Department of Psychiatry & Behavioral Sciences – Institute of Psychiatry (rev 2/09)
http://www.musc.edu/psychiatry/
Chairman: Thomas W. Uhde, MD
The Department of Psychiatry & Behavioral Sciences emphasizes excellence in clinical care, teaching, and research. MUSC Psychiatry is headquartered in its own building, the Institute of Psychiatry (IOP), where the majority of the department’s faculty, residency training programs, research programs, and administrative offices are located. The Institute of Psychiatry includes a 90-bed inpatient hospital located a short block from the Medical University Hospital. The IOP, a principal clinical teaching facility, has been named by U.S. News & World Report as one of the best hospitals in the U.S. for the treatment of psychiatric disorders, and as Hospital of the Year (2005) by the South Carolina Chapter of the National Alliance for the Mentally Ill. The IOP houses five inpatient treatment units, focusing on acute care, general adult, addiction, youth, and geriatric services. Also housed in the IOP are a variety of day treatment programs, the Center for Drug and Alcohol Programs (CDAP), the Brain Stimulation Laboratory, and other psychiatry research space, including two wings where neurobiological studies pertinent to the understanding of psychiatric illness are conducted. The department offers three residency training programs: General Psychiatry Residency Training, Combined Residency Training in General Psychiatry and General Internal Medicine, and Combined Residency Training in General Psychiatry and General Neurology. In addition, the department offers four fellowship programs: Addiction Psychiatry, Geriatric Psychiatry, Child & Adolescent Psychiatry, and Forensic Psychiatry. Research tracks are available for all programs, supported in part by an NIH training grant (R25) from the National Institute on Drug Abuse (NIDA). The department also directs the Charleston Consortium Psychology Internship Program in partnership with the Psychology Service of the Ralph H. Johnson VA Medical Center. The program provides a year-long, full-time, American Psychological Association-accredited internship training experience for PhD students in APA-accredited clinical and counseling psychology programs. It has trained more than 300 psychology interns, many of whom are now pursuing careers in universities, medical schools, VA Medical Centers, teaching hospitals, and other settings. The department also provides required course work in each year of the medical student curriculum, with each course, building upon the previous one. In addition to the required courses, the department provides numerous 4-week electives available to 4th year students. With regard to research, faculty interests span the study of clinical, psychological and neurobiological interfaces in patients with a spectrum of psychiatric conditions. The department ranks among the top 15 psychiatry departments in the U.S., and the top 3 in the Southeast, in terms of funding from the National Institutes of Health. In FY2008 departmental faculty received 124 grant and contract awards, totaling $24.2 million in extramural research support. Ongoing research projects range from basic neuroscience and brain imaging, to clinical pharmacology and treatment studies. The department’s Center for Drug and Alcohol Programs, which includes a major NIH-funded Alcohol Research Center, involves extensive collaboration with basic science and other clinical departments. The addictions program was ranked 9th in the nation by U.S. News & World Report (2009). Psychiatry researchers carry out clinical trials, including participation in national clinical trials networks; lead a center on women’s health, a family services research center, a national crime victim’s center, and a new brain imaging center of excellence. Studies are underway utilizing transcranial magnetic stimulation, and a mood disorders clinic has been expanded to include a vagus nerve stimulation treatment and research program for patients with refractory depression. Researchers in geriatric psychiatry are focusing on Alzheimer’s disease, and extensive research is being carried out on post-traumatic stress disorder, particularly in the mental health division of the VA Hospital, located just two blocks from the IOP. The main research divisions in the Department are the Brain Stimulation Laboratory, Center for Drug and Alcohol Programs, Clinical Neuroscience Division, Family Services Research Center, Geropsychiatry Division, National Crime Victims Center, Public Psychiatry Division, and Weight Management Center.
Behavioral, Epidemiologic and Community Health Division (BEACH) Psychiatry
http://www.musc.edu/psychiatry/research/public/public_home.htm
The mission of the Behavioral, Epidemiologic and Community Health Division (BEACH) is to further research, clinical, and educational activities relevant to public mental health agencies, including the federally-funded Veterans Affairs healthcare system and the state-funded Community Mental Health system. This is the largest division within the Department of Psychiatry & Behavioral Sciences at MUSC, with over 25 full-time faculty. The division is responsible for approximately 30% of the teaching conducted within the department, including clinical supervision and mentorship of psychology interns and psychiatry residents, supervision of 3rd and 4th year medical students, and didactic course teaching of 1st and 3rd year medical students. Total research funding for the Division over the past three years is more than $4 million. The Division offers a number of important resources and provides an atmosphere of collegial investigators from a range of disciplines, including psychiatry, psychology, epidemiology, pharmacology, and biostatistics.
