What You Helped Us Achieve in 2018
University of Miami Miller School of Medicine Department of Psychiatry and Behavioral Sciences
TRANSFORMING LIVES THROUGH TEACHING, RESEARCH AND SERVICE. Health
UNIVERSITY OF MIAMI HEALTH SYSTEM Psychiatry & Behavioral Sciences
What You Helped Us Achieve in 2018
Letter from
DR. RADU V. SAVEANU Interim Chairman, Department of Psychiatry and Behavioral Sciences In my 35 years as a psychiatrist, I cannot remember another time of such vigorous conversation centered on mental health than we saw in 2018. Celebrities, athletes, professionals from all different industries came forward unashamedly to share their experiences with depression, anxiety, bipolar disorder and other mental illnesses. This paradigm shift had immediate effects. More companies began offering mental health days to their employees, and universities (UM included) and implemented screening programs designed to encourage those struggling to seek help confidentially. The topic of mental health became a staple in our media, frequently making headlines and helping generate a change in conversation we’ve craved for too long. Among one of the issues we saw covered regularly was physician burnout. Data showed that one doctor commits suicide every day in the U.S., the highest suicide rate of any profession. Of all the medical
specialists, psychiatrists rank near the top. As unnerving as this statistic is, it forces us to acknowledge the fact that mental health issues do not discriminate, affecting even those who have dedicated their careers to improving the well-being of others. It reinforces the dire need for action: for community partners to come together and fight back against behavioral health disorders, for the development of new programs and initiatives to address the struggles of those suffering, and, perhaps the most critical need, for those entering the medical profession to choose psychiatry as their practice area. Your generosity enables us to take such actions. The inadequacy of government reimbursement and federal funding for mental health means we must rely on private gifts in order to offer critical programs and services. Following up on our successes in 2018, featured throughout this publication, we have big plans for 2019. We’ll be expanding our suicide prevention program on campus and establishing a new one, for adults age 44 and older. We will welcome a new, talented class of residents from all over the world. And, we’ll continue our work developing the only comprehensive campus offering the full continuum of care for the treatment of mental illness in Miami-Dade County. We owe each of you an enormous debt of gratitude for caring and for supporting our efforts. There remains much work to be done, but our commitment to you and our community is sincere and steadfast: we will continue in our pursuit of transforming lives thorough teaching, research, and service. With the utmost gratitude,
Radu V. Saveanu, MD 2
What You Helped Us Achieve in 2018
The Department of Psychiatry and Behavioral Sciences prides itself on being a collaborative, multidisciplinary team. In 2018, we welcomed four talented new faculty members, adding to our many areas of expertise.
Lujain Alhajji, MD Assistant Professor
Stefania Prendez-Alvarez, MD Assistant Professor
Marcela Kitaigorodsky, PsyD Assistant Professor
Raul Poulsen, MD Assistant Professor
Clinical trials are the backbone of evidence-based medicine. Broadly speaking, clinical trials evaluate the safety and effectiveness of a medical strategy, treatment, or device. Moreover, clinical trials provide an opportunity for the general public to participate in the process of developing novel treatments for a variety of conditions. The results from these clinical trials provide the data necessary to assist in future medical decision-making.
We currently have 16 clinical trials in the areas of: Thought Disorders (4), Mood and Substance Disorders (7), and Cognitive Decline (5).
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What You Helped Us Achieve in 2018
New Program Launches, Geared Toward Children and Adolescents Facing Tics, OCD and Related Disorders A Note from Dr. Barbara Coffey,
About the Program
Director, UHealth Tics, OCD
The UHealth Tics, OCD and Related Disorders Program is comprised of a multidisciplinary team of pediatric and adult health care providers, including psychiatrists, psychologists, and neurologists. Centered within the Division of Child and Adolescent Psychiatry at the University of Miami Miller School of Medicine, the Program provides comprehensive evaluation and treatment of individuals of all ages with tic disorders, Tourette Syndrome, Obsessive Compulsive Disorder (OCD) and related disorders such as Attention Deficit Hyperactivity Disorder (ADHD), mood and anxiety disorders, Autism Spectrum Disorder (ASD) and learning disorders. The Program draws on the expertise of each member to provide a seamless integration of high quality, personalized, evidence-based care for patients at every stage of illness—from those with onset of symptoms to those suffering from a treatment-resistant disorder which has failed to respond to therapy elsewhere. These combined
and Related Disorders Program I joined the University of Miami in 2017 as Chief of the Division of Child and Adolescent Psychiatry. I have dedicated my career to the study and treatment of Tics, Tourette’s Disorder, OCD and ADHD, and as I learned more about UM, it became clear that the prospect of bringing these specialties to the excellent program in place was robust. Therefore, I am delighted to be formally launching the UHealth Tics, Tourette’s, OCD and Related Disorders Program in the
specialties enable us to offer a range of state-of-the-art assessments and
Spring of 2019. This new center
treatments, including semi-structured diagnostic interviews, neuropsycho-
is dedicated to the study and
logical testing, pharmacotherapy, and psychosocial interventions (such
treatment of the aforementioned disorders. We are officially
as Comprehensive Behavioral Intervention for Tics (CBIT) and Cognitive
accepting referrals of individuals
Behavioral Therapy (CBT) for children, adolescents and adults. It is well
of all ages.
