Archive for the ‘Penn State’ category

Personalize This

January 17th, 2013

The future of psychiatry, and indeed all of medicine, will emerge as we unravel the double helix of the genetic code, the proteins DNA commands, and the epigenetic factors that allow our environment to influence genetic expression. Today, I caught a brief glimpse of that future.

I just attended the ceremonial opening of the Penn State Hershey Institute for Personalized Medicine, one of a handful of high technology centers that will pave the way to a new era in health care. This multimillion dollar facility was enabled by federal, state, and private funds, and the inaugural event was attended by a U.S. senator and many United States, Pennsylvania, and university dignitaries. The Institute consists of laboratories that can quickly and relatively inexpensively map individual genomes, a tissue repository for samples from thousands of patients, and an information technology hub.

When I was a medical student in the 1960s, virtually all children with leukemia died. Today, almost all survive. The difference has been discoveries about the mysteries of individual cancers and how to target treatments to their unique signatures. Not only has survival increased, but when cancer treatments can be personalized, doctors can apply less toxic medicines than the systemic poisons we have used for decades.

I am committing significant discretionary funds from my department to leverage our new center’s technology to achieve breakthroughs in psychiatry. Instead of blasting every cell in the body with increased levels of serotonin, someday we should be able to target interventions to distinct pathophysiology underlying diseases of impulse, mood, and thought. As in other medical specialties, we will bank tissue samples from psychiatric patients, establish diagnoses, track symptoms systematically over time, record responses to treatments, and use computer programs to link biology to pathology and ultimately to cure. It is an exciting time.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry

Dandelions and Orchids

March 11th, 2011

Dandelions are hardy. Give them a crack on a city sidewalk, and they will thrive. The beautiful orchid, by contrast, is much more delicate. To thrive it needs conditions like those in Costa Rica: warm, sunny, and moist.

Increasingly, research on the human genome suggests that important gene-environment interactions may lead to psychiatric syndromes. An example is that two short alleles on the serotonin-transporter (5-HTT) gene may heighten vulnerability to depression under adverse circumstances.

Why would such vulnerability genes survive? Shouldn’t people who inherit them be adversely selected, so their genes would decrease and die out over generations? Or, might such genetic patterns give evolutionary advantage in selected environments—something like sickle-cell trait making people more resistant to malaria?

Emerging evidence, including data from studies by Penn State scientists, suggests that some genetic patterns, such as two short 5-HTT alleles, might confer behavioral advantages in an optimal environment. People with two short alleles who grow up in nurturing, intact families, with educational and economic privilege, may actually show greater resilience and creativity, while others with the same genetic pattern, who come from poverty and dysfunction, may do worse than average. If this theory is correct, the people with two short 5-HTT alleles are “orchids,” doing beautifully in ideal environments, but worse than average in bad environments. The majority of people, who have either a short and a long or two long alleles, are “dandelions,” doing moderately well in a broad range of environments.

As I write periodically in BTP, we stand on the threshold of dramatic and exciting breakthroughs in understanding the brain. In time, these discoveries should help people who suffer from psychiatric syndromes—including autism, ADHD, depression, and PTSD

Alan J. Gelenberg, M.D.
Editor,
Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief,
Journal of Clinical Psychiatry

Personalized Medicine: when will it come to psychiatry?

August 23rd, 2010

I recently wrote a piece on personalized medicine, which appears in the September issue of BTP. I thought of it following a meeting with pharmacology faculty members from Penn State Hershey’s cancer center.

As I mention in the newsletter, personalized medicine is gradually becoming a reality in cancer treatment, as genetic understanding points the way to specific diagnoses and tailored treatments. Now scientists are extending understanding slowly to brain diseases and psychiatric therapies.

My colleagues are working with in vitro preparations to identify drug-metabolizing enzymes and the genetic variants that control them. Based on new research, we hope to figure out which patients may be at greater risk of specific medication toxicities, and conversely, who may take our drugs with relative impunity. Soon, I hope, this new knowledge will affect the treatment of major psychiatric diagnoses.

Much research remains to be done—in laboratories, hospitals, and clinics—before these new approaches will be ready for “prime time.” But I anticipate that this “brave new world” will soon be upon us.

Why I am excited about partnerships

June 8th, 2010

I have spent my career trying to bring together various organizations and factions in a community that share a commitment to helping the mentally ill but don’t historically work together to accomplish that goal. A lot of money and effort is wasted when bureaucrats or community activists protect their fiefdoms at the expense of helping patients.

It’s hard to change that mentality, but well worth it.

When I began my career in Massachusetts, I worked at the Erich Lindemann Mental Health Center, a collaboration among the Commonwealth of Massachusetts, Harvard Medical School, and the Massachusetts General Hospital. Together we built systems of care, research, and education—all to serve people with mental illness.

Later when I moved to Arizona as head of the UA Medical School’s Department of Psychiatry, I reached out to the broader community to form coalitions. We were actually quite successful. We were able to create the Community Partnership of Southern Arizona. And eventually the University of Arizona and our physicians’ group practice partnered with Pima County to build and operate a brand-new psychiatric hospital.

Now that I’m in Pennsylvania, I am working with a wonderfully dedicated group to put strong legs under the fledgling Pennsylvania Psychiatric Institute. I talked a little about it in my last blog.

Partnerships must be the future of medicine in this country. There’s too little money and too great a need to put personal power-building ahead of real progress in medical care for people in serious need.

Public-Private-Academic Partnerships

June 1st, 2010

With the nation in the midst of the largest health reform since the advent of Medicare/Medicaid, we will undoubtedly see more public-private partnerships in the health care arena.

Let me tell you how a similar partnership is working for psychiatry in central Pennsylvania.

Two years ago, Penn State Hershey Medical Center (HMC) created a brand- new not-for-profit entity in partnership with Pinnacle Health, also a not-for-profit. Pennsylvania Psychiatric Institute (PPI), serves provides in-patient and out-patient services for patients in the Harrisburg area and across a large swath of central PA.

Of course there were hurdles. It’s never easy to get Medicare certification for a new organization, for example. But some hurdles were avoided by wise planning. For instance, PPI’s board is made up equally of Hershey Medical Center, Pinnacle Health, and community leaders. That balance is reflected in the balanced strategic planning and tactical interventions required of the organization.  (Full disclosure: I sit on the board). And another huge plus: both HMC and Pinnacle were willing to losing several million dollars during the initial phases of start-up, demonstrating a true commitment to the treatment of the mentally ill.

Is the Pennsylvania Psychiatric Institute out of the woods? Certainly not yet, and perhaps not as long as doctors and hospitals try to survive the age of slim reimbursement.  But so far, so good. It’s a very promising partnership, and one that may serve as a model for others. I, for one, am delighted to be part of the team, bringing teaching and research to a system that seeks to provide state-of-the-art care.