Ian A Cook MD Maintaining brain health during aging As one's brain ages, many potential trajectories exist between normal healthy brain function in adulthood, and the possibilities on the one hand of healthy older brains, or on the other, the brain disorders of Alzheimer's Disease and other forms of dementia. As members of the Baby Boom generation enter their senior years, questions of brain health and healthy aging are taking on even greater public health significance than before. The factors that may lead to these different aging pathways have been the focus of much research, not just in terms of mitigating the impact of degenerative brain disorders but also in terms of steps towards optimal health and function at the other end of the spectrum. A leader in this area of biomedical research is our grand rounds speaker, Dr. Gary W. Small. Dr. Small is Director of the UCLA Center on Aging. He is also the Parlow-Solomon Professor on Aging at the David Geffen School of Medicine at UCLA, and is a Professor of Psychaitry and Biobehavioral Sciences at the Semel Institute for Neuroscience and Human Behavior at UCLA. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2008-107.m4a Tue, 11 Nov 2008 16:00:01 PST 4:20 aging, memory, vitality, dementia, optimal, exercise, Alzheimer, Alzheimers, stroke, health, psychiatry, grand rounds, mental health, UCLA no Sally A Frautschy, PhD MS & Ian A Cook MD New therapeutic agents for Alzheimer's Diease http://psychiatrygrandrounds.com/podcast/PsychiatryGR2008-108.m4a Tue, 02 Dec 2008 16:00:01 PST 2:00 alzheimer, alzheimer's, dementia, aging, elderly, neuroprotection, cumin, NSAID, psychiatry, grand rounds, mental health, UCLA no Tyrone D Cannon, PhD & Ian A Cook MD Longitudinal findings about onset of schizophrenia Clinical lore and retrospective studies have long reported that individuals who develop significant psychotic illnesses, such as schizophrenia, often have a prodromal period that precedes a first fully-developed psychotic episode. Prodromal periods can last for months to years, and are marked by changes in a person's behavior, sense of self, mood, or how the person handles stress. Changes in personal hygiene, difficulties at school or work, or social withdrawal from family and friends are commonplace. The prodromal period often happens during adolescence, and differentiating this from normal adolescent behavioral phases can be challenging at times. Nonetheless, studies of the behavioral and biological harbingers of a first psychotic episode may shed important light on the pathophysiology of schizophrenia and may suggest new directions for treatment. Prospective monitoring of a large cohort of youth who are at risk for developing psychosis can illuminate these issues, and this Grand Rounds presentation by Dr. Tyrone Cannon focuses on developments in these areas. Dr. Cannon is the Staglin Family Professor of Psychology and Psychiatry and Biobehavioral Sciences at UCLA, the Carol Moss Spivak Scholar in Neuroscience, and the Director of the Staglin Music Festival Center for Cognitive Neuroscience at UCLA. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2008-109.m4a Tue, 09 Dec 2008 16:01:02 PST 4:29 psychosis, schizophrenia, prodrome, prodromal, conversion, onset, adolescence, DISC1, gray matter, grey matter, neuroimaging health, psychiatry, grand rounds, mental health, UCLA no Larry J Siever MD & Ian A Cook MD Neurobiological factors and the management of Axis II disorders Historically, much of the psychiatric literature on personality disorders has focused on psychological factors, particularly early childhood experiences, that may lead to dysfunctional behavioral patterns in adulthood. In recent years, research has expanded our understanding of these diagnoses to include recognition of important neurobiological factors and how the biological and psychological features relate to one another. In studies of borderline personality disorder, diminished top-down control of affective responses may underlie the excessive emotional dysregulation in this disorder, a phenomenon potentially related to abnormal function in specific midline regions of prefrontal cortex. In addition, genetic, neuroendocrine, and neuroimaging findings point to a role for serotonin in this problem of affective disinhibition. UCLA is pleased to welcome Dr. Larry J. Siever, to update us on how the growing body of neurobiological research may impact on the care of individual patients with Axis II disorders. Dr Siever is the Director of the Special Evaluation Program for Mood and Personality Disorders at the Mount Sinai School of Medicine in New York, where he is also a Professor of Psychiatry. Additionally, he is the Director of both the Outpatient Psychiatric Division and the VISN 3 MIRECC at the James J Peters VA Medical Center in the Bronx. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-001.m4a Thu, 01 Jan 2009 16:00:00 PST 5:05 psychosis, schizophrenia, prodrome, prodromal, conversion, onset, adolescence, DISC1, gray matter, grey matter, neuroimaging health, psychiatry, grand rounds, mental health, UCLA no Itzhak Fried MD PhD & Ian A Cook MD New perspectives on how memories are stored and recalled Of all mental faculties, human memory in particular has intrigued not only neuroscientists and clinicians, but poets and philosophers as well. Theories about the workings of memory have been numerous, and research in recent decades has demonstrated that there are a number of important subtypes of memory - declarative memory, implicit memory, working memory, and many more. Several key brain structures have been implicated in aspects of encoding and retrieval processes - the hippocampus and amygdala in particular appear to play crucial roles. Some of this work has been performed at UCLA, and to share with us some of his recent findings and interpretations, we are pleased to welcome Dr. Itzhak Fried. Dr. Fried is Director of the UCLA Epilepsy Surgery Program and is a Professor both of Neurosurgery and of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA and at the Semel Institute for Neuroscience and Human Behavior. Dr. Fried presents some of his findings discovered through work with patients undergoing neurosurgery for treatment resistant epilepsy. Individuals had electrodes implanted surgically in their brains to aid in planning their treatment; while the electrodes were still in place, Dr. Fried and his team showed images and played sound recordings in the operating room, and the pattern of activation suggests that certain cells or groups of cells may be important for storing key abstractions, at least about people and places. The full webcast program contains examples of stimuli and the brain responses, for example, to viewing images of Oprah, Jennifer Aniston, or the Eiffel Tower. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-002.m4a Tue, 06 Jan 2009 16:00:10 PST 2:14 memory, amygdala, hippocampus, depth electrode, electrocorticography, Penfield, neurosurgery, epilepsy, psychiatry, grand rounds, mental health, UCLA no Nelson Freimer MD & Ian A Cook MD Neurogenetics and Mood Disorders With the completion of preliminary mapping in the Human Genome Project, there was much excitement about the potential to usher in a new age of personalized medicine, with treatments driven by an individual’s genetic data. While this is leading to advances in care for some disorders, the common psychiatric illnesses have not yielded easily to this approach. It appears than many complex behavioral disorders may emerge from interactions between a number of different genes, rather than be governed by the actions of single genes. To bring us up to date on progress in this area with a focus on bipolar disorder, we are pleased to welcome Dr. Nelson Freimer. Dr. Freimer is Director of the UCLA Center for Neurobehavioral Genetics and is a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine and at the Semel Institute for Neuroscience and Human Behavior at UCLA http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-003.m4a Tue, 20 Jan 2009 16:00:00 PST 2:36 bipolar, bipolar disorder, manic depression, gene, genetics, genomics, human genome project, DSM, endophenotype, psychiatry, grand rounds, mental health, UCLA no editor@PsychiatryGrandRounds.com (Ian A Cook MD) Ira Lesser MD & Ian A Cook MD Help for suicidal physicians http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-004.m4a Tue, 27 Jan 2009 16:00:00 PST 0:01 mood, depression, suicide, suicidal, physician, well-being, well being, suicide prevention, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Gail Wyatt PhD & Ian A Cook MD Competence and understanding cultural and ethnic diversity The Los Angeles region enjoys some of the greatest cultural and ethnic diversity in the world, and research conducted here has illuminated the importance of understanding diversity in social and cultural aspects when addressing the healthcare needs of individual patients. While parallel principles apply across many medical illnesses, these are particular areas of importance in the realms of physical and sexual trauma, in mental health care broadly, and in the HIV/AIDS epidemic. To share with us her long-term perspectives on these topics and to mark Black History Month, we are pleased to present this Grand Rounds talk by Dr. Gail Wyatt. Dr. Wyatt is the Associate Director of the UCLA AIDS Institute and is a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA and the Semel Institute for Neuroscience and Human Behavior. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-005.m4a Tue, 03 Feb 2009 16:00:00 PST 4:20 diversity, culture, ethnicity, african-american, black, lantino, latina, asian-american, competence, HIV, AIDS, sexual abuse, trauma, PTSD, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Chris Evans PhD & Ian A Cook MD Opioid receptors and medications - uses and abuses Molecules that bind to opioid receptors have been important to human society for centuries. Historical examples include tinctures of poppies in folk medicine and hookah smoking in opium dens, while contemporary examples include of the powerful synthetic opioids used constructively in health care and destructively misused in the context of drug addiction. Neurobiological studies have shown that the opioid system plays a role not only in pain and analgesia, but in mood and substance abuse disorders broadly. Present uses of these molecules need to be viewed with awareness of both biomedical evidence and historical context. Presenting an update on these important topics is UCLA's own Dr. Christopher Evans. Dr. Evans is Director of the UCLA Brain Research Institute and he also directs the Shirley and Stefan Hatos Center for Neuropharmacology in the Semel Institute for Neuroscience and Human Behavior. He is also the Stefan Hatos Professor of Psychiatry & Biobehavioral Sciences at the David Geffen School of Medicine at UCLA. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-006.m4a Fri, 13 Feb 2009 13:00:01 PST 4:59 opiate, opioid, drug, addiction, mu, kappa, delta, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Mark Rapaport MD & Ian A Cook MD Mark Rapaport MD & Ian A Cook MD How conceptual models of anxiety disorders relate to therapeutics Anxiety disorders are among the most common psychiatric illnesses. As it has become clearer how the brain processes fear, anxiety, and traumatic experiences, our therapeutic opportunities for our patients have widened. Individuals with anxiety disorders can receive evidence-based care using a range of medications and manualized psychotherapies, and research is examining the experimental use of brain stimulation approaches as well. The close reciprocal relationship between our conceptual models of the illnesses and our treatment approaches is vital, and this Grand Rounds talk will help make this connection more transparent. Each year, the Department of Psychiatry honors the memory of Dr. Richard Rosen, one of our outstanding clinician-teachers and experts in anxiety who died tragically in 2000 in a plane crash. This year's Rosen Memorial Lecturer will be Dr. Mark Rapaport. Dr. Rapaport is Chair of the Department of Psychiatry at Cedars-Sinai Medical Center in Los Angeles, where he holds the Polier Chair in Schizophrenia and Related Disorders. In addition, Dr. Rapaport is a Vice Chair of the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-007.m4a Tue, 24 Feb 2009 16:00:00 PST 3:14 anxiety, anxiety disorder, anxious, generalized anxiety, phobia, PTSD, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Joel Nigg PhD & Ian A Cook MD Joel Nigg PhD & Ian A Cook MD New research on etiology and pathophysiology of ADHD Attention Deficit Hyperactivity Disorder or ADHD has many manifestations besides the attentional and behavioral disturbances suggested by the disorder's name. The disruptions in peer and family relationships and the challenges to effective learning can shape a child's developmental trajectory. Many questions exist about the heterogeneity of the condition, and efforts to understand causes and mechanisms often employ endophenotyping strategies to arrive at subject groups with similar biology and similar presentations. While the illness runs in families, it may well be that it is a vulnerability to the illness which is heritable and that some other event - exposure to a toxic molecule or a life stressor, for example - may be necessary for an individual to develop ADHD. This Grand Rounds presentation will update us on recent research in this area. Each year, the Department of Psychiatry honors the memory of Dr. Dennis Cantwell, one of the early leaders in the treatment of psychiatric illness in children and adolescents and a pioneer of child psychopharmacology. This year's Cantwell Memorial Lecturer will be Dr. Joel Nigg. Dr. Nigg is a Professor of Psychiatry at Oregon Health and Science University in Portland. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-008.m4a Tue, 10 Mar 2009 16:00:00 PST 2:05 ADHD, attention, hyperactivity, attention deficit hyperactivity disorder, ADD, endophenotype, cognition, lead, toxin, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Linda Ercoli PhD & Ian A Cook MD Linda Ercoli PhD & Ian A Cook MD Neuroimaging to find those at greatest risk for cogntive decline Demographic trends in the United States suggest that there will be an explosion in the number of older adults at risk for developing Alzheimer's Disease and other dementias in this decade. The presence of symptoms and cognitive deficits can help detect the disorder once it has happened to measurable amounts, but how can we find those individuals at greatest risk at the earliest possible time, so that brain function can be preserved by offering early intervention? Demographic and genetic risk factors get us part of the way there, but these account for only some of the risk. It has been challenging to make direct measurements of pathological processes in the living brain, such as the development of the hallmark plaques and tangles. Advances in neuroimaging offer new opportunities, and this Grand Rounds presentation will update us on recent research in this area. Today's presentation will be made by Dr. Linda Ercoli. Dr. Ercoli is an Assistant Clinical Professor at the David Geffen School of Medicine at UCLA and the Semel Institute for Neuroscience and Human Behavior. