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  • Families and Addictions: Forgiveness as a Powerful Clinical Tool

    Camino-Gaztambide, Richard F.; Malavé de León, Eunice; Department of Psychiatry and Health Behavior
    Short Description: Addictions are complex behaviors that have a profound impact on the individual, family, and society. Forgiveness can transform negative emotions for oneself or others to achieve or sustain recovery. The purpose of the workshop is to offer the clinical underpinnings that can facilitate the implementation of forgiveness in practice. Abstract: Addictions are complex behaviors that have a profound impact on the individual, family, and at a societal level. Although many see addictions as fundamentally a disease of the brain and clearly brain structures and functions are significantly involved, nevertheless, brain function alone does not address the consequences and profound effects that addictions have on the patient's ecosystem. Family, friends, co-workers, and neighborhood, all are altered with frequent feelings of anger, shame, guilt, and rejection present in all parties. Usually, these feelings are in response to real or perceived transgressions by one or more persons, and it is not uncommon that trauma is present, producing persistent stress which can interfere with recovery. The concept of forgiveness can be a powerful tool to help patients address the injury and trauma that they have done or received by others. Shame, defined as a “flawed self, often accompanied by feelings of worthlessness and powerlessness” is associated with negative feelings and poorer recovery. In contrast, guilt, that focuses more on the behavior not necessarily reflected as the total self, is more amenable to forgiveness. Forgiveness as a disposition to where the use of negative emotions for oneself or others can be transformed to achieve or sustain recovery. The Twelve-step facilitation model can be integrated, especially focusing on steps four through nine, as other models like Narrative, ACT, and CBT are also able to use the concept of forgiveness in effective ways. The purpose of the workshop is to provide basic theoretical and clinical underpinnings, use case presentations, interactive discussions, to provide skills that can facilitate the implementation of forgiveness in clinical practice. “Addiction is more than a disease and involves more than the brain: it is a systemic behavioral disorder.”
  • Questionnaire Design and Responsiveness in a Data Capture Tool for Student Sharing of Experiences of Statewide Clerkship Sites

    Zheng, Stephanie; Behrman, David; Agrawal, Parth; Basco, Brian; Ball, Charlotte; Rose, Jennifer; Miller, Samel; Wood, Elena (2017-03)
    Positive clerkship experiences and student performance in the clinical years has been correlated to perceived quality of education and specialty choice amongst medical students [1-3]. The Medical College of Georgia uses a distributed campus model with more than 250 clerkship rotation sites across the state and beyond, making student clerkship choices imperative to their development as physicians. We developed a survey to collect both quantitative and qualitative data from students during their clerkship years and a system to distribute that information to students. The data allowed us to evaluate the effectiveness of various question formats through responsiveness, the length of responses, and time spent on the survey. In addition to this, we looked at the number of responses per clerkship in order to see whether or not our survey was getting information about all of the 3rd year rotations. We aspire to take these findings and utilize them to expand t he program and improve the questionnaire in order to yield more responsiveness from students.
  • Assessing Medical Students Knowledge in Diagnosis and Initial Treatment of Depression

    Youssef, Nagy A.; Thomas, Andria; Ange, Brittany; Yassa, Mark; Boswell, Elizabeth; Wallach, Paul M.; Department of Psychiatry and Health Behavior; Department of Psychological Sciences; Department of Chemistry and Physics; Augusta University (2017-03)
    Depression is one of the leading causes of premature death, and one of the highest burdens of overall disability. Depression rates are around 13% in primary care settings. Depressive episodes are still underdiagnosed and undertreated. Factors that contribute to this include lack of detailed knowledge, lack of confidence in treatments among others. Thus, addressing these gaps would improve patients care. Moreover, bipolar depression can be difficult to distinguish from unipolar; and requires a different treatment. Improving education of students in these areas would improve care for patients. Aims are as follows: 1) assess students’ level of confidence and knowledge in diagnosing and treating depression, and any barriers to gaps in knowledge, 2) assess students’ knowledge in differential diagnosis of depression and any barriers to gaps in knowledge. We are assessing these by an online survey on website used by Medical College of Georgia for student questionnaires, sent to all third-year medical students after internal medicine rotation. The survey is sent through academic affairs office. This will provide valuable knowledge in improving our education and curriculum for the new generation of physicians.
  • Gene-Environment Interaction Modulates Schizophrenic Endophenotypes in Heterozygous Reeler Mice

    Howell, Kristy R.; Department of Psychiatry and Health Behavior (2013-07)
    Aim 1: To determine the effect of chronic stress on the VEGF signaling pathway. Aim 2: To determine the effects of prenatal hypoxia on VEGF signaling, behavioral activities, blood flow, and brain volume in heterozygous reeler mice during early adulthood. Aim 3: To evaluate long lasting effects of prenatal hypoxia on VEGF signaling, behavioral activities, blood flow, and brain volume in heterozygous reeler mice. Aim 4: To determine the correlation between serum VEGF levels and brain volumes in schizophrenia subjects.
  • Cysteamine Attenuates the Decreases in TrkB Protein Levels and the Anxiety/Depression-Like Behaviors in Mice Induced by Corticosterone Treatment