established that the vast majority of patients with Tourette’s Disorder
Among children diagnosed with Tourette’s, an estimated
experience a wide range of clinical complexity characterized by psychiatric
and astounding 86%1 also receive
comorbidity. By centralizing specialists in these related conditions in one
a diagnosis of another mental,
program, our Division and its components—including the Research Program—
behavioral or developmental disorder. I am proud to work
are able to provide comprehensive, high-quality, and clinically sensitive care.
closely with other departments
Expertise of our multidisciplinary clinical team enables a unique develop-
at UM to provide medical,
mental perspective on all of our patients’ needs throughout the life cycle.
psychological, collaborative care, and consultation to schools and other clinicians when necessary. I am thrilled to be able to share my passion for helping children and adolescents facing tics, Tourette’s and related disorders with the Miami community.
From the initial evaluation, conducted by the Program Director, through the course of treatment, our team of experts—many of whom are leaders in their fields—takes a collaborative approach to working together to provide an individually tailored, optimal care plan for our patients. For more information on the program, please click here or email mxc1668@med.miami.edu
1. A National Profile of Tourette Syndrome, 2011-2012. Journal of Developmental & Behavioral Pediatrics: June 2014-Volume 35-Issue 5-pp317–322.
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What You Helped Us Achieve in 2018
COMBATING A PUBLIC HEALTH CRISIS: Saving Lives with our UHealth î Žerapeutic Program for Adult Suicide Prevention
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Suicide is a public health crisis with more than 45,000 Americans over age 18 taking their own lives each year. It is the only top 10 cause of death in the U.S. that is rising; between 2000 and 2016, the CDC determined the suicide rate for women 45-64 increased to 9.9 deaths per 100,000 people (up from 6.2) and for men, to 29.1 deaths per 100,000 people (up from 21.3).1
million Americans age 18 and older suffers from a diagnosable mental disorder in a given year
Suicide affects men and women of all races, ages, religions and professions, and across all geographic regions. The Department is committed to doing our part to help combat this crisis and with your help is continually implementing new suicide prevention initiatives. Thanks to a generous gift from The Fields Galley Private Foundation, the De-
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partment is launching the UHealth Therapeutic Program for Adult Suicide Prevention, led by clinical psychologist Dr. Ingrid Barrera, who specializes in psycho-oncology and eating disorders, areas where patients often experience suicidal ideation. Using a combination of Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), and other evidence-based techniques, our expert clinicians will administer a personalized treatment plan to each individual participating in the program. To help address the rising suicide rate among adults, the program is aimed specifically at those age 44 and older. It requires a minimum six-month commitment that includes both individual and group therapy. Each patient receives personalized treatment based on his or her behaviors, and works with the therapist until their goals are achieved. The Department is proud to be able to offer this new program and provide the expertise of our mental health professionals. Private gifts in support of initiatives such as this are crucial to advancing treatments for those struggling with mental illness. The Department is grateful to The Fields Galley Private Foundation for their generosity and dedication to suicide prevention.
million of these people experience suicidal ideation
one person dies by suicide every three hours in Florida Suicide is
fifth leading cause of death for people ages 45-54 in Florida
1. https://www.cdc.gov/nchs/products/databriefs/db309.htm
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What You Helped Us Achieve in 2018
A Novel Approach to
ALZHEIMER’S DISEASE M E D I C AT I O N
An estimated 5.7 million people are affected by Alzheimer’s disease, a number so staggering that the World Health Organization (WHO) has declared AD a global health priority. Disappointingly, there have been a number of recent clinical trial failures in Alzheimer’s disease (AD). Experts in the field now agree that AD is a multifactorial disease and that fundamentally new therapeutic approaches must be tested. In other words, there are likely multiple underlying problems in the brains of AD patients and these problems would ideally Karolina J. Janczura, PhD, Claes Wahlestedt, MD, need to be simultaneously corrected by an effective treatPhD, and Claude-Henry Volmar, PhD ment. This would either necessitate the development of a number of new drugs that act in concert (a seemingly unsurmountable task as they must be tested one-byone) or, preferably, a single drug that by itself has the ability to affect multiple problems. Dr. Claes Wahlestedt, Associate Dean and Director of the Center for Therapeutic Innovation and Professor of Psychiatry and Behavioral Sciences, and his team addressed this challenge and conducted a study that resulted in the identification of a novel epigenetic drug target to simultaneously normalize multiple deficits in Alzheimer’s disease. Essentially, they discovered a type of gene expression re-programming that restores each of these deficits at the same time. Their research has significant implications for tackling Alzheimer’s disease. The team has accumulated ample preclinical data demonstrating that single epigenetic (small molecular) drugs simultaneously affect the expression of a number of defined AD-related genes that directly relate to AD hallmarks, including beta amyloid formation, tau accumulation and neuroinflammation1, typical signs of the disease when the brains are examined. Importantly, age is the greatest risk factor for AD. Nevertheless, a majority of individuals do not develop AD by their ninth decade of life. There is considerable emerging evidence that aging processes are strongly influenced by epigenetic phenomena. Dr. Wahlestedt and the CTI’s approaches therefore involve targeting the epigenetic endogenous protective mechanisms associated with ‘healthy aging’ and argue that this strategy represents a sound scientific paradigm for addressing AD prevention. These multidisciplinary approaches to AD prevention involve both new drug development as well as assessing changes in lifestyle (diet and exercise). This work was supported by the National Institutes of Health (NIH) and the State of Florida (the Ed and
Ethel Moore Alzheimer’s Disease Research Program) and generous support from your private gifts.