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-009.m4a Mon, 16 Mar 2009 16:00:01 PDT 3:20 Alzheimer, Alzheimer's disease, dementia, cognitive decline, at risk, vulnerability, cognition, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Michael Irwin MD & Ian A Cook MD Michael Irwin MD & Ian A Cook MD Sleep disturbances increase inflammatory signalling, with implications for depression and cognition The reasons for sleep in humans has been the study of much research spanning many decades of work. Importantly, disturbances in sleep are common in many psychiatric and other medical disorders as well as in many older individuals. Recent work suggests that disruption of the normal sleep architecture patterns can have adverse impact not only on a person's subjective sense of well being, but also on the brain, immune system, and other vital organ systems as well. This Grand Rounds presentation will update us on recent research in this area. Today's presentation will be made by Dr. Michael Irwin. Dr. Irwin is the Norman Cousins Distinguished Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA and is the Director of the Cousins Center for Psychoneuroimmunology at the Semel Institute for Neuroscience and Human Behavior http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-010.m4a Fri, 20 Mar 2009 16:00:01 PDT 2:50 Sleep, Insomnia, inflammation, cytokine, inflammatory, psychoneuroimmunology, PNI, Alzheimer's disease, dementia, cognitive decline, at risk, vulnerability, cognition, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com John Piacentini PhD & Ian A Cook MD John Piacentini PhD & Ian A Cook MD New findings from multisite trial of CBT in Tic Disorders Unusual human behaviors have always fascinated the public, and the complex verbal and behavioral tics of Tourette Syndrome have captured the attention of many. Manifestations of the illness commonly begin in childhood, and optimizing treatments for each individual patient has proven challenging. Behavioral interventions have gained interest, particularly as concerns about pharmacotherapy in children have shaped the public dialog. A large multisite trial called CBIT for "Comprehensive Behavioral Intervention for Tics" was sponsored by the NIMH, and findings from this project have begun to be reported. This Grand Rounds presentation will update us on the study's contributions to treatment for Tourette Disorder Today's presentation will be made by Dr John Piacentini. Dr. Piacentini is Director of the Child OCD, Anxiety, and Tic Disorders Program at the Semel Institute for Neuroscience and Human Behavior, and is a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-011.m4a Thu, 26 Mar 2009 16:00:02 PDT 3:14 Tourette, Tourette's, Tourette Disorder, Tourette Syndrome, tic, tic disorder, CBIT, CBITS, behavior, behavioral intervention, behavioral medicine, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Cameron Carter MD & Ian A Cook MD Cameron Carter MD & Ian A Cook MD New research on the neural substrates of cognitive dysfunction in psychosis Schizophrenia is a complex disorder, with several different categories of symptoms. While the positive symptoms of hallucinations and delusions have captured the attention of the public and often are well managed with current treatments, other symptom spheres have been less well understood and treated. Impaired cognition in schizophrenia has long been recognized as a core symptom area, and has come to be appreciated as a major determinant of how well a person returns to high levels of function in domains like employment and independent self-care. Recent work with neuroimaging has expanded what is known about the neural substrates of impaired cognition in psychosis, and has suggested new ways to develop treatments that target this symptom domain. Each year, the Department of Psychiatry honors the memory of Dr. Philip R.A. May, one of the prominent leaders in the treatment of psychosis in the mid 20th century. This year's May Memorial Lecturer will Dr Cameron Carter. Dr. Carter is Director of the Imaging Research Center at the University of California, Davis, and is a Professor of Psychiatry and Behavioral Sciences at the UC Davis School of Medicine. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-012.m4a Tue, 14 Apr 2009 16:00:01 PDT 2:51 schizophrenia, psychosis, learning, memory, cognition, cognitive dysfunction, neurobiology, imaging, neuroimaging, fMRI, EEG, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Russell Poldrack PhD & Ian A Cook MD Russell Poldrack PhD & Ian A Cook MD Understanding the brain systems involved in learning habits and overriding them How do we decide what to do each moment? Certainly, external circumstances play a large role as these contingencies are always changing. A large part of our behaviors, however, might well be identified as "habits." Some habits are adaptive and helpful -- for example, we teach children to look both ways before crossing the street. Other habitual behaviors are not so good for ourselves, and overriding inappropriate and malaptive habits requires the use of several different and distinct yet interconnected brain systems. Memory systems that support the learning of habits are different from those that help us recall the narratives of our lives. Prefrontal systems that integrate memories and allow us to stop ourselves involve still other brain regions. Understanding the ways these different brain systems interact to allow us to make decisions may have implications for the management of a wide range of psychiatric disorders. This Grand Rounds presentation will update us on recent findings in this area. Today's presentation will be made by Dr. Russell Poldrack, a leader in this field. Dr. Poldrack is the holder of the Wendell Jeffrey and Bernice Wenzel Term Chair in Behavioral Neuroscience and is a Professor of Psychology at UCLA and at the Semel Institute. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-013.m4a Sun, 19 Apr 2009 16:00:01 PDT 3:17 learning, memory, habit, cognition, cbt, cognitive behavioral therapy, addiction, depression, anxiety, compulsion, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com David Mrazek MD & Ian A Cook MD David Mrazek MD & Ian A Cook MD Genotyping for factors that alter risk for side effects Considerable research effort has been undertaken to realize the central promise of Personalized Medicine, namely, "the right treatment for the right person at the right time." The role of genetic factors in influencing the bioavailability of psychiatric medications has been a key part of this work. In particular, the role of hepatic enzymes in influencing the serum concentration of psychotropic medications has received much attention. Elements of the liver's cytochrome P450 enzyme system have been identified and specific genetic variants have been associated with greater or lesser enzymatic activity. A number of institutes have pursued the idea of genotyping individual patients to provide guidance about which medications are most likely to cause adverse events and thus might be avoided. Much of the leading work in this area has taken place at the Mayo Clinic, where genotyping is now offered as a clinical service. Today's presentation will update us on this intriguing work. Each year, the Department of Psychiatry honors the memory of Dr. Gertrude Rogers Greenblatt, and this year's Rogers Greenblatt Memorial Lecturer will be Dr. David Mrazek. Dr. Mrazek is a Professor of Psychiatry, Psychology, and Pediatrics at the Mayo Clinic School of Medicine in Rochester, MN, where he is also Director of the S.C. Johnson Genomics of Addictions Program. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-014.m4a Tue, 28 Apr 2009 16:00:00 PDT 3:17 gene, genetic, genomic, genomics, genotyping, bioavailability, psychotropic medication, antidepressant, hepatic, cytochrome, cytochrome P450, CYP, CYP540, CYP2D6, CYP219, CYP1A2, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com George Vaillant MD & Ian A Cook MD George Vaillant MD & Ian A Cook MD Approaching the role of positive emotions in mental health Most of modern medical research and teaching focuses on illness - making a diagnosis, understanding pathophysiology and etiology, and developing therapeutics to correct a problem. A complementary perspective can be found in the field of "positive psychology," which considers the characteristics of what might be termed positive, healthy, or desirable states: happiness, contentment, well-being, joy, gratitude, inspiration, love, and kindness, for example. Studies from positive psychology can balance research into deficit states, and may have implications for the treatment of psychiatric illness as well as a richer understanding of the phenomenology and pathophysiology. An expert in bringing this area of psychological study to application in psychiatry is Dr. George E. Vaillant. Dr. Vaillant is Co-Director for the program on the Study of Adult Development in the Department of Psychiatry at Brigham and Women's Hospital in Boston, and is a Professor of Psychiatry at Harvard Medical School. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-015.m4a Tue, 5 May 2009 16:00:10 PDT 2:01 positive psychology, positive emotion, panas, eudaimonia, Fredrickson, joy, hope, love, awe, gratitude, serenity, interest, psychology, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Mark Kleiman PhD & Ian A Cook MD Mark Kleiman PhD & Ian A Cook MD Approaches to drug-using criminal offenders The substance users who use the most drugs and create the highest social costs frequently are also criminally active as drug dealers themselves and as property and violent offenders. The criminal justice system and mental health care system intersect in the management these individuals. Different jurisdictions have tried different approaches, with variable outcomes. An innovative approach has been pioneered in Hawaii, named Hawaii's Opportunity Probation with Enforcement program or H.O.P.E. H.O.P.E. aims to reduce drug use and crime among drug-using offenders by laying out clear expectations for drug-free behavior and backing up those expectations with tight monitoring linked to swift and certain consequences. Those who test positive are subject to immediate, brief incarceration. In contrast, typical community-based corrections, including most drug-diversion programs and California's Proposition 36, have little provision for monitoring for drug use. Furthermore, when drug use is detected, the responses are unpredictable and often are long delayed. Today's presentation will update us on perspectives and experiences in California and elsewhere in this difficult societal issue. Each year, the Department of Psychiatry honors the career of Dr. Thomas Ungerleider and this year's Ungerleider Lecturer will be Professor Mark Kleiman. Dr. Kleiman is a Professor of Policy Studies at the School of Public Policy and Social Research here at UCLA. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-016.m4a Mon, 11 May 2009 16:00:00 PDT 4:23 drug use, drug abuse, criminal, justice, HOPE, Proposition 36, Prop 36, Ungerleider, policy, public policy, DOJ, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Elizabeth Sowell PhD & Ian A Cook MD Elizabeth Sowell PhD & Ian A Cook MD Prenatal exposure alters the trajectory of brain development into adulthood Unlike some organ systems, the development of the human brain is not complete at the time of birth, but continues for decades afterwards. Nonetheless, exposure to certain compounds during gestation can alter the growth trajectory for the developing central nervous system for an individual's lifetime. Fetal alcohol syndrome has been associated with clinical features and neurobehavioral issues for many years, but new data demonstrate how prenatal exposure to alcohol alters the trajectory of brain growth throughout childhood and adolescence. Findings from prenatal exposure to crystal meth also show long-lasting effects. Dr. Elizabeth Sowell will discuss these new insights from neuroimaging and behavioral studies in this Grand Rounds presentation. Dr. Sowell is an Associate Professor of Neurology at the David Geffen School of Medicine at UCLA and leads the Developmental Cognitive Neuroimaging Group at the UCLA Laboratory of Neuroimaging. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-017.m4a Tue, 02 Jun 2009 16:00:20 PDT 2:01 drug use, drug abuse, alcohol, alcohol abuse, fetal alcohol syndrome, FAS, fetal alcohol spectrum disorder, brain, development, brain growth, trajectory, brain damage, brain injury, CNS, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Nim Tottenham PhD & Ian A Cook MD Nim Tottenham PhD & Ian A Cook MD Adverse experiences in childhood can lead to enduring changes in brain and behavior For decades the phenomenologic importance of early childhood experiences in shaping lifelong patterns of behavior and mental health has been recognized. Many different theories have been invoked to explain this relationship. Deprivation of infant-maternal bonding and other adverse experiences in early life may contribute to lasting brain structural and functional alterations that have enduring behavioral consequences. Some of these changes may be probed by evaluating brain activation during tasks of identifying and understanding the emotional state of others communicated by their facial expressions. To update us on developments in this important research area is UCLA's own Dr. Nim Tottenham. Dr. Tottenham is an assistant professor in the UCLA Department of Psychology, where she leads the Developmental Affective Neuroscience Laboratory. For decades the phenomenologic importance of early childhood experiences in shaping lifelong patterns of behavior and mental health has been recognized. Many different theories have been invoked to explain this relationship. Deprivation of infant-maternal bonding and other adverse experiences in early life may contribute to lasting brain structural and functional alterations that have enduring behavioral consequences. Some of these changes may be probed by evaluating brain activation during tasks of identifying and understanding the emotional state of others communicated by their facial expressions. To update us on developments in this important research area is UCLA's own Dr. Nim Tottenham. Dr. Tottenham is an assistant professor in the UCLA Department of Psychology, where she leads the Developmental Affective Neuroscience Laboratory. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-101.m4a Fri, 11 Sep 2009 16:00:20 PDT 3:02 brain, development, brain growth, trajectory, brain damage, brain injury, CNS, orphan, orphanage, maternal, maternal-infant, deprivation, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Warren Taylor MD MHS & Ian A Cook MD Warren Taylor MD MHS & Ian A Cook MD Genetic factors may impact on other risk factors for developing depression in the elderly Depression in older adults is a common clinical problem. Some patients may have a recurrent episode in a depressive disorder that began earlier in life, while others may experience the onset of a major depressive episode for the first time in their life. Social and psychological factors have been often considered as reasons for late life depression, along with medical factors such as vascular disease. New data raise important questions about genetic factors as well. In contrast to studies of so-called "vulnerability genes" that lead more-or-less directly to illnesses that begin in the first two or three decades of life, new studies have considered genetic factors that may modify other risk factors in later life that may in turn lead less directly to depression. Genetic factors that may influence other aspects of physical health or that may skew social interactions are among the targets in this expanded paradigm. To update us on these developments and describe how they may come to impact clinical care, we are pleased to welcome Dr. Warren Taylor in his visit to UCLA. Dr. Taylor is an associate professor in the Associate Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, NC. Depression in older adults is a common clinical problem. Some patients may have a recurrent episode in a depressive disorder that began earlier in life, while others may experience the onset of a major depressive episode for the first time in their life. Social and psychological factors have been often considered as reasons for late life depression, along with medical factors such as vascular disease. New data raise important questions about genetic factors as well. In contrast to studies of so-called "vulnerability genes" that lead more-or-less directly to illnesses that begin in the first two or three decades of life, new studies have considered genetic factors that may modify other risk factors in later life that may in turn lead less directly to depression. Genetic factors that may influence other aspects of physical health or that may skew social interactions are among the targets in this expanded paradigm. To update us on these developments and describe how they may come to impact clinical care, we are pleased to welcome Dr. Warren Taylor in his visit to UCLA. Dr. Taylor is an associate professor in the Associate Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, NC. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-102.m4a Fri, 18 Sep 2009 16:00:22 PDT 4:24 brain, gene, CNS, depression, major depression, neuroimaging, MRI, fMRI, PET, SPECT, late life depression, elder, elderly, older, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Richard Jackson MD MPH & Ian A Cook MD Richard Jackson MD MPH & Ian A Cook MD How the built environment influences our health and is shaped by our policies As our national dialog about healthcare continues at a fever pitch, the role of the environment is a factor of potentially considerable importance that has escaped much attention. While a common-sense perspective lets us appreciate the benefits of clean air and water, much of the environment in which we live and work is the so-called “built environment” -- cities, highways, public buildings, or private homes, for example. How communities are constructed, how the spaces of our daily lives are organized, how easy or difficult it is for our children to find safe places to play -- all these factors may also exert subtle or not-so-subtle effects on our physical and mental health and well-being. To update us on research in this area, to discuss the way policy decisions in this area may impact the health of our patients, and to outline ways in which we, as healthcare providers, can fulfill our professional responsibilities by becoming part of the process, we are pleased to welcome Dr. Richard Jackson. A pediatrician and public health leader, Dr. Jackson is Professor and Chair of Environmental Health Sciences at the UCLA School of Public Health. As our national dialog about healthcare continues at a fever pitch, the role of the environment is a factor of potentially considerable importance that has escaped much attention. While a common-sense perspective lets us appreciate the benefits of clean air and water, much of the environment in which we live and work is the so-called “built environment” -- cities, highways, public buildings, or private homes, for example. How communities are constructed, how the spaces of our daily lives are organized, how easy or difficult it is for our children to find safe places to play -- all these factors may also exert subtle or not-so-subtle effects on our physical and mental health and well-being. To update us on research in this area, to discuss the way policy decisions in this area may impact the health of our patients, and to outline ways in which we, as healthcare providers, can fulfill our professional responsibilities by becoming part of the process, we are pleased to welcome Dr. Richard Jackson. A pediatrician and public health leader, Dr. Jackson is Professor and Chair of Environmental Health Sciences at the UCLA School of Public Health. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-103.m4a Fri, 25 Sep 2009 16:00:00 PDT 3:14 mind, mental, mental health, architecture, civic, policy, community, building, buildings, psychiatry, grand rounds, mental health, UCLA no editor@psychiatrygrandrounds.com Marco Iacoboni MD PhD & Ian A Cook MD Marco Iacoboni MD PhD & Ian A Cook MD How brain systems let us understand the feelings of others Successful social communication is vital to human life, and a major factor in establishing connections with other people is understanding their emotions. In healthy human interactions, empathy is a critical factor for social organizations, all the way from dyadic couples to family units to societies as a whole. In disorders such as autism, there appear to be impairments in understanding the emotions of others. The neurobiological underpinnings of empathy have recently been tied to the mirror neuron system in the brain. In this Grand Rounds presentation, Dr. Marco Iacoboni will update us on research into mirror neurons and empathy, and the implications of dysfunction of this system for mental health. Dr. Iacoboni is Director of the Transcranial Magnetic Stimulation Lab in the Ahmanson-Lovelace Brain Mapping Center at UCLA, and is