An Interview by Bruce Hershfield, M.D.

[Winter 2003; Vol. 29, No. 2; Pg 5, 9]

Dr. Brandt is an MPS Assembly Representative to the APA and Chair of the Department of Psychiatry at St. Joseph Hospital.

This interview was conducted on November 8, 2002

Question: Please tell us about your work at St. Joseph's.
Answer: (Dr. Brandt): I've been at St. Joseph now since 1996-- 6 years. I'm doing primarily clinical work, still spending a lot of time seeing patients, doing psychotherapy, medication management, directing the over-all programs at St. Joe's, also spending a fair amount of time doing research. We finished a pilot project with a Swiss foundation on the genetics of eating disorders and we followed that with a proposal to NIH with 10 other groups to do a continuous study of the genetics of anorexia.

Question: What led you to become an expert on eating disorders?
Dr. Brandt: My work in eating disorders actually started when I became a Fellow at the National Institute of Health. That was purely by serendipity. Robert Post, who is a leader in the treatment of mood disorders, came to Spring Grove when I was a Resident and he gave a talk. I was interested and I went up to him and asked him if I could come do an elective during my senior year of Residency . About 6 months later I got a letter from NIH that somebody had taken a position elsewhere and that they were looking for somebody to come do a Fellowship there. We were able to work it out for me to finish my Residency at NIH while pursuing the Fellowship and it turned out that I was placed on the Eating Disorder Unit.

Question: How has the area changed since you first began working in this field?
Dr. Brandt: It has changed dramatically, both in terms of identification of better ways to treat patients and in terms of how it has been affected by special forces in health care, with diminishing lengths of stay on inpatient units. It has also been affected by the social forces that emphasize the feeling that people need to be thin to be considered successful and attractive.

Question: What kinds of treatment settings do you use?
Dr. Brandt: I've seen that change dramatically. In 1990, when I moved from NIH to Mercy Hospital in Baltimore, the average length of stay for anorexia was about 40 to 50 days and our current length of stay on the St. Joseph inpatient unit is under 10 days. We've been forced to develop new ways to treat patients for longer periods of time , but not on an inpatient basis. We've developed partial hospitalization programs and intensive outpatient programs, so the over-all length of stay has not changed nearly as dramatically.

Question: Have you been able to get cooperation from third party payers when you explain the needs of these patients?
Dr. Brandt: We've worked at that. We've tried to help insurers understand the nature of our treatment and how in the long-term it will end up saving them money to allow us to apply a treatment that really leads to some behavioral and cognitive change for the patient, as opposed to the revolving door model of care that we saw developing a number of years ago.

Question: What programs were already in place in Baltimore when you arrived and how have you been able to build on that?
Dr. Brandt: Baltimore has a history of treating eating disorder patients. Arnold Andersen was at Hopkins and really was a pioneer in the inpatient treatment of patients with eating disorders and Angela Guarda has followed up on his work at Hopkins. Still, we found that there was a place for our type of multidimensional treatment at Mercy. The program at Mercy grew over the 6 years that we were there and then in 1996 the opportunity came up for me to move to St. Joe's and to take over as Head of Psychiatry. Also, St. Joe's basically built us a state-of-the-art unit to continue the program.

Question: You do some teaching, too?
Dr. Brandt: Yes, since about 1990 I've been teaching the medical student track at University in eating disorders and the Residency segments on eating disorders, and supervising Residents. We also have an affiliation with University for training where medical students and Residents rotate through our unit at St. Joe's.

Question: I understand that you've also been doing research on the genetics of eating disorders.
Dr. Brandt: Genetics is our current project. We've done some other projects as well through the years. We're currently doing a placebo-controlled study of olanzapine and fluoxetine in the treatment of anorexia. But the genetics work is our primary focus right now. We're really excited about that because genetics research not only helps identify genetic defects and potentially new treatments, but it also helps to reduce the stigma about mental illness.

Question: The description of anorexia has been around since about 1870, hasn't it?
Dr. Brandt: The earliest description of a patient who probably had anorexia nervosa was in 1689. There were more modern descriptions in the 1800's. Bulimia as an illness was described also in that era, but was not identified as a modern illness until 1979 by Gerald Russell.

Question: Tell us about the CME program at St. Joseph's.
Dr. Brandt: That program long predated me at St. Joe's. Each November we invite a series of speakers with some theme for a symposium. Additionally, program about eating disorders.

Question: You must have opportunities to work with other leaders in the field.
Dr. Brandt: I do. Something that was exciting for me this past year was that I was on an NIH Consensus Panel to try to figure out directions for both treatment and research in eating disorders. It was an opportunity to interact with a number of experts on eating disorders. Because anorexia nervosa is a relatively rare illness in terms of the population at large (though it affects certain populations at a higher rate, like high school and college-age women), there's a real need for multi-center, collaborative studies. That way, we can get a large-enough group of patients to really understand certain things, to have a high-enough power statistically to figure out certain questions that have been around for a long time.

Question: How did you get involved with the MPS and how do you like being a Representative to the Assembly?
Dr. Brandt: I've greatly enjoyed my involvement in the MPS, first at the local level, where I was able to rise through the Council and the officership track. I'm not a person who likes to sit on the sidelines and watch what's going on. I've gotten some sense of having some potential role in affecting what's happening to psychiatry. Patients, and myself. I enjoyed that and then, at a time that I was completing my stay in the officership track, I made the decision to move to the Assembly. It's actually been quite an education to see how the Assembly works and to meet people from around the country who are grappling with many of the same issues we're grappling with in Maryland.

Question: I know that you are married to a psychiatrist and that Joanna has been very helpful to the MPS. What is it like to have two psychiatrists in the family?
Dr. Brandt: It has worked well for Joanna and me. I won't say we never talk shop at home, but we each have our core areas of interest. Joanna is a forensic psychiatrist and has been very helpful to me when I've been involved in forensic cases. Psychiatry is an interest that we share. We try to treat our kids as kids, as opposed to letting our psychiatric background impinge, but some aspects of being a parent have helped a lot in psychiatry and some aspects of psychiatry in parenting.

Question: What thoughts do you have about the future?
Dr. Brandt: I'm optimistic. There have been some trends in psychiatry that have been concerning, like the diminishing use of psychotherapy and psychodynamic concepts in psychiatry, but I've found that in my own career, at least, that I've been able to integrate the areas of psychiatry that have been very interesting to me. I think that there are some reasons to be optimistic about the future of psychiatry right now. Clearly, the impact of managed care has been difficult, but we may emerge stronger as a result, if we can figure out ways to effectively provide care and to help people understand the important nature of what we do.