Brain Stimulation Laboratory
http://www.musc.edu/fnrd/tms.htmThe Brain Stimulation Laboratory (BSL) is located in a series of labs and offices (>3000 square feet) primarily located on the 5th floor of the Institute of Psychiatry (IOP). BSL studies use electromagnetic approaches as either research tools investigating neuroscience questions or as investigational or FDA approved treatments for brain diseases. Techniques actively being used by BSL researchers and their collaborators include: transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), transcranial direct current stimulation (tDCS), electroconvulsive therapy (ECT), deep brain stimulation (DBS) and epidural cortical stimulation (epCS). TMS is a non-invasive technique for mapping brain functions and possibly treating neurospychiatric disorders such as Parkinson's disease, chronic pain and depression. MUSC’s BSL team has been a world leader in TMS research since 1995, performing basic research studies using TMS as well as using TMS in clinical trials, such as an NIMH-sponsored study of depression (OPT-TMS) and studies of TMS to inhibit pain, determine if TMS can change food cravings, and determine if TMS can help modify symptoms in stroke patients. ECT, VNS and TMS are clinical services offered within the BSL. BSL researchers at MUSC were the first in the world (in 1998) to implant VNS devices in patients with major depression who had not adequately responded to traditional antidepressants. DBS and epCS are more invasive than TMS or VNS, but are less invasive than traditional brain surgery, where the brain is permanently lesioned. DBS of the thalamus is approved for the treatment of Parkinson's disease and the BSL has studies underway using DBS or epCS for treatment resistant depression. Members of the BSL team overlap and collaborate with the Center for Advanced Imaging Research (CAIR). In some instances, brain stimulation techniques are delivered in conjunction with fMRI studies to examine relevant circuitry.
Current equipment in the BSL includes 14 TMS machines, some of which are historical display pieces: a 1993 Cadwell® High Speed MES-10 (with a water-cooled figure-8 coil), a Dantec® MagPro (with a figure-8 and a round coil) and newer Dantec machine, four NeoPulse Neotonus® Model 3600 stimulators (with solid focal coils and sham coils), a Magstim® Rapid, Super-Rapid and Bistim machines (with figure-8 and double-cone coils). We also have a new Brainsway H-coil device and a Neuronetics Neurostar machine. For determining motor thresholds, the BSL has a Dantec® Cantata EMG machine and a laptop computer with MacCRO Spike software and Colborne amplifiers. The ECT suite has two MECTA Spectrum 5000Q machines and a Thymotron IV. Desktop computers with 22” LCD monitors run Brainsight®, a software program for frameless stereotaxy used for image-guided targeted TMS.
The laboratory also contains a resting ECG analysis system, phlebotomy chair, exam table refrigerator, automated blood pressure monitor, ophthalmoscope, and an L-shaped counter with two sinks. There is a nasal oxygen supply and an emergency cart. The BSL has 3 image analysis workstations networked directly to the Center for Advanced Imaging Research (CAIR) for rapid image data analysis and transfer of functional imaging data needed to guide TMS placement using Brainsight. The BSL psychometrician utilizes a designated neuropsychological testing room containing desktop and laptop computers to run neurocognitive and attentional test software such as the CPT, PsyScope.1.2.1, visual working memory task, WCST, etc.
Previous studies in the BSL have ranged from clinical trials in unipolar depression, bipolar affective disorders, borderline personality disorder (BOPD), chronic pain and acute laboratory pain, to challenge studies in generalized anxiety disorder, post-stroke aphasia, Tourette’s syndrome, Parkinson’s disease and schizophrenia. There are numerous studies as well integrating TMS with functional imaging (SPECT tracers injected in this lab or interleaved TMS/fMRI studies in the CAIR). Additionally the BSL was funded through the Defense Advanced Research Projects Agency (DARPA) to perform sleep-deprivation studies in healthy adults and use within-individual fMRI-guided TMS to determine if TMS can produce improvements in performance.
Inter-TMS-administrator reliability is established across all clinicians involved in studies to insure safety and standardization of TMS delivery and minimal, standardized interaction with research patients during TMS delivery. TMS treatment is logged in terms of the number of magnetic stimuli exposure for both study patients and researchers present in the room. Weekly meetings are held to discuss clinical and research related issues as well as to share the latest scientific findings and to discuss future projects related to the field.
