[Fall 2003; Vol. 30, No. 1; Pg 14, 16]
Research is thriving at the University of Maryland School of Medicine. The Department of Psychiatry researches a wide variety of diseases using differing scientific approaches from laboratory based bench studies to health services research. Lisa Dixon MD, Professor at the University of Maryland School of Medicine, asked three investigators to summarize some of their recent work. Alan Bellack, PhD, Professor and Director of the Psychology Division, Julie Kreyenbuhl, PhD, Assistant Professor and a young investigator in the Division of Services Research, and James Koenig, PhD, Associate Professor and basic researcher at the Maryland Psychiatric Research Center provide brief discussions of exciting research findings from their laboratories.
A Summary of Research at the VA Capitol Health Care Network
By Alan Bellack
The Veteran's Administration Capitol Health Care Network MIRECC (Mental llness Research Education and Clinical Center) is a partnership between the VA and the University of Maryland that focuses on schizophrenia and severe mental illness. MIRECC investigators are conducting research on a wide range of topics, including: drug abuse, medical co-morbidity, cognitive rehabilitation, victimization of women and post traumatic stress disorder, psychopharmacology, and health services.
One group of investigators has developed an innovative behavioral treatment for drug abuse that appears to be highly effective in reducing cocaine use, and they have been funded by the NIAAA to apply it to alcohol abuse. Another group has developed a promising cognitive rehabilitation program that employs educational software developed for classroom use. Work on diabetes suggests that people with schizophrenia may suffer from an unusual form of the illness, and a study on women who abuse drugs indicates that they are at extremely high risk for sexual abuse and victimization. Another study indicates that the quality of care provided by VA clinicians is equal to, if not better than care provided by community agencies, although neither VA nor community clinicians are highly adherent to the Schizophrenia Patient Outcomes Research Team (PORT) treatment guidelines.
Specific Research in Press at the MIRECC
By Julie Kreyenbuhl
Kreyenbuhl J, Zito JM, Buchanan RW, Soeken KL, Lehman AF. Ethnic disparity in the pharmacologic management of schizophrenia.
In press, Schizophrenia Bulletin. As a part of the Schizophrenia Patient Outcomes Research Team (PORT) Study, we investigated racial differences in the prescription of psychopharmacologic treatments to individuals with schizophrenia. Data were derived from a patient survey and medical record review for 344 persons with schizophrenia recruited from outpatient psychiatric facilities from two states between December 1994 and March 1996.
We found that African-American patients were three times more likely to be prescribed depot anti-psychotic medications and 76% less likely to receive the new-generation anti-psychotic medications clozapine and risperidone, compared to their Caucasian counterparts. Chlorpromazine-equivalent anti-psychotic dosages did not differ significantly between African-American and Caucasian patients. African-American patients received slightly higher chlorpromazine-equivalent anti-psychotic doses than Caucasians (765 vs. 711 CPZ-EQs), but the difference did not reach statistical significance. Compared to Caucasians, a larger proportion of African-Americans were prescribed anti-parkinsonian medications (63% vs. 48%), but African-Americans were less than half as likely to receive adjunctive psychopharmacologic treatments. Specifically, as compared to Caucasian patients, a smaller proportion of African- Americans were prescribed antidepressants (35% vs. 25%), anti-anxiety agents (21% vs. 8%), and mood stabilizers (23% vs. 13%), respectively.
Pronounced racial variations in the psychopharmacologic management of schizophrenia is typical in clinical practice settings. These findings persisted when analyses were adjusted for selected patient demographic and clinical characteristics, including age, gender, geographic location, years of education (a proxy for socioeconomic status), diagnostic subtype, and medical co-morbidity. A prospective, longitudinal evaluation is warranted to determine if the observed patterns of prescribing are associated with poorer differential therapeutic outcomes in minority patients.
Research News from the Maryland Psychiatric Research Center
By James Koenig
Schizophrenia is a devastating human neuropsychiatric disorder that afflicts approximately one percent of the global population. Unfortunately, the pathophysiological origins of this disease remain to be elucidated. Research into the origin and treatment of schizophrenia has been hampered by the lack of a heuristic animal preparation. Recent work being conducted by James Koenig, Ph.D., Professor of Psychiatry at the University of Maryland School of Medicine's Maryland Psychiatric Research Center may be on the verge of filling this void and opening new vistas for the treatment of schizophrenia.
The psychiatric literature is replete with reports documenting that exposure of pregnant women to severe stress during specific periods of their pregnancy elicits an increased incidence of schizophrenia in the offspring upon reaching adulthood. Using this information, Koenig exposed pregnant female rats to a series of mild stresses during the final week of pregnancy and evaluated the offspring that underwent the prenatal stress during early adulthood. Interestingly, the offspring that were in utero at the time of the maternal stress showed a number of behavioral changes, including diminished sensorimotor gating, enhancement of dopamine function in the striatum, increased predisposition to drink alcohol and marked changes in stress reactivity. A variety of neurochemical changes associated with schizophrenia, such as alterations in prefrontal cortex glutamate, have also been identified in the animals exposed to stress during pregnancy.
While it is impossible to determine whether these animals have delusions or hallucinations, the findings thus far suggest that it is possible to produce some aspects of schizophrenia in experimental animals. This preparation may also be helpful in identifying the early pathological mechanisms causing the changes in glutamate and dopamine that are prominent in schizophrenia.