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by Simone Macri, Ph.D.,
2007 NARSAD Young Investigator
Sect. Behavioural Neuroscience, Istituto Superiore di Sanità, Rome, Italy
Stress during development has often been regarded as a potentially disruptive force, capable of inducing disease states if overly prolonged or exceedingly intense. It can also, however, favor resiliency and adaptive processing that are crucial to navigating a human life.
Countless studies have indicated that severe neglect during infancy, both in humans and in laboratory animals, results in long-term abnormal development of biological systems involved in the regulation of emotions. Although this view has fostered considerable theoretical advancements (e.g., the understanding of the fundamental causes of emotional disturbances) and practical improvements (design of experimental models of human disorders), it neglects the functional role played by the stress response system in regulating individual attunement and response to specific environments.
Along with other colleagues, such as Marco Del Giudice, Bruce Ellis and Elizabeth Shirtcliff, I also regard the response to stress as a key driver to individual development. The biological system responsible for physical reactions to a stressor not only coordinates immediate responses to external challenges but also functions as a tool that enables the characterization of an environment as favorable or threatening. Thus—under the assumption that environmental cues encountered early in development predict the challenges the adult individual will face in characterizing the context of different environments—the stress response system promotes long-term adaptive processes that prepare the individual to cope with specific external challenges.
Karen Parker and Dario Maestripieri cogently clarified this view that, in analogy with vaccination, has been termed “stress inoculation theory”. Whilst the fundamental mechanisms linking severe neonatal stress with psychiatric disturbances have been detailed, the potentially positive effects exerted by mild forms of developmental stress have been far less characterized. A recent Special Issue in Neuroscience & Biobehavioral Reviews (partly supported by a NARSAD Grant) attempted to bridge this gap and to clarify the link between developmental stress and adaptive plasticity.
These studies summarize scientific evidence that support the hypothesis that moderate challenges encountered during the early stages of life may ‘prepare’ the individual to cope with future stressors, thus building resiliency. Within this framework, pathological outcomes may occur either as a consequence of extreme stressors exceeding individual adaptive capacities (e.g., infantile neglect or childhood abuse) or under conditions in which the early environmental cues fail to adequately predict the environment the adult lives in. This view may disclose important avenues in the study of human pathologies whereby it offers a novel theoretical framework against which experimental models can be designed.
by Matthew M. Kurtz, PhD
NARSAD Young Investigator Grantee
“This study would likely never have occurred without the support of the Brain & Behavior Research Foundation”
We know that there are large differences in outcome between people with schizophrenia, and there is evidence that these differences may be related to differences in cognitive skills such as the ability to pay attention, concentrate, remember things and solve problems. Furthermore, individuals with impaired cognitive skills linked to the illness often show less of an ability to benefit from psychosocial interventions designed for them. Thus, we have been running a study to investigate whether improving cognitive skill with a new behavioral intervention, called cognitive remediation, translates into better benefit from well-established psychosocial interventions and ultimately better outcomes for people with the illness.
Over the past four years, with the support of a NARSAD Young Investigator Grant, Bruce Wexler at Yale University, Kim Mueser at Boston University and I have been investigating the use of cognitive remediation, a novel intervention for cognitive impairment in schizophrenia and for increasing benefit from social skills training, a well-established psychosocial treatment for improving social function in people with schizophrenia. Cognitive remediation, which is a class of interventions designed to improve cognitive skills typically through the use of strategy training or repeated task practice, has shown strong efficacy in over 40 randomized, controlled trials. Social skills training has a longer history of research, also has a strong evidence base and produces real changes in social functioning both measured in role-plays and, much more importantly, in measures of community integration. In fact it is recommended regularly by panels of schizophrenia treatment experts in the U.S. and in other countries as a key treatment for schizophrenia (e.g. PORT guidelines, 2010).
To date we have enrolled 68 people with diagnoses of schizophrenia and/or schizoaffective disorder in the study. The results to date are very promising with ratings of social function showing greater improvement when social skills training is paired with cognitive remediation as compared to when social skills training is offered to individuals without cognitive remediation. These results are preliminary, and could change as the sample gets larger, but the results are exciting to us. They suggest the potential value of meshing different psychosocial treatments aimed at different aspects of illness-related disability for more optimal outcomes in the disease. This is a study which would likely never have occurred without the support of the Brain & Behavior Research Foundation.
by Herbert Pardes, M.D.
President, Brain & Behavior Research Foundation Scientific Council,
Executive Vice Chairman of the Board of Trustees of NewYork–Presbyterian Hospital,
As the President of the Foundation Scientific Council, I want to express my pride and gratitude as the Foundation celebrates its 25th Anniversary. It’s astounding to me that a set of conversations which began 25 years ago considering whether we would pay out the first $50,000 in NARSAD Grants has led to a program that has supported psychiatric research to the tune of close to $300 million for thousands of NARSAD Grants around the world. This investment has had a powerful influence on the psychiatric field and helped advance our understanding of and treatments for brain and behavior disorders.
