Director, NIMH. July 1, 2017. About the NIMH Director. Director’s Research Priorities. Current State of NIMH. Science Highlights and Updates. Participation in Research. Future Directions. Welcome. 2. ID: 690007
DownloadNote - The PPT/PDF document "Update From the NIMH Joshua A. Gordon, M..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Update From the NIMH
Joshua A. Gordon, M.D., Ph.D.
Director, NIMH
July 1, 2017
Slide2About the NIMH Director
Director’s Research Priorities
Current State of NIMHScience Highlights and UpdatesParticipation in ResearchFuture Directions
Welcome
2
Slide3About the NIMH Director
Director’s Research Priorities
Current State of NIMH
Science Highlights and Updates
Participation in Research
Future Directions
Introduction
3
Slide4University of California, San Francisco
Received dual M.D./Ph.D.
Pioneered methods to study brain plasticity in miceColumbia University Psychiatry residency, neuroscience fellowshipJoined Department of PsychiatryDirector of the Columbia University/New York State Psychiatric Institute Adult Psychiatry Residency Program
Research focus on neural activity in mice carrying mutations of relevance to psychiatric disease
Maintained psychiatric practice, caring for patients who suffer from the illnesses studied in the lab
Background
4
Slide5About the NIMH Director
Director’s Research Priorities
Balanced Portfolio: Timeframes
Short-term: Suicide PreventionMedium-term: Circuit Neuroscience
Long-term: Computational & Theoretical
Current State of NIMH
Science Highlights and Updates
Participation in Research
Future Directions
Director Priorities
5
Slide6Good Science
Strong Study Design
High Standard of Rigor
Potential ImpactDiversity
Subject Matter
Workforce
Research ParticipantsTimeframes
NIMH Portfolio Balance
6
Slide7Research Priorities
7
Short-term Goals:
Suicide Prevention
Identify implementable evidence-based practices and knowledge gaps
Medium-term Goals:
Neural Circuits
Develop technologies to interrogate neural circuits, and ultimately improve the understanding and treatment of mental health disorders
Long-term Goals:
Computational Psychiatry
Develop computational perspectives and approaches to improve the understanding and treatment of mental health disorders
Slide8About the NIMH Director
Director’s Research Priorities
Current State of NIMH
BudgetGrants
Interactions with SAMHSA
Science Highlights and Updates
Participation in Research
Future Directions
NIMH Updates
8
Slide9NIMH Budget Updates
9
Slide10NIMH Budget Updates
10
Slide11NIMH Budget Updates
11
Slide12Key Provisions for Mental Health Care:
Appoints Directors of NIMH, NIDA, NIAAA to SAMHSA advisory councils
Encourages collaboration to ensure evidence-based practices
Strengthens existing mental and behavioral health care parity legislation
Includes broad provisions to assist for special populations
21
st Century Cures Act:Interactions Between NIH and SAMHSA
12
Slide1313
Update on RAISE:
Implementation Science to Broad Clinical Care
Slide14NIMH RAISE Findings Influenced States’ Adoption of
Evidence-Based Care for
First Episode Psychosis
Dates and Milestones
July, 2009
RAISE studies begin
December, 2013
RAISE feasibility study completed
January, 2014
H.R. 3547 ($25M set-aside for FEP)
April, 2014
NIMH/SAMHSA
provide guidance to states
December, 2014
H.R. 88 ($25M set-aside for FEP)
October, 2015
RAISE clinical trial completed
October, 2015
CMS coverage of FEP intervention services
December, 2015
H.R. 2029 ($50M set-aside for FEP)
Mental Health Block Grant Plans:
https://bgas.samhsa.gov/
14
Slide152008
2014
2016
2018
$100M in FY16 – FY17: 187 community clinics
Projected Coordinated Specialty Care
Programs in 2018
15
Slide16About the NIMH Director
Director’s Research Priorities
Current State of NIMH
Science Highlights and UpdatesCircuit Basis of Psychosi
s
Suicide Prevention
Race and Ethnicity in the Mental Health Research Network
Brief Therapy for Hispanic Youth with Anxiety and Depression
Participation in Research
Future Directions
Science Updates
16
Slide17Science Highlight:
Circuit Basis of Psychosis?
17
Slide1818
Understanding Genetic Predisposition
Circuit
Cell
Gene
System
Mutation
Behavior
Disease
Phenotype
Slide19The 22q11 Deletion Syndrome (22q11DS)
De novo copy number variant
High penetrance (25-30%) for psychosis0.5-2% of schizophrenia cases
22q11.2
Chun…Zakharenko,
Nature Medicine
, 2017
19
Slide2022q11DS Model Mice
Chun…Zakharenko,
Nature Medicine
, 2017
20
Slide2122q11DS Mice have Deficits in
Thalamocortical Synaptic Strength
Chun…Zakharenko,
Nature Medicine
, 2017
21
Slide22MicroRNA 338 Overexpression Rescues Deficits
Chun…Zakharenko,
Nature Medicine
, 2017
22
Slide23Understanding Genetic Predisposition
Mutation
Disease
Phenotype
Dgcr8
Psychosis?
