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Behavioral Health Forum: Integrating the Science and the Practice for the Future University of Texas MD Anderson Cancer Center Houston, TX – June 8, 2012.

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Presentation on theme: "Behavioral Health Forum: Integrating the Science and the Practice for the Future University of Texas MD Anderson Cancer Center Houston, TX – June 8, 2012."— Presentation transcript:

1 Behavioral Health Forum: Integrating the Science and the Practice for the Future University of Texas MD Anderson Cancer Center Houston, TX – June 8, 2012 John M. Oldham, MD, MS Senior Vice President and Chief of Staff The Menninger Clinic Professor and Executive Vice Chair Menninger Department of Psychiatry and Behavioral Sciences Baylor College of Medicine; Immediate Past President, American Psychiatric Association

2 Changing Stages in the Field of Psychiatry EraPredominant Influence 1940s – 1970sPsychoanalytic (psychogenic) 1960s – presentPsychopharmacological (chemical imbalance) 1980s – presentBiopsychosocial 1990 – 2000Decade of the Brain (NIMH) (Bidirectional Gene-Environment Interaction) Decade of Discovery (NIMH) (Genomics, proteomics, molecular neurobiology, neuropsychotherapy)

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4 Rethinking Mental Disorders Mental disorders are brain disorders Mental disorders are developmental disorders Mental disorders result from complex genetic risk plus experiential factors - T Insel, 2012

5 Mental Disorders are Chronic and Disabling WHO 2008

6 Annual U.S. Cost of Brain Disease 2012 estimated medical and long-term costs related to brain disease = $515B (19% of total national health expenditures) 2012 estimated medical, non-medical, and long-term costs = $934B - Michael Thompson, Price Waterhouse Cooper, 2012

7 Mental Disorders: Mortality Over 36,000 suicides per year in the U.S. (CDC, 2008) For context: 18,000 homicides 33,000 traffic fatalities - T Insel 2012

8 Mental disorders are the chronic diseases of the young

9 The Most Costly Conditions

10 Insel, JCI, 2009 High Heritability of Mental Disorders

11 Insel, Sci Am, 2010 Hopelessness, helplessness, suicidal thoughts, anorexia, loss of libido, sleep disturbance Depression as a Brain Disorder

12 Frasure-Smith N et al. JAMA. 1993;270: Months After Heart Attack Mortality (%) Depressed (n = 35) Nondepressed (n = 187) Cumulative Mortality for Depressed and Non-depressed Patients Following Heart Attack

13 Modified from Duman, Heninger, Nestler, AGP 54(7): , 1997 Other neuronal insults: Hypoxia-Ischemia Hypoglycemia Neurotoxins Viruses Genetic Factors Increased Survival and Growth Atrophy/Death of Neurons Normal Survival and Growth Glucocorticoids Serotonin and NE BDNF GlucocorticoidsBDNF Normal Stress + Heritable Risk Depression Antidepressants and/or Psychotherapy

14 Deaths per 100,000 Year ~ 514,000 Actual Deaths in 2000 ~ 1,329,000 Projected Deaths in 2000 Impact of Research on Heart Disease 63% decrease in mortality ~ 1 million early deaths averted per year $2.6 trillion in economic return New, effective treatments and prevention strategies

15 Millions of People Number of Survivors Impact of Research on Cancer For the first time in recorded history, annual cancer deaths in the United States have fallen 10 million survivors

16 Impact of Research on Mental Illness Diagnosis is by observation, detection is late, prediction is poor. Etiology is unknown; prevention is not well- developed for most disorders. Treatment is trial and error – no cures, no vaccines. Bottom line: Prevalence has not decreased for any illness. Mortality has not decreased for any illness. - T Insel, 2012

17 Molecule Cell System Individual Social GWAS Sequencing Transgenics Epigenetics Databases Stem Cells RNAseq Proteomics Optical imaging Databases Electrode arrays Connectomics Imaging Databases Sensors Eye gaze Cognitive tools Epidemiology Databases Web 2.0 Knowledge management NIMH Research Domain Criteria (RDoC): Transforming Diagnosis

18 Cost of Genomic Sequencing - T Insel, 2012 YEARCOSTTIME 1 Million Bases:2001$6,000Several weeks centsSeveral hours Entire Genome:First$3 Billion12 years Today$10002 days sequence, 9 days analysis

19 The Menninger Mental Health Epicenter Goal:The MD Anderson of Mental Health

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22 New Directions at The Menninger Clinic Vice President and Medical Director Susan Hardesty, M.D. Comprehensive Psychiatric Assessment Service Benjamin Weinstein, M.D. Professional Assessment Service Christopher Flynn, M.D. Research Outcomes (Allen) Suicide (Greene, Ellis, Jobes) Addiction (Kosten, Flack) Mentalization (Fonagy, Bleiberg, Allen) Personality Disorders (Skodol, Oldham, Bender, Morey) Translational – e.g. neuropsychotherapy (future Menninger/Baylor studies) Admissions Service James Flack, M.D. Future research, educational, and clinical partnerships with Baylor

23 Proposed Menninger / Baylor Neuroscience Project Standardized clinical diagnosis on all adult patients (SCID I & II) Specialized brain imaging Gene sequencing to identify heritable risk factors (Provisionally approved, Baylor IRB)

24 Thank you for your interest


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