1 Volmar et al, Proc. Natl. Acad. Sci. 2017; Janczura et al. Proc. Natl. Acad. Sci., 2018.
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What You Helped Us Achieve in 2018
Molecular Therapeutics Shared Resource Underway to Advance Preclinical Drug Discovery and Development Nearly all human-directed research is aimed at understanding disease with the goal of finding treatments. One of the most powerful and efficient ways to treat disease is by use of pharmaceuticals. The Molecular Therapeutics Shared Resource (MTSR) is a newly established state-of-the-art drug discovery and development facility aimed at providing access to the necessary resources for therapeutic discovery to Sylvester Comprehensive Cancer Center members and the University of Miami community as a whole. The MTSR is a premier program that has emerged from the Center for Therapeutic Dr. Shaun Brothers, Director, MTSR Innovation (CTI), a center that was developed within the auspices of the Department of Psychiatry and Behavioral Sciences in 2011 to bring drug discovery expertise and labs to the Department and the University of Miami Miller School of Medicine. These MTSR resources were both increased and varied to accommodate demand from those scientists outside of Psychiatry and the CTI, whose programs would benefit by having access to drug discovery technologies and experts. The MTSR holds enormous potential to enable basic research to translate to clinical utility by way of the services that they offer. Essentially, a shared resource is a collection of technologies and experts that can serve to elevate the scientific programs of other scientists. Shared resources can be for anything, including for example microscopy or genomics. The major goal for the MTSR is to provide resources for the identification MTSR scientists conferring on the outcomes of their work. and development of drugs that hold potential to treat disease. The MTSR was originally positioned to serve major Sylvester Comprehensive Cancer Center research programs, particularly users from Tumor Biology and Epigenetics. Counted among the MTSR’s successes are two invention disclosures and data to support the designing of three clinical trials. The Resource was expanded to allow the entire university to take advantage of their programs, and even scientists globally can now connect Evaluating molecular responses to different kinds of drugs to determine which ones may hold some future clinical potential. with the MTSR.
“The MTSR partners with outstanding scientists with similarly outstanding scientific programs to help shift the science toward clinical utility. It is a critical step necessary to begin to address disease and improve health.” — Dr. Shaun Brothers 7
What You Helped Us Achieve in 2018
ALL IN THE FAMILY How a Son’s Diagnosis Sparked Two Generations of Mental Health Advocates During his freshman year in college, Susan and David Racher’s son began acting out of character. A bright, happy, well-liked and well-adjusted young man, Matthew began to lose interest in his schoolwork, his music and his social life. Susan, a financial professional, and David, a neurologist, attributed their son’s lack of engagement to the stress of transitioning to college and a persistent thought that he perhaps made an error in his choice of college; after all, he was attending a very rigorous university in a Midwestern city far from home and sunshine. What the family and the community psychiatrist treating their son after freshman year did not know until much later was that Matthew was exhibiting prodromes, or early symptoms, of a serious mental illness and not an “adjustment issue.” In 2011, Matthew experienced a severe psychotic break plunging him into a dark abyss of fear, delusions, and paranoia. The son who had grown up and flourished for the past two decades was hijacked. The Rachers embarked on a daunting mission to find help and treatment that would bring their son back to his gregarious self. It wasn’t easy—at the time, there was an absence of community-based information about where to access mental health care in Miami. A cousin who is a psychiatrist outside Florida advised the Rachers that some of the most highly regarded global thought leaders and clinicians were available right in their backyard at the University of Miami’s Department of Psychiatry and Behavioral Sciences. Susan at the NASW reception where she received the Public Citizen of the Year Award. 2017.