The BSL also serves as the international editorial office headquarters of Brain Stimulation, Basic, Translational and Clinical Research in Neuromodulation, published by Elsevier.
Center for Drug & Alcohol Programs (see previous description, in “Centers Section”)
http://www.muschealth.com/cdap/
Clinical Neuroscience Division (rev. 01/09)
http://www.musc.edu/psychiatry/research/cns/cns_home.htm
The Clinical Neuroscience Division (CND) team includes researchers with a wide variety of skills and expertise including psychiatry, psychology, nursing, pharmacology and neuroscience, working collaboratively to investigate mechanisms, causes and treatments for a number of psychiatric disorders with emphasis on substance use disorders and psychiatric disorders that co-occur with substance use. CND faculty conduct federally funded research on marijuana, cocaine, opiate, alcohol and nicotine dependence, as well as schizophrenia, bipolar disorder, attention deficit hyperactivity disorder and post-traumatic stress disorder. Studies involve a multidisciplinary team of investigators using state-of-the-art approaches to elucidate the causes of these disorders in order to improve prevention and treatment. The CND hosts two NIH-funded translational research centers. It is one of only 17 regional research and training centers in the National Institute on Drug Abuse (NIDA)-sponsored Clinical Trials Network (CTN). Through this initiative, MUSC has collaborations with community treatment programs throughout the Southeast with the primary goal of closing the gap between research and treatment. Clinical trials of empirically based substance abuse treatments are conducted in front-line treatment settings with the ultimate goal of enhancing communication/collaboration so that clinical practice is increasingly informed by scientific development. The CND also houses one of only 11 NIH Specialized Centers of Research on Sex and Gender Factors Affecting Women’s Health. The center at MUSC, known as the Women’s Research Center (WRC), forges connections between basic scientists and clinical investigators studying gender-based differences in substance use disorders. Through initiatives such as these, the Clinical Neuroscience Division helps improve the translation of basic science findings into clinical practice, and move best clinical practices into front-line treatment settings. Education, training and research career development are also major activities. Key initiatives include the ACGME-certified Addiction Psychiatry Fellowship Program, an NIH-funded postdoctoral research training program in which basic and clinical scientists train together with a focus on translational research, and the NIH-funded Drug Abuse Research Training program that provides clinical research training and experience within the context of residency training. This newly developed initiative is a model program designed to address the growing shortage of physicians involved in clinical and translational research. In addition, the CND is the home for the NIH-funded faculty scholars program (K–12) focused on career development in translational research in the area of women’s health.
Family Services Research Center
http://www.musc.edu/psychiatry/research/fsrc/abt_fsrc.htmThe overarching purpose of the Family Services Research Center (FSRC), established in 1992, is to increase the effectiveness of the state and nation's mental health and substance abuse services for children, adolescents, and their families. The primary strategies used to further this purpose have been to conduct rigorous research on the development, validation, and dissemination of clinically effective and cost-effective mental health and substance abuse services for youths who present serious clinical problems and their families.
As such, FSRC projects have included numerous community-based randomized trials with challenging clinical populations (e.g., violent and chronic juvenile offenders, youths presenting psychiatric emergencies, substance abusing juvenile offenders, maltreating families, and youths and adults with chronic health problems such as diabetes and HIV infection). In addition, dissemination studies for multisystemic therapy and other evidence-based treatments have been conducted in numerous states of the U.S. as well as in other countries. In recognition of excellence in community service directed at solving community problems, the FSRC has received the Annie E. Casey “Families Count” Award as well as the Points of Light Foundation President's Award.
The FSRC includes 13 faculty and receives approximately $4,000,000 annually in research funding, primarily from the National Institutes of Health.