I continue to volunteer my time as President of the Foundation Scientific Council because mental health has been an important part of my career and life. I became fascinated with psychiatry in my college and medical school days. I’ve done virtually every kind of psychiatry – individual, psychotherapy, psychoanalysis, hospital care, pharmacotherapy, outpatient care, and adolescent inpatient care over the years. I feel deeply troubled by families whose lives are made miserable by these illnesses and I want to make them better. All of us, myself included, have had people in our families who have had psychiatric illness; anything we can do to eliminate the likelihood or get them better treatments represents a wonderful mission.
Can we imagine seeing a world without mental illness in the very near future? That seems like quite a stretch. But to say that’s our ultimate aim, that we want to get rid of illnesses that affect so many people, that’s right on target. We certainly have made significant progress in treating mental illness in comparison to 100 years ago, when there was little if any treatment – and it’s getting demonstrably better step by step. It excites me to think of what will come from research in the next 25 years, and how it will change the world.
Carol A. Tamminga, M.D.
Prizewinner, Lieber Prize for Schizophrenia Research
NARSAD Distinguished Investigator Grantee
Professor and Chairman, University of Texas at Southwestern Medical Center at Dallas
As the Brain & Behavior Research Foundation celebrates 25 Years of Discovery to Recovery, it seems fitting to share a video of a presentation given by Carol A. Tamminga, M.D., the most recent winner of the Lieber Prize for Schizophrenia Research. The Lieber Prize has been given annually since the inception of the Foundation in 1987, for recognition of a research scientist who has made distinguished contributions to the understanding of schizophrenia.
In Dr. Tamminga’s fascinating presentation, she discusses her latest NARSAD Grant-funded schizophrenia research on psychosis pertaining to learning and memory. She also discusses the history of the Prize, her long and illustrious career and relationship with the Foundation, and various historical depictions of psychosis from the 1700s to the present.
This presentation was given in October 2011 at the Brain & Behavior Research Foundation 23rd Annual New York City Mental Health Research Symposium:
by Toby Serrouya
Paralegal, Mother, Donor – Brain & Behavior Research Foundation
Alan began to exhibit signs of obsessive behavior in junior high school. In high school, though he was in all honors classes in a very advanced private school, had trouble completing his assignments on time and being ready to go anywhere on time. The car pool was always waiting for him!
But it was when he was a sophomore at Yeshiva University that things took a dark turn. Alan began to sleep all day, not go to classes, and he even stopped eating. We received calls from his friends in the dorm telling us that something was very wrong with him. We took him out of school for a long Thanksgiving recess break and had an evaluation done by the Chief of Psychiatry at St. Barnabas Hospital in Livingston, NJ. It was there Alan was diagnosed with bipolar disorder. The doctor advised us to take Alan out of school with a leave of absence, and have him begin therapy immediately. I didn’t realize it at the time, but there were no medications that existed that could help him in the long-term. There is still much work to be done in terms of research breakthroughs and medications. It was only after Alan’s death that I learned how low a priority fund-raising is for mental illness – it is the “step child” of all fund-raising endeavors, even at the Congressional level.
So I decided to organize my own annual fundraiser, A Walk for a Cure, back in May 2001, and looked around for an organization to donate funds to. A good friend of mine, Janet Reckenbeil, gave me a NY Times clipping of a wonderful article that talked about the Brain & Behavior Research Foundation (then called NARSAD), and the rest is history.
The psychiatrist wanted to put Alan on medication ─ Alan fought it for a long while, but finally agreed. We quickly learned that until the right combination was found, each medication could exacerbate the symptoms it was meant to alleviate. We finally found an effective combination with lithium as the catalyst.
Lithium enabled Alan to return to college, read and focus again, and ultimately graduate, going on to get a great job. Unfortunately, this medication began to attack his kidneys and he had to be taken off of it. His doctor was never able to find an adequate substitute.
Because people often mask the signs of mental illness, some of my friends thought Alan was faking it and that I was spoiling him, and even refused to accept his diagnosis. It wasn’t until Alan died that those around him accepted the truth.
One devastating night in 2000, the police department called and gave us the news every parent dreads: that our son had been in a terrible accident, and to come to the police department as soon as possible. On the ride to the police department, I kept asking why we weren’t going to the hospital, but I soon learned why. My beautiful private school-educated son had jumped to his death from the roof of his apartment building. He was just 27 and a half years old.
Once I returned to work after a period of mourning, my colleagues greeted me and told me that they were going to help me heal ─ and they did! Part of my healing process after Alan died was to take their suggestion to write a book. The solitary, healing exercise brought back happy memories of raising Alan, which had been eclipsed by all the years of his illness. I wrote the dedication “in loving memory to my son Alan who always wanted to do the right thing and have all of those whom he knew and loved do the right thing as well.”
People still view mental illness as something that only the homeless or criminals have. The only way to change this is to share stories of people like my son, and to let others know that mental illness can strike anyone – your mother, your sister, your best friend, your son. That’s why I want to keep fighting and tell others to keep fighting mental illness, and keep raising money for the wonderful research that is funded by NARSAD Grants.