“One in 5 people has a mental disorder,” Susan points out, “but nobody wants to talk about it. Millions suffer just like Matthew did, often in silence.” 8
What You Helped Us Achieve in 2018
“Mental health deserves parity funding to physical health and our community deserves high standards of care. These illnesses manifest in youth and most can be successfully treated if early intervention occurs, averting a lifetime of disability and economic hardship.” — Matthew Racher
Responsive and compassionate about the sudden crisis the Rachers were living left Carlos Larrauri, through, the Department admitted Matthew immediately and assigned him a treat- ARNP and Matthew ment team. Consisting of psychiatrists, psychologists, nurses and trained aides, this preparing for their band, FOGDOG’s, outstanding team stabilized Matthew and gave him kind and effective care during a performance. lengthy hospitalization. right Relieved to see her son responding effectively to treatment, Susan was still dismayed Matthew sharing his story during an event at the lack of public information and resources about conditions like Matthew’s. She hosted by This Is My immersed herself in the world of mental health. She explored dozens of different Brave, Inc., a nonprofit that works to eradicate avenues, reaching out to behavioral health organizations, researching the science the stigma of mental behind psychotic disorders, and taking on active roles in her community and within health. Click to watch. the Department to help educate people and raise awareness on the neglected and taboo topic of mental illness. In addition to co-chairing the Department's External Advisory Board, she also led the charge to resurrect NAMI Miami, taking on the role of President, and joining the South Florida Behavioral Health Network as Chair of Strategic Planning. Today, Matthew’s progress is as apparent as ever. Guided by the team of experts at UM, Matthew responded positively to a combination of psychosocial help, medication, and peer and family support. And, like his impassioned mother, Matthew has found meaning in helping others struggling with their mental health. A graduate of the University of Miami, he earned a degree in psychology and music business. He is now a peer counselor at Jackson Behavioral Health Hospital and an advocate for improvements in our community’s system of care. A passionate musician, Matthew formed a band, FOGDOG, with a fellow mental health advocate—they play original songs about their personal journeys through mental illness all over the U.S. Matt bravely shares his story with others as a testament that one can recover from and manage to have quality of life with a mental illness, using his own voice to remind the people who may have lost theirs, that they are heard. 9
What You Helped Us Achieve in 2018
CENTER FOR COGNITIVE NEUROSCIENCE AND AGING
CNSA Center for Cognitive Neuroscience and Aging
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What You Helped Us Achieve in 2018
Dear Friends, 2018 was an extremely busy and productive year for the Center for Cognitive Neuroscience and Aging (CNSA). As the newest Center to join the Department of Psychiatry and Behavioral Sciences and the Miller School of Medicine, the CNSA hit the ground running in pursuit of the latest and greatest science and technology that will further our understanding of brain-behavior relations and enhance the health and well-being of older adults. We have seen innovative instruments and tools developed at the CNSA adopted by research groups worldwide, such as the Loewenstein and Acevedo Scales for Semantic Interference and Learning measure (LASSI-L). Papers published in leading scientific journals have shown how our cognitive paradigms are sensitive to numerous brain biomarkers indicative of the earliest stages of Alzheimer’s disease, and have been featured on the National Institute on Aging website as high-impact research. Our faculty have received an unprecedented degree of NIH federal grant support as well as state grant support for total awards exceeding $10 million committed over the next several years. Importantly, the CNSA was invited to lead the University of Miami’s efforts in renewing the Alzheimer’s Disease Research Center (ADRC), working closely with other major universities throughout the state of Florida. Exhilarating as all of this is, we also recognize that so much of what we do wouldn't be possible without you. Your investments in our programs and willingness to participate in our clinical trials are helping move the needle in furthering treatments for cognitive disorders in elderly adults. It is my honor and privilege to work every day with Dr. Rosie Curiel Cid, our Chief of Cross-Cultural Neuropsychology and Cognitive Neuroscience who received a prestigious R01 grant on computerized cognitive stress tests for early detection of brain disease, and Dr. Elizabeth Crocco, Chief of Geriatric Psychiatry and Medical Director of the CNSA and our UM Memory Disorders Clinic—the only state-funded clinic at UM. These outstanding individuals, our wonderful faculty and committed staff dedicate each and every day to making the CNSA a hub for early detection and treatment of Alzheimer’s disease and memory disorders and providing innovative programs for care providers. Together, these, outstanding individuals and our talented team of other professionals are helping create an environment where we are able to train our next generation of leaders in the field. We are particularly grateful to the Department of Psychiatry and Behavioral Sciences and our many university partners who have supported us in our mission to become national and international leaders in cognitive neuroscience, as related to normal aging and neurodegenerative diseases in the brain. We aspire to be the destination center for those afflicted with Alzheimer’s disease and other neurodegenerative disorders. As we continue to pursue novel opportunities to transform the landscape of cognitive neuroscience and aging, we look forward to sharing more exciting discoveries in the year ahead! With much appreciation,