miRNA
DRD2
Chun…Zakharenko,
Nature Medicine
, 2017
23
Slide24Science Highlight:
Suicide Screening
American Journal of Preventive Medicine
24
Slide25Science Highlight:
Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE)
2017
25
Slide26New Findings from ED-SAFE
26
Miller…ED-SAFE Investigators,
JAMA Psychiatry
, 2017
Three phase study of 1,400 suicidal patients in eight U.S. EDs
Treatment as usual (phase 1)
Universal suicide risk screening (phase 2)
Universal suicide risk screening + intervention (phase 3):
Secondary suicide risk screening by ED physician
Discharge resources
Post-ED telephone calls to reducing suicide risk
Slide27Universal Suicide Screening is
Possible to Implement
Boudreaux…Miller,
Am J Prev Med
, 2016
27
Slide28Universal Suicide Screening Increases Detection
Boudreaux…Miller,
Am J Prev Med
, 2016
28
Slide29Universal Screening Plus Intervention Reduces Number of Suicide Attempts
29
Miller…ED-SAFE Investigators,
JAMA Psychiatry
, 2017
Intervention led to a 30% decrease in suicide attempts over the 52-weeks follow-up, as compared to standard emergency treatment care
Slide302016
Science Highlight:
Tracking Disparities in Access to Care
30
Slide31http://hcsrn.org/mhrn/en/ResearchProjects/
MHRN is the nation’s preeminent source of population-based research on mental health, partnering with 13 health system research centers that provide care of a diverse population of over 12.5 million people in 15 states
(1)
Mental Health Research Network (MHRN)
31
Slide32Karen Coleman, Greg Simon et al, 2016, Psychiatric Services
Coleman…Simon,
Psychiatric Services
, 2016
Are Racial-Ethnic Differences in Psychiatric Diagnosis and Treatment Present in Health Care Systems Across the US?
(n= 7.5 million adults)
Racial-Ethnic Differences in
Psychiatric Diagnosis and Treatment
Racial-ethnic differences in the diagnosis and treatment of psychiatric conditions persist, especially for Blacks
Blacks were nearly twice as likely as Whites to receive a diagnosis of Schizophrenia
Depression and anxiety diagnoses were lower among racial-ethic minorities compared to non-Hispanic Whites
Exception: Native American and Alaskan Native groups had similar rates as Whites
32
Slide33Science Highlight:
Brief Therapy for Pediatric Anxiety and Depression
2017
33
Slide34Clinical Trial of Children andAdolescents with Depression or Anxiety
34
Weersing…Iyengar,
JAMA Psychiatry
, 2017
Enrolled 185 children and adolescents (ages 8 – 16) with depression or an anxiety disorder
Random assignment to assisted referral care (ARC) or brief behavioral therapy (BBT)
BBT
addressed both depression and anxiety using a streamlined approach
Children and adolescents in the BBT group showed greater improvement than those in the ARC group
Slide35Striking Benefits for Hispanic Children and Adolescents
35
Hispanic youth who received BBT showed the greatest improvement and performed best on measures of functioning
Weersing…Iyengar,
JAMA Psychiatry
, 2017
Slide36About the NIMH Director
Director’s Research Priorities
Current State of NIMH
Science Highlights
Participation in Research
Big Data Approaches
All of Us Cohort
Future Directions
Active Participation in Research
36
Slide37Big Data Approach to
Identifying Depression Subtypes
37
Slide38Patterns of Resting State Connectivity
Drysdale…Liston,
Nature Medicine
, 2017
38
Slide39Clustering Patients Based on Connectivity
*
Drysdale…Liston,
Nature Medicine
, 2017
39
Slide40Subtypes Differ in Clinical Dimensions
Drysdale…Liston,
Nature Medicine
, 2017
40
Slide41Subtypes Differ in Responsivity to Prefrontal Cortex Repetitive Transcranial Magnetic Stimulation
Drysdale…Liston,
Nature Medicine
, 2017
41
Slide42NIH All of Us Research Program
42
Historic effort to gather data from one million or more people in the U.S.
Focus on individual differences in lifestyle, environment, and biology
Paving the way toward precision medicine
Slide43About the NIMH Director
Director’s Research Priorities
Current State of NIMH
Science Highlights
Participation in Research
Future Directions
Moving Forward
43
Slide44Prioritize excellent science, and within the realm of excellent science, diversity.
Focus on learning and working closely with all of you to gain insight that can help inform the future directions of our research programs.
Address challenges facing NIMH.Think more broadly about neuroscience, psychiatry, and public health.Help build momentum towards treatments that can change the lives of individuals, families, and communities affected by mental disorders.
The Road Ahead
44
Slide4545
NIMH’s Mission
www.nimh.nih.gov
Research = Hope
Next Slides
What happened
Nickel metal hydride nimh handbook and application manual ni
Joshua 7
Joshua 7:10-
Joshua 7:10- 13 (nkjv)
Joshua book of joshua timeline
Joshua 1-7
Sir joshua reynolds the golden age of english
Joshua and judges document#: tx004707