a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA Successful social communication is vital to human life, and a major factor in establishing connections with other people is understanding their emotions. In healthy human interactions, empathy is a critical factor for social organizations, all the way from dyadic couples to family units to societies as a whole. In disorders such as autism, there appear to be impairments in understanding the emotions of others. The neurobiological underpinnings of empathy have recently been tied to the mirror neuron system in the brain. In this Grand Rounds presentation, Dr. Marco Iacoboni will update us on research into mirror neurons and empathy, and the implications of dysfunction of this system for mental health. Dr. Iacoboni is Director of the Transcranial Magnetic Stimulation Lab in the Ahmanson-Lovelace Brain Mapping Center at UCLA, and is a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-104.m4a Sat, 10 Oct 2009 06:00:00 PDT 2:42 mind, mental, mental health, brain, neuron, mirror, mirror neuron, empathy, sympathy, understanding, autism, autistic, psychiatry, grand rounds, mental health, UCLA no http://www.psychiatrygrandrounds.com editor@psychiatrygrandrounds.com Allan Abbass MD & Ian A Cook MD Allan Abbass MD & Ian A Cook MD Evidence-based clinical practice in psychotherapy with ISTDP Much attention has been directed in recent years to the practice of evidence-based medicine, where the central tenet is that there should be scientifically-sound research to support the procedures we employ in patient care. In some areas, there is a solid precedent, such as studying medications by using evidence from placebo-controlled trials or using comparisons with sham treatments for medical and surgical procedures. Such studies in psychotherapy have been, at times, more challenging to conduct, given the way that practitioners customize the material discussed in each session to the individual patient's circumstances, and the difficulties of establishing how a control or sham psychotherapy session should be constructed. Despite these sorts of challenges, it has been possible to conduct high quality research into a number of types of psychotherapy, and a particular type of psychotherapy that has been examined with rigor is Intensive Short-Term Dynamic Psychotherapy or ISTDP. With roots in classic psychoanalysis but also in attachment theory and other aspects of psychology, the development of ISTDP by Davanloo and others has led to a set of practices that include a series of emotionally-intense sessions which overcome resistance, which trace the origins of current emotions to their antecedents in the past, and which lead to the construction of a clearer narrative of self-understanding that is not solely cognitive but goes to the emotional core. In this Grand Rounds presentation, Dr. Allan Abbass will update us on research into ISTDP. Dr. Abbass is Founding Director of the Centre for Emotions and Health and Director of Education for the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada. Much attention has been directed in recent years to the practice of evidence-based medicine, where the central tenet is that there should be scientifically-sound research to support the procedures we employ in patient care. In some areas, there is a solid precedent, such as studying medications by using evidence from placebo-controlled trials or using comparisons with sham treatments for medical and surgical procedures. Such studies in psychotherapy have been, at times, more challenging to conduct, given the way that practitioners customize the material discussed in each session to the individual patient's circumstances, and the difficulties of establishing how a control or sham psychotherapy session should be constructed. Despite these sorts of challenges, it has been possible to conduct high quality research into a number of types of psychotherapy, and a particular type of psychotherapy that has been examined with rigor is Intensive Short-Term Dynamic Psychotherapy or ISTDP. With roots in classic psychoanalysis but also in attachment theory and other aspects of psychology, the development of ISTDP by Davanloo and others has led to a set of practices that include a series of emotionally-intense sessions which overcome resistance, which trace the origins of current emotions to their antecedents in the past, and which lead to the construction of a clearer narrative of self-understanding that is not solely cognitive but goes to the emotional core. In this Grand Rounds presentation, Dr. Allan Abbass will update us on research into ISTDP. Dr. Abbass is Founding Director of the Centre for Emotions and Health and Director of Education for the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia, Canada. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-105.m4a Fri, 23 Oct 2009 16:00:01 PDT 2:51 psychotherapy, ISTDP, psychodynamic, dynamic, short-term, Davanloo, Bowlby, Sifneos, transference, resistance, psychiatry, grand rounds, mental health, UCLA no http://www.psychiatrygrandrounds.com editor@psychiatrygrandrounds.com David Hovda PhD & Ian A Cook MD David Hovda PhD & Ian A Cook MD Cellular energy needs and the pathophysiology of traumatic brain injury Traumatic brain injury, or TBI, is associated with considerable risk for long term neurological and psychiatric disability. TBI has gained considerable public attention recently, in part because of the large number of veterans returning from Iraq and Afghanistan who have sustained traumatic brain injury, potentially along with post traumatic stress disorder. The neurological, psychiatric, and functional consequences of these injuries are becoming better characterized along with greater neurobiological insights into the early cellular and tissue-level events. A greater elucidation of the neurobiology of TBI can help us both to understand the pathophysiologic connections between injury and clinical outcome, and to develop new interventions that focus on the cascade of events tied to the increased in cellular energetic demands when brain tissue is injured in this way. In this Grand Rounds presentation, we will be updated on recent work in this area by Dr. David Hovda, Director of the UCLA Brain Injury Research Center. Dr Hovda is Professor and Vice Chairman of Research and Academic Affairs in the Department of Neurosurgery at the David Geffen School of Medicine at UCLA. Traumatic brain injury, or TBI, is associated with considerable risk for long term neurological and psychiatric disability. TBI has gained considerable public attention recently, in part because of the large number of veterans returning from Iraq and Afghanistan who have sustained traumatic brain injury, potentially along with post traumatic stress disorder. The neurological, psychiatric, and functional consequences of these injuries are becoming better characterized along with greater neurobiological insights into the early cellular and tissue-level events. A greater elucidation of the neurobiology of TBI can help us both to understand the pathophysiologic connections between injury and clinical outcome, and to develop new interventions that focus on the cascade of events tied to the increased in cellular energetic demands when brain tissue is injured in this way. In this Grand Rounds presentation, we will be updated on recent work in this area by Dr. David Hovda, Director of the UCLA Brain Injury Research Center. Dr Hovda is Professor and Vice Chairman of Research and Academic Affairs in the Department of Neurosurgery at the David Geffen School of Medicine at UCLA. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-106.m4a Thu, 29 Oct 2009 16:00:00 PDT 3:20 brain injury, trauma, traumatic, traumatic brain injury, TBI, energy, mitochondria, glutamate, PTSD, veteran, psychiatry, grand rounds, mental health, UCLA no http://www.psychiatrygrandrounds.com editor@psychiatrygrandrounds.com Eileen Luders PhD & Ian A Cook MD Eileen Luders PhD & Ian A Cook MD Structural and functional changes with regular meditation practice When one considers brain development over the lifecycle, the early phases of life are marked by the generation of brain structures and modifying how they are connected through neuroplastic changes. Some of these processes generally are thought to plateau once one reaches maturity in adulthood. Much later in life, degeneration of neural structures has been linked to many common neuropsychiatric disorders, including Alzheimer's disease, fronto-temporal dementia, Parkinson's disease, and others. Along with loss of neural tissue comes loss of function, manifest as motor, cognitive, or affective symptoms. New work provides provocative evidence that it may be possible to increase the size and function of brain structures even in fully-developed adults. Although many pharmacologic interventions are also under examination, some behavioral approaches that have been studied rely on regular repeated activity, such as meditation or focused learning tasks. With functional and structural neuroimaging methods, it is possible not only to measure change in performance on tests, but also changes in volume and activity of the fundamental brain structures that support these activities. In this Grand Rounds presentation, we will be updated on recent work in this area by Dr. Eileen Luders, from the Laboratory of Neuro Imaging in the Department of Neurology at the David Geffen School of Medicine at UCLA. When one considers brain development over the lifecycle, the early phases of life are marked by the generation of brain structures and modifying how they are connected through neuroplastic changes. Some of these processes generally are thought to plateau once one reaches maturity in adulthood. Much later in life, degeneration of neural structures has been linked to many common neuropsychiatric disorders, including Alzheimer's disease, fronto-temporal dementia, Parkinson's disease, and others. Along with loss of neural tissue comes loss of function, manifest as motor, cognitive, or affective symptoms. New work provides provocative evidence that it may be possible to increase the size and function of brain structures even in fully-developed adults. Although many pharmacologic interventions are also under examination, some behavioral approaches that have been studied rely on regular repeated activity, such as meditation or focused learning tasks. With functional and structural neuroimaging methods, it is possible not only to measure change in performance on tests, but also changes in volume and activity of the fundamental brain structures that support these activities. In this Grand Rounds presentation, we will be updated on recent work in this area by Dr. Eileen Luders, from the Laboratory of Neuro Imaging in the Department of Neurology at the David Geffen School of Medicine at UCLA. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-107.m4a Fri, 30 Oct 2009 16:00:00 PDT 3:20 brain, neuroplasticity, degeneration, neurodegenerative, dementia, Alzheimer's, meditation, learning, memory, hippocampus, amygdala, practice, psychiatry, grand rounds, mental health, UCLA no http://www.psychiatrygrandrounds.com editor@psychiatrygrandrounds.com Dorie Glover PhD & Ian A Cook MD Dorie Glover PhD & Ian A Cook MD Effects of stress on the brain and body The experience of stress is a common one, yet the impact of stressful life events on mind, brain, and body are still incompletely understood. The concept of allostatic load has been advanced by researchers including McEwen, and refers to the physiological costs of chronic exposure to the neuroendocrine stress response. While this response is essential for managing acute threats, frequent activation of the body's stress response can damage the body in the long run. Much of the work in this area has focused on the impact on cardiovascular or endocrine systems, but what of adverse impact on the brain itself? Recent studies of the impact of stress on specific brain structures and the relationship to indices of allostatic load have been conducted by Dr. Dorie Glover, our Grand Rounds speaker. Dr. Glover is an Assistant Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine and the Semel Institute for Neuroscience and Human Behavior at UCLA. The experience of stress is a common one, yet the impact of stressful life events on mind, brain, and body are still incompletely understood. The concept of allostatic load has been advanced by researchers including McEwen, and refers to the physiological costs of chronic exposure to the neuroendocrine stress response. While this response is essential for managing acute threats, frequent activation of the body's stress response can damage the body in the long run. Much of the work in this area has focused on the impact on cardiovascular or endocrine systems, but what of adverse impact on the brain itself? Recent studies of the impact of stress on specific brain structures and the relationship to indices of allostatic load have been conducted by Dr. Dorie Glover, our Grand Rounds speaker. Dr. Glover is an Assistant Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine and the Semel Institute for Neuroscience and Human Behavior at UCLA. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-108.m4a Thu, 12 Nov 2009 16:00:00 PDT 4:19 brain, stress, allostasis, allostatic load, PTSD, post traumatic stress disorder, mind-body, cardiovascular, endocrine, neuroendocrine, psychiatry, grand rounds, mental health, UCLA no http://www.psychiatrygrandrounds.com editor@psychiatrygrandrounds.com Phillip Atiba Goff PhD & Ian A Cook MD Phillip Atiba Goff & Ian A Cook MD Race-associated bias can influence behavior without overtly racist beliefs Though some observers have asserted we are now living in "post racial America," there is considerable evidence that perceptions of race and ethnicity continue to exert effects on behavioral patterns. Stereotypes, fears of being labeled "racist," and other factors may impact how people of different races interact, even when people do not endorse overtly racist beliefs and perspectives. Issues with bias may be especially problematic in circumstances where there is less time to fully understand people as individuals, such as in an emergency room setting or in a police SWAT team operation. In this Grand Rounds presentation, we will be updated on recent work in this area by Dr. Phillip Atiba Goff, Assistant Professor of Psychology at the University of California, Los Angeles. He is also co-Founder and Executive Director of Research for the Consortium for Police Leadership and Equity. Though some observers have asserted we are now living in "post racial America," there is considerable evidence that perceptions of race and ethnicity continue to exert effects on behavioral patterns. Stereotypes, fears of being labeled "racist," and other factors may impact how people of different races interact, even when people do not endorse overtly racist beliefs and perspectives. Issues with bias may be especially problematic in circumstances where there is less time to fully understand people as individuals, such as in an emergency room setting or in a police SWAT team operation. In this Grand Rounds presentation, we will be updated on recent work in this area by Dr. Phillip Atiba Goff, Assistant Professor of Psychology at the University of California, Los Angeles. He is also co-Founder and Executive Director of Research for the Consortium for Police Leadership and Equity. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2009-109.m4a Tue, 1 Dec 2009 16:00:00 PDT 2:05 race, racial, racist, racism, black, african american, afroamerican, ethnicity, gender, bias, stereotype, discrimination, disparity, hate, hate crime, emergency room, SWAT, police, psychiatry, grand rounds, mental health, UCLA no http://www.psychiatrygrandrounds.com editor@psychiatrygrandrounds.com Vernon Rosario MD PhD & Ian A Cook MD Vernon Rosario MD PhD & Ian A Cook MD Transgenderism and Gender Identity Disorder for clinicians Issues of gender and gender identity have clinical aspects but are embedded in a context marked by social, political, economic, religious, and cultural aspects as well. As the Diagnostic and Statistical Manual of Mental Disorders, the DSM, approaches its fifth revision, questions remain as to how transgenderism will be addressed. Transgender refers to the situation of a mismatch between person's sex, the identification as male or female by others, based upon physical and genetic sex, and one's "gender identity" the self-identification as woman, man, or neither. The past few decades have been marked by increasing visibility of transgender individuals in society. People frustrated by gender-related life experiences may seek mental health care, so practitioners must be knowledgeable about transgenderism, its phenomenology and clinical aspects, and some of the controversies surrounding it. Some of the early influential work in this area was conducted in past decades at the UCLA Neuropsychiatric Institute. This Grand Rounds presentation will update us on more recent work in this area. Our speaker is Dr. Vernon Rosario, Assistant Clinical Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA. Issues of gender and gender identity have clinical aspects but are embedded in a context marked by social, political, economic, religious, and cultural aspects as well. As the Diagnostic and Statistical Manual of Mental Disorders, the DSM, approaches its fifth revision, questions remain as to how transgenderism will be addressed. Transgender refers to the situation of a mismatch between person's sex, the identification as male or female by others, based upon physical and genetic sex, and one's "gender identity" the self-identification as woman, man, or neither. The past few decades have been marked by increasing visibility of transgender individuals in society. People frustrated by gender-related life experiences may seek mental health care, so practitioners must be knowledgeable about transgenderism, its phenomenology and clinical aspects, and some of the controversies surrounding it. Some of the early influential work in this area was conducted in past decades at the UCLA Neuropsychiatric Institute. This Grand Rounds presentation will update us on more recent work in this area. Our speaker is Dr. Vernon Rosario, Assistant Clinical Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA. http://psychiatrygrandrounds.com/podcast/PsychiatryGR2010-003.m4a Tue, 2 Feb 2010 16:00:00 PDT 2:30 transgender, transgenered, transsexual, transsexualism, gender identity, gender identity disorder, gender, bias, stereotype, discrimination, disparity, hate, hate crime, psychiatry, grand rounds, mental health, UCLA no http://www.psychiatrygrandrounds.com editor@psychiatrygrandrounds.com David Miklowitz PhD & Ian A Cook MD David Miklowitz PhD & Ian A Cook MD Better outcomes by augmenting medications with family focused treatment Bipolar disorder is centrally characterized by periodic significant variations in mood, ranging for example from the depths of depression to the highs of euphoric mania. The triggering of an episode is thought to reflect a combination of biological factors in the brain of the individual, and environmental factors, such as stresses related to family, friends, work, and school. The arrow points both ways, however, and the impact of bipolar disorder on the family, friends, and colleagues of a person with that illness can be very marked as well. Medications are a core element of treatment for this disorder, but considerable attention has also been focused on how involvement of the family can lead to an improved course of illness. Family focused therapy has been studied in adults with bipolar disorder as well as in children and adolescents. It may be able not only to improve the function and symptoms of patients but also potentially to prevent the onset of the illness in at-risk children. In this Grand Rounds presentation, Dr. David Miklowitz will update us on the work he and others have done in this area. He is a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, Director of the Integrative Study Center in Mood Disorders at the Semel Institute, and Director of the new Child and Adolescent Mood Disorders Program (CHAMP). Bipolar disorder is centrally characterized by periodic significant variations in mood, ranging for example from the depths of depression to the highs of euphoric mania. The triggering of an episode is thought to reflect a combination of biological factors in the brain of the individual, and environmental factors, such as stresses related to family, friends, work, and school. The arrow points both ways, however, and the impact of bipolar disorder on the family, friends, and colleagues of a person with that illness can be very marked as well. Medications are a core element of treatment for this disorder, but considerable attention has also been focused on how involvement of the family can lead to an improved course of illness. Family focused therapy has been studied in adults with bipolar disorder as well as in children and adolescents. It may be able not only to improve the function and symptoms of patients but also potentially to prevent the onset of the illness in at-risk children. In this Grand Rounds presentation, Dr. David Miklowitz will update us on the work he and others have done in this area. He is a Professor of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, Director of the Integrative Study Center in Mood Disorders at the Semel Institute, and Director of the new Child and Adolescent Mood Disorders Program (CHAMP). http://psychiatrygrandrounds.com/podcast/PsychiatryGR2010-004.m4a Tue, 16 Feb 2010 16:00:00 PDT 3:04 bipolar, bipolar disorder, mania, manic, manic depression, therapy, family, family therapy, family focused therapy, family focused treatment, psychiatry, grand rounds, mental health, UCLA no http://www.psychiatrygrandrounds.com editor@psychiatrygrandrounds.com