David Loewenstein, PhD, ABPP/CN Director, Center for Cognitive Neuroscience and Aging (CNSA), Professor of Psychiatry and Behavioral Sciences Chief, Neuropsychology, University of Miami Miller School of Medicine
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What You Helped Us Achieve in 2018
AGING IN THE 21st CENTURY New Multidisciplinary Center Integrates Novel Methods and Technology for Advanced Care in Older Adults In recent years, the prevalence of Alzheimer’s disease has climbed to the number six spot as a leading cause of death. Currently, it affects 5.7 million people and their caregivers. These skyrocketing statistics have made the development of efficacious, novel treatments a global health priority. To address this urgent need for intervention and treatment of Alzheimer’s disease and related disorders, the UM Department of Psychiatry and Behavioral Sciences established the Center for Cognitive Neuroscience and Aging (CNSA) in June of 2018. Led by Dr. David Loewenstein, the Center is staffed by a highly regarded team of clinical investigators to provide innovative clinical trials as well as novel cognitive, behavioral and psychosocial interventions for patients and their families. Technologically advancing the cognitive assessment methodologies that are sensitive to preclinical dementia is a core CNSA research aim. The CNSA has a strong partnership with the University of Miami’s computer scientists to advance their digital cognitive tools to assess dementia. These advancements overcome the many limitations inherent in conventional assessment and increases standardization, scoring accuracy, real time data transfer, and accessibility through remote deliverability. This is done while incorporating the diverse needs of individuals of varying cultures, languages, and ability levels. The CNSA and its partners are on the forefront of technology development for assessing and diagnosing conditions that affect at-risk older adults. They also deliver computerized training for persons seeking to actively maintain their cognitive health. Along with Dr. Loewenstein, Dr. Elizabeth Crocco, memory disorders expert and Medical Director of CNSA and the UM Memory Disorders Clinic, and Dr. Rosie Curiel Cid, Chief of Cross-Cultural Neuropsychology and Cognitive Neuroscience are leading CNSA’s efforts to prevent and effectively treat brain disorders that affect the cognition and healthy, independent functioning of older adults. These experts are making CNSA a renowned center for the evaluation, management, treatment and care for older individuals. Mission The mission of the Center for Cognitive Neuroscience and Aging (CNSA) is to be national and international leaders in understanding the aging brain and a hub to develop and employ the most state-of-the-art techniques for the study of brain disorders.
from left Dr. Rosie Curiel Cid Dr. David Loewenstein Dr. Elizabeth Crocco
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Vision The vision of the CNSA is to further develop the understanding of brainbehavior relations, to relate cognitive profiles to specific disorders of the brain and central nervous system, and to enhance the health and wellbeing of older adults.
What You Helped Us Achieve in 2018
CLINICAL ADVANCEMENTS AT THE UM MEMORY DISORDERS CLINIC The state of Florida has the second highest number of residents over the age of 65 living with Alzheimer’s disease, currently estimated at 540,000,1 and expected to grow to 720,000 by 2025. Alzheimer’s disease and related dementias (ADRD) have transcended generations, rising to become the sixth leading cause of death in the U.S. Dr. Elizabeth Crocco, Medical Director of the CNSA and UM Memory Disorders Clinic, has devoted her career to fighting this progression. An expert in geriatric psychiatry, one of Dr. Crocco’s specialties lies in the development and testing of inventive neuropsychological and functional measures to detect Mild Cognitive Impairment (MCI) and preclinical MCI – both of which lead to Alzheimer’s disease. The MDC services Miami-Dade and Monroe counties, where about 56,000 people have probable AD. To address the needs of this population, Dr. Crocco leads a renowned, multidisciplinary team specializing in state-of-the-art, evidence-based assessment and management of cognitive impairment as well as psychiatric and behavioral symptoms in this vulnerable elderly population. “The Clinic is devoted to identifying the causes of cognitive impairment including Alzheimer’s disease and developing effective treatments for all its complications. We provide comprehensive evaluations, diagnostic services and psychosocial services to achieve this goal,” Dr. Crocco explains. “Eighty-two percent of seniors say it’s important to get their memory checked, but startlingly, only 16% report receiving regular cognitive assessments.2 Administering memory screenings is an integral part of our work and extremely important for early identification and intervention of this The Memory Disorders Clinic (MDC) at the University of Miami is one of 16 state-designated clinics devastating illness.” approved by the State of Florida Department of For more information on the UM MDC or to participate Elder Affairs since 1986. Recognized as a Center of Excellence, the clinic is run by Medical Director in a memory screening, click here or call 305.355.9028 and Dr. Elizabeth Crocco and the only MDC at UM to be state-funded. select option 1. 1. https://www.alz.org/media/Documents/florida-alzheimers-facts-figures-2018.pdf | 2. https://alz.org/media/Documents/alzheimers-facts-and-figures-infographic-2019.pdf
5.7 million
The reality of Alzheimer’s disease
individuals in the United States are living with Alzheimer’s disease
Every 65 seconds,
540,000 individuals are living with AD in Florida
12%
1 in 3
of Florida’s senior population has been diagnosed with AD
seniors dies with Alzheimer’s or another dementia
someone in the U.S. develops the disease
It is the 6th leading cause of death in the U.S.