    Kutiyanawalla, Ammar; Terry, Alvin V.; Pillai, Anilkumar; Department of Psychiatry and Health Behavior; Department of Pharmacology and Toxicology (2011-10-19)
    Objective: Stress and glucocorticoid hormones, which are released into the circulation following stressful experiences, have been shown to contribute significantly to the manifestation of anxiety-like behaviors observed in many neuropsychiatric disorders. Brain-derived neurotrophic factor (BDNF) signaling through its receptor TrkB plays an important role in stress-mediated changes in structural as well as functional neuroplasticity. Studies designed to elucidate the mechanisms whereby TrkB signaling is regulated in chronic stress might provide valuable information for the development of new therapeutic strategies for several stress-related psychiatric disorders.
  • Long-Term Continuous Corticosterone Treatment Decreases VEGF Receptor-2 Expression in Frontal Cortex

    Howell, Kristy R.; Kutiyanawalla, Ammar; Pillai, Anilkumar; Department of Psychiatry and Health Behavior (2011-05-27)
    Objective: Stress and increased glucocorticoid levels are associated with many neuropsychiatric disorders including schizophrenia and depression. Recently, the role of vascular endothelial factor receptor-2 (VEGFR2/Flk1) signaling has been implicated in stress-mediated neuroplasticity. However, the mechanism of regulation of VEGF/Flk1 signaling under long-term continuous glucocorticoid exposure has not been elucidated.
  • Plasma BDNF Levels Vary in Relation to Body Weight in Females

    Pillai, Anilkumar; Bruno, Davide; Sarreal, Antero S.; Hernando, Raymundo T.; Saint-Louis, Leslie A.; Nierenberg, Jay; Ginsberg, Stephen D.; Pomara, Nunzio; Mehta, Pankaj D.; Zetterberg, Henrik; et al. (2012-07-2)
    Brain derived neurotrophic factor (BDNF) has been implicated in the pathophysiology of depression as well as neuropsychiatric and neurodegenerative disorders. Recent studies show a role of BDNF in energy metabolism and body weight regulation. We examined BDNF levels in plasma and cerebrospinal fluid (CSF) samples from age matched elderly depressed and control subjects. Also, the association of BDNF levels with age, gender, body weight, body mass index (BMI), and cognitive performance was evaluated. We did not find any significant differences in plasma and CSF BDNF levels between depressed and control subjects. Plasma BDNF levels were negatively correlated with age (but not with BMI and body weight), when analyses were performed including both depressed and control subjects. A significant reduction in plasma BDNF levels was observed in females as compared to male subjects, and the change in BDNF levels were significantly and positively related to body weight in females. Furthermore, significant increases in Total Recall and Delayed Recall values were found in females as compared to males. In conclusion, the lower BDNF levels observed in females suggest that changes in peripheral BDNF levels are likely secondary to an altered energy balance. However, further studies using larger sample size are warranted.
  • Pharmacogenetics of antipsychotic adverse effects: Case studies and a literature review for clinicians.

    Foster, Adriana; Wang, Zixuan; Usman, Manzoor; Stirewalt, Edna; Buckley, Peter F.; Department of Medicine; Department of Pathology; Department of Psychiatry and Health Behavior (2009-03-20)
    There is a growing body of literature supporting the contribution of genetic variability to the mechanisms responsible for the adverse effects of antipsychotic medications particularly movement disorders and weight gain. Despite the current gap between research studies and the practical tools available to the clinician to identify such risks, it is hoped that in the foreseeable future, pharmacogenetics will become a critical aid to guide the development of personalized therapeutic regimes with fewer adverse effects. We provide a summary of two cases that are examples of using cytochrome P450 pharmacogenetics in an attempt to guide treatment in the context of recent literature concerning the role of pharmacogenetics in the manifestation of adverse effects of antipsychotic therapies. These examples and the review of recent literature on pharmacogenetics of antipsychotic adverse effects illustrate the potential for applying the principles of predictive, preventive, and personalized medicine to the therapy of psychotic disorders.
  • Decreased expression of Sprouty2 in the dorsolateral prefrontal cortex in schizophrenia and bipolar disorder: a correlation with BDNF expression.

    Pillai, Anilkumar; Department of Psychiatry and Health Behavior (2008-03-12)
    BACKGROUND: Current theories on the pathophysiology of schizophrenia suggest altered brain plasticity such as decreased neural proliferation and migration, delayed myelination, and abnormal synaptic modeling, in the brain of subjects with schizophrenia. Though functional alterations in BDNF, which plays important role in neuroplasticity, are implicated in many abnormalities found in schizophrenia, the regulatory mechanism(s) involved in the abnormal signaling of BDNF in schizophrenia is not clear. The present study investigated whether Sprouty2, a regulator of growth factor signaling, is abnormally expressed in schizophrenia, and is associated with the changes in BDNF mRNA in this disorder. The potential effect of antipsychotic drugs on Sprouty2 expression was tested in adult rats. METHODS AND FINDINGS: Sprouty2 and BDNF gene expression were analyzed in dorsolateral prefrontal cortex samples from the Stanley Array Collection. Quantitative real-time PCR analysis of RNA in 100 individuals (35 with schizophrenia, 31 with bipolar disorder, and 34 psychiatrically normal controls) showed significantly decreased expression of Sprouty2 and BDNF in both schizophrenia and bipolar disorder. Moreover, a significant correlation between these two genes existed in control, schizophrenia and bipolar subjects. Long-term treatment with antipsychotic drugs, haloperidol and olanzapine, showed differential effects on both Sprouty2 and BDNF mRNA and protein levels in the frontal cortex of rats. CONCLUSION: These findings demonstrating decreased expression of Sprouty2 associated with changes in BDNF, suggest the possibility that these decreases are secondary to treatment rather than to factors that are significant in the disease process of either schizophrenia and/or bipolar disorder. Further exploration of Sprouty2-related signal transduction pathways may be helpful to design novel treatment strategies for these disorders.