Geropsychiatry (rev date 10/07)
http://www.musc.edu/psychiatry/research/gero/gero_home.htm
Psychiatric disorders are common in the elderly. It is anticipated that the number of elderly with psychiatric conditions will increase to 15 million by 2030 (up from 4 million in 1970). Currently, the field of geriatric mental health is witnessing an explosion of new information in both the clinical and research arenas. MUSC’s Geropsychiatry Division is charged with developing cutting edge research and generating innovative clinical concepts while being committed to treating a diverse population. Training incorporate both clinical and research perspectives to develop leaders in treatment, translation, and discovery in a variety of psychiatric conditions in the elderly, notably Alzheimer’s disease, geriatric depresson, and psychosis in the elderly. The program includes an ACGME-accredited Geriatric Psychiatry Fellowship Program, clinical research training program, a variety of clinical programs including outpatient and inpatient services, nursing home consulting services, and a clinical research program. Inpatient facilities for Geropsychiatry are provided in the Behavioral Intensive Care Unit (BICU) of the Institute of Psychiatry. This is a 10-bed facility dedicated to providing intensive (24 hr/day) observation with especially designed instruments and state of the art behavioral and pharmacological treatment. Many of the research activities in Geropsychiatry are housed at the Geriatric Psychiatry and Alzheimer’s Clinical Research Program (ARCP) Outpatient Office, located 10 minutes from main campus in the North Charleston area. Conveniently located with easy access from major freeways, this facility has access to more than 40 parking spaces, including parking with full disabled access to accommodate frail elderly people. The facilities consist of more than 4500 ft2 of purpose-designed space (provided through a special private endowment), which displays artwork by local artists suffering from Alzheimer’s disease. The clinical research area has a separate administrative area with a full-time receptionist and accountant. All needed office equipment, such as copy and fax machines, are centrally located and available to all researchers and trainees. The clinical research laboratories have a Dell NT server for real-time continuous backup capability; access to Internet and MUSC information technology is provided by ISDN lines. The clinical research laboratories also have two fully equipped classrooms/ conference room areas with complete audiovisual projection and video equipment and videoconferencing capabilities. In addition to full access to the MUSC library, researchers at ARCP have access to a specialized library on Alzheimer’s disease. The Geropsychiatry and ARCP facilities also include fully equipped exam rooms with direct fiber optic connections to MUSC radiology, cardiology and other clinical services. In addition, the Memory Disorder Clinic, a joint program with the Department of Neurosciences, provides a comprehensive approach to the assessment of patients with memory problems, including a social and functional assessment.
National Crime Victims Center (rev. 10/07)
http://colleges.musc.edu/ncvc/
The National Crime Victims Research and Treatment Center (NCVC) is a division of the Department of Psychiatry & Behavioral Sciences at MUSC. Since 1974 the NCVC faculty and staff have been devoted to achieving a better understanding of the impact of criminal victimization on adults, children, and their families. The activities and contributions of the NCVC faculty to the crime victim and child abuse field have been recognized nationally and internationally. The program activities of the NCVC are focused in four major areas: scientific research, evidence-based treatment, professional education, and consultation. The NCVC faculty includes 12 doctoral-level professionals, whose common interest in traumatic stress provides a solid foundation for building strong research and clinical programs. Each faculty member also maintains unique interests, as reflected in a robust portfolio of grants and contracts from federal sponsors, foundations, and private entities. Current projects focus on bereavement and response to natural and manmade disasters in older adults, risk for mental illness in sexually assaulted adolescents, date-rape and forcible rape, domestic violence, child sexual abuse, child physical abuse, youth violence, and victim assistance and survivorship. The National Crime Victims Research and Treatment Center has opportunities for a year-long internship experience for Ph.D. students in APA-accredited clinical and counseling psychology programs, and postdoctoral training for qualified mental health professionals. The Charleston Consortium Psychology Internship Training Program is a collaborative effort between MUSC and the Psychology Service of the VA Medical Center, supported in part by the Health Resources and Services Administration (HRSA). The postdoctoral fellowship, supported by the National Institute of Mental Health, offers advanced clinical training in cognitive-behavioral and family-based techniques, and advanced research training focused on responses to sexual assault, other violent crimes, natural disaster, urban violence, and other forms of trauma.
Weight Management Center – Psychiatry
http://www.muschealth.com/weight/Information for corporate sponsors at:
http://www.muschealth.com/weight/CorporateResearch/CorporateResearchINTRO.htmThe MUSC Weight Management Center utilizes a team of clinical psychologists, physicians, dietitians and exercise physiologists to offer a wide range of the most current and safe weight management programs, medicines and research advances to serve the varying needs of different people. All patient-oriented programs include a strong emphasis long-term lifestyle changes that are so important for success in the long run. Fundamental approaches include activity changes (exercise), behavioral changes (problematic eating behaviors), cognitive changes (thought patterns), dietary changes (healthy nutrition), and support systems (group and individual sessions). A wide range of research projects funded by federal sponsors and pharmaceutical companies, as well as state-based initiatives such as the South Carolina Nutrition Consortium, support testing of new chemically- and behaviorally-based approaches and allow patients to access the latest developments in weight loss and maintenance in a safe, therapeutic setting. MUSC also offers a comprehensive Weight Loss (Bariatric) Surgery program in conjunction with the Department of Surgery. In this program the Weight Management Center is an integral member of the multidisciplinary team to meet the needs of patients who are candidates for a surgical weight loss option.