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What You Helped Us Achieve in 2018
DR. ROSIE CURIEL CID Receives Prestigious NIH Grant for Research in Alzheimer’s Disease
One percent. It’s a small number that carries big meaning for Dr. Rosie Curiel Cid. In the world of research and science, federally funded grants are not easy to come by. Even tougher are R01 grants, issued by the National Institutes of Health (NIH), and considered the highest funding mechanism offered to individual scientists. In fact, the most recent data available1 shows that under two percent of faculty in Dr. Curiel Cid’s age group—age 36—receive this level of award across all health specialties. Yet, in spring 2018, Dr. Curiel Cid was awarded a 5-year, $3 million NIH R01 grant, effectively establishing herself as a one-percenter. A geriatric neuropsychologist, Dr. Curiel Cid’s expertise lies in the assessment of neurodegenerative conditions, particularly Alzheimer’s disease (AD) and related disorders. She joined the Miller School of Medicine faculty in 2011 as an assistant professor and serves as Chief, Cross-Cultural Neuropsychology and Cognitive Neuroscience in the newly established CNSA. A true scientist-practitioner, Dr. Curiel Cid is devoted to her clinical practice, and is greatly passionate about her clinical research, which ultimately aims to improve early detection of cognitive decline in older adults.
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NIH R01 Grant The NIH defines a Research Project (R01) grant as an award made to support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing the investigator’s specific interest and competencies, based on the mission of the NIH. It is considered the highest funding mechanism offered to individual scientists.
What You Helped Us Achieve in 2018
“Alzheimer’s disease is a devastating illness for the patient and their loved ones, and I don’t believe that we as a society are prepared to successfully and humanely meet the needs of so many older adults that will be affected by this illness if a disease modifying treatment, prevention, or cure is not found. I have every intention of continuing to do my part and am confident that our program of research at the Center for Cognitive Neuroscience and Aging will generate relevant knowledge that can contribute to advancing these efforts.” The project for which Dr. Curiel Cid received the grant focuses on validating new computerized cognitive assessment instruments to detect early cognitive change associated with Alzheimer’s disease and related disorders. Pilot data suggests that experimental measures may be sensitive enough to detect subtle deficits specific to preclinical Alzheimer’s disease, and may be highly associated with biological markers of early AD pathology. Plainly, Dr. Curiel Cid and her team are developing digital tools that can identify the existence of AD and intervene before it escalates. This is particularly significant, as AD is the only top 10 cause of death that cannot be prevented, cured, or even slowed, making it one of the most important, urgent and unmet medical needs of our time.2 Together with CNSA Director Dr. David Loewenstein and the UM Memory Disorders Clinic Medical Director Dr. Elizabeth Crocco, Dr. Curiel Cid and her team are challenging the status quo and forming a direct comparison of their measures to the “gold standard” in Alzheimer’s research. Dr. Curiel Cid explained, “This is significant because no previous research in AD has implemented a cognitive outcome measure that has been associated to known biological markers of AD pathology, such as amyloid burden, even among asymptomatic individuals. A primary aim of not only the project but the CNSA in general includes the computerization of the assessments to make them user-friendly and remotely deliverable clinical outcome measures with the goal of advancing cognitive assessment efforts in clinical trials targeting preclinical AD.” Armed with the expertise, the team, and now the funds, Dr. Curiel Cid is poised to continue breaking through in her critical research, stopping the progression of these debilitating cognitive disorders.
HHHHH
Dr. Rosie Curiel Cid is the youngest Hispanic female ever to receive an R01 grant at UM.
1 Percentage of NIH R01 Equivalent Principal Investigators of All Degrees: Age 35 and Younger vs. Age 66 and Older. FY 1980-2014. http://www.report.nih.gov/displayreport.aspx?rid=827 2 Alzheimer’s Association. 2018 Alzheimer’s Association Disease Facts and Figures. Alzheimers Dement. 2018;14:367-429.
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What You Helped Us Achieve in 2018
Amplifying Our Impact: A Snapshot of Our Faculty’s Published Papers in 2019 Syed SA, Beurel E, Loewenstein DA, Lowell JA, Craighead WE, Dunlop BW, Mayberg HS, Dhabhar F, Dietrich WD, Keane RW, de Rivero Vaccari JP, Nemeroff CB. Defective Inflammatory Pathways in Never-Treated Depressed Patients Are Associated with Poor Treatment Response. Neuron. 2018 Sep 5;99(5):914-924 Treatment-naive Major Depressive Disorder patients have increased levels of pro- and anti-inflammatory markers, but overall the balance shifts toward immunosuppression of immune cells. Consistent with these findings, absence of response to antidepressant treatments has been associated with defective anti-inflammatory response.
Devanand DP, Strickler JG, Huey ED, Crocco E, Forester BP, Husain MM, Vahia IV, Andrews H, Wall MM, Pelton GH. Lithium treatment for agitation in Alzheimer’s disease (Lit-AD): clinical rational and study design. Contemporary Clinical Trials, 2018: 71: 33-39. Peer-reviewed article in collaboration with Dr. Devanand at Columbia University on the methodology and design of a NIA-funded study examining the use of Lithium in the treatment of agitation in Alzheimer’s dementia. Crocco EA, Loewenstein DA, Curiel RE, Alperin N, Czaja SJ, Harvey PD, et al. A novel cognitive assessment paradigm to detect pre-mild cognitive impairment (PreMCI) and the relationship to biological markers of Alzheimer’s disease. Journal of Psychiatric Research, 2018: 96: 33-38. Peer-reviewed article examining the usefulness in a novel neuropsychological test developed by the Team at CNSA in diagnosing patient at the highest risk for Alzheimer’s disease in its earliest phases.
Lin, A., Arnold, B.F., Mertens, A.N., Lin, J., Unicomb, L., Dhabhar, F.S., et al. (2018) Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a randomized trial in rural Bangladesh. Elife, DOI: 10.7554/eLife.29365. Gates Foundation sponsored ongoing collaboration with colleagues at Stanford & Berkeley. Paper viewed ~2,600 times since publication this year. Dhabhar, F.S. (2018) The Short-Term Stress Response—Mother Nature's Mechanism for Enhancing Protection and Performance Under Conditions of Threat, Challenge, and Opportunity. Frontiers in Neuroendocrinology, 49: 175-192. DOI: 10.1016/j.yfrne.2018.03.004. Review article that includes work supported by NIAID, NIMH, NCI, and NIA, the Office of Naval Research, and other agencies. Cited 4 times and viewed 58 times since publication in March 2018.
Watson, Clarence; Leong, Gregory; and Eth, Spencer. Capital Punishment. In: B. Puri and I. Treasaden (editors), Forensic Psychiatry: Fundamentals and Clinical Practice, Taylor & Francis (CRC Press), Boca Raton, 2018. This textbook chapter explores the evolving psychiatric and legal issues involved in the death penalty in the United States, which continues to be a controversial public and political issue. Echenique, M., Musselman, D., Avellaneda, V. B., Illa, L., Rodriguez, A. E., Wawrzyniak, A., & Kolber, M. A. (2018). Integrated mental health and HIV care in a majority minority clinic. Personalized Medicine in Psychiatry.
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We report the results of screening by an embedded psychology service within a large HIV specialty clinic in a public county hospital setting, and examine factors associated with subsequent “after screening” initiation of mental health services at a nearby specialty mental health clinic (HIV MHC). Sartor GC, Powell SK, Velmeshev D, Lin DY, Andrade NS, Faghihi MA, Wahlestedt C, et al. Cocaine alters Homer1 natural antisense in the nucleus accumbens. Mol Cell Neurosci. 2017 Dec;85:183-189. doi: 10.1016/ j.mcn. 2017.10.003. Epub 2017 Oct 18. In this paper, we showed that noncoding antisense transcripts are frequently present and perform important regulatory function related to drug additions. Gould F, Dunlop BW, Rosenthal JB, Iosifescu DV, Mathew SJ, Neylan TC, Rothbaum BO, Nemeroff CB, Harvey PD. Temporal Stability of Cognitive Functioning and Functional Capacity in Women with Posttraumatic Stress Disorder. Arch Clin Neuropsychol. 2018 Aug 15. doi: 10.1093/arclin/acy064. This is the first study ever to examine the temporal stability of cognitive performance and functional capacity in the PTSD literature.
Deckler E, Hodgins GE, Pinkham AE, Penn DL, Harvey PD. Social Cognition and Neurocognition in Schizophrenia and Healthy Controls: Intercorrelations of Performance and Effects of Manipulations Aimed at Increasing Task Difficulty. Front Psychiatry. 2018;9:356. Authored by two medical students and Dr. Harvey’s federally funded collaborators, this paper was viewed over 1300 times in the first two months of on-line publication.
This article illustrated that an HIV medication was associated with increasing suicidal ideation in pregnant women. Loewenstein, D.A., Curiel, R.E., DeKosky, S., Bauer, R.M., Rosselli, M., Guinjoan, S., Adjouadi, M., Penate, A., et al. (in press) Utilizing Semantic Intrusions to Identify Amyloid Positivity in Mild Cognitive Impairment, Neurology. Sept. 2018, 91 (10) e976-e984. This study showed how a novel cognitive stress test (LASSI-L) developed by UM researchers could detect brain amyloid load indicative of very early Alzheimer’s disease in at-risk older adults and could differentiate them from older adults with other neurological and neuropsychiatric conditions. It was in the upper 95th percentile in terms of scientific impact. Curiel, R.E., Loewenstein, D.A., Rosselli, M., Penate A., et al. (in press) Semantic Intrusions and Failure to Recover from Proactive Semantic Interference in Amnestic Mild Cognitive Impairment: Relationship to Amyloid Load and Cortical Thickness. Current Alzheimer’s Research. 15(9):848-855. This investigation focused on the utility of semantic intrusions on the LASSI-L as a more effective means than raw scores in loss of cortical thickness and volumetric loss in Alzheimer’s prone regions. Loewenstein, D.A., Curiel, R.E., Buschke, H., Duara, R. (2017) Novel Cognitive Paradigms for the Detection of Memory Impairment in Preclinical Alzheimer’s Disease, Assessment Apr;25(3):348-359. This is a review of the need for cognitive stress paradigms to address the earliest detection of AD and other neurodegenerative disorders.
Rodriguez, V.J., Radusky, P., Jones, D.L., Nemeroff, C., & Kumar, M., Measurement Invariance of the Childhood Trauma Questionnaire by Gender, Poverty Level, and HIV Status. Personalized Medicine in Psychiatry. Published online 16 Oct 2018.https://doi.org/10.1016/ j.pmip.2018.10.002 This article addresses measurement error in assessment of childhood trauma, and the need for measurement that does not result in measurement bias due to differences in gender, poverty or HIV status. Accurate measurement is the key to correct treatment.
Petyuk VA, Chang R, Ramirez-Restrepo M, Beckmann ND, Henrion MYR, Piehowski PD, Zhu K, Wang S, Clarke J, Myers AJ, et al. (2018) The human brainome: network analysis identifies HSPA2 as a novel Alzheimer’s disease target. Brain DOI:10.1093/brain/awy215 This manuscript details findings by Dr. Myers and her colleagues using her series of ~3000 human brain tissues to map novel Alzheimer’s disease risk effects. This article was the cover of the September issue of BRAIN.
Rodriguez, V.J., Peltzer, K., Matseke, G., & Jones, D.L. Pre-and postnatal exposure to intimate partner violence among South Africa HIV infected mothers and infant developmental functioning at 12 months of age. Archives of Women’s Mental Health. 21(6) 707-713. 2018.DOI: 10.1007/s00737-018-0857-7 This article illustrates the impact of domestic violence on infant development, and the importance of male involvement in children’s development. The study was designed to increase men’s involvement during pregnancy.
Daniel E. Falk Ph.D., Megan L. Ryan M.B.A., Joanne B. Fertig Ph.D., Ihsan M. Salloum M.D., M.P.H., D. Jeffrey Newport M.D., et al. Alcoholism: Clinical & Experimental Research. Article published online November 7, 2018. This study was published in Alcoholism: Clinical and Experimental Research, the premier journal for alcohol research. It details the latest effort by the National Institute on Alcohol Abuse and Alcoholism Clinical Investigations Group (NCIG) to assess the efficacy of a medication for the treatment of alcohol use disorder.
Jones, D.L., Rodriguez, V.J., Alcaide, M.L., Weiss, S.M., and Peltzer, K. (July, 2018). The Use of Efavirenz During Pregnancy is Associated with Suicidal Ideation Postpartum among Women in Rural South Africa. AIDS & Behavior. 2018. DOI: 10.1007/s10461-018-2213-3. PMID: 29607661. 978906.
Wawrzyniak AJ, Sabbag S. PTSD in LGBT Populations. In CB Nemeroff & C Marmar (Eds.), Post-Traumatic Stress Disorders Textbook. 2018. Oxford: Oxford University Press. This book chapter highlights how PTSD can adversely affect the LGBT population. Recommendations for providing therapy for LGBT patients with PTSD is offered in the chapter.
Department Leadership
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Radu V. Saveanu, MD Interim Chair, Executive Vice Chair for Clinical Services and Education
Ana Campo, MD Chief, Medical Student Education
Claes Wahlestedt, MD, PhD Vice Chair, Research L. Jared Abramson Vice Chair, Administration
Barbara Coffey, MD, MS Chief, Child and Adolescent Psychiatry Edmi Cortes-Torres, MD Chief, UMH Psychiatry Elizabeth Crocco, MD Chief, Geriatric Psychiatry
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UNIVERSITY OF MIAMI HEALTH SYSTEM Psychiatry & Behavioral Sciences
Dante Durand, MD, MBA Director, Clinical Services Philip Harvey, PhD Chief, Psychology David Loewenstein, PhD Director, Center for Cognitive Neuroscience and Aging Ihsan Salloum, MD, MPH Chief, Substance and Alcohol Abuse
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UNIVERSITY OF MIAMI HEALTH SYSTEM Psychiatry & Behavioral Sciences
Common Purpose Our mission is to conduct research that deepens our understanding of the development, pathophysiology, and prevention of psychiatric illness; offer comprehensive treatment and care to our patients, their families and the community; and provide outstanding mental health education and multidisciplinary training to the next generation of healthcare providers and investigators. Soffer Clinical Research Center 1120 NW 14th Street | Suite 1457 Miami, Florida 33136 Telephone: 305.243.4000 psychiatry@med.miami.edu Executive Editor Samantha Richter Assistant Director, Communications
