Research

Research at Duke Psychiatry---in a Nutshell

 CENTERS AND INSTITUTES

Brain Stimulation and Neurophysiology Center (Drs. Sarah “Holly” Lisanby, Richard Weiner, Andrew Krystal, Angel Peterchev, Bruce Luber) includes  the Brain Stimulation Clinic and Research Program,  the Brain Stimulation Engineering Lab (BSEL), and the Non-Invasive Neuromodulatory Neuroscience (N3) Laboratory.  The Brain Stimulation and Neurophysiology Division uses innovative technologies and tools to investigate brain function and improve mental health, clinical services, and educational activities.  The Center also includes the Duke Insomnia and Sleep Research Program, the Laboratory for Psychiatry Neuroengineering (affiliated with Dr. Miguel NicolelisCenter for Neuroengineering), and the Appelbaum lab. 

Behavioral Medicine Research Center (Drs. James Blumenthal, Frank Keefe, Erin Martinez, Laura Porter, Andrew Sherwood, and Redford Williams) The BMRC is a large research program that examines the interface between psychiatric and behavioral disorders and medical conditions.  Research includes telephone-based coping skills for COPD patients, exercise, depression and cardiac risk, pain distress and mammography use in breast cancer patients, psychosocial factors in bariatric surgery, coping skills training for spinal cord stimulator patients and in patients with heart failure, and genes/environmental stressors as pathways to heart disease.  The Biofeedback and Pain Management group (Dr. Christopher Edwards, Director) focuses on psychosocial and medical factors that influence the manifestation of Sickle Cell Disease, genetic and medical factors in Fibromyalgia, and the manifestation and treatment of chronic pain in diverse and multicultural populations.  Dr. Richard Surwit’s lab is focused the role of stress, depression and personality variables in diabetes mellitus. 

Center for Child and Family Health (Drs. Lisa Amaya-Jackson, Robert A. Murphy and Karen O’Donnell) The Center for Child and Family Health offers preventative, diagnostic and treatment services for children and families affected by or at risk of social, emotional, and behavioral difficulties. CCFH hosts a variety of major local, national and international research projects to better understand child development, chronic stress, traumatic stress, and bereavement.

Center for Child and Family Policy (Dr. Kenneth Dodge, Director) The Center for Child and Family Policy supports major programs of research in early life adversity and child abuse prevention; education policy and analysis; and adolescent problem behavior development and prevention.   See a video about the Center at:  http://www.youtube.com/watch?v=XbKu7bOXpB0&feature=player_embedded

Center for Cognitive Neuroscience (Drs. Alison Adcock, Ahmed Hariri, Kevin Labar, Michael Platt, Mary Waldorf) The Center for Cognitive Neuroscience has served as the central focus at Duke University for research, education, and training in the psychological, computational, and biological mechanisms of higher mental function; variability in these mechanisms among individuals, across the lifespan, and between species; application of these mechanisms to real-world problems; and their dissolution in disease and mental disorders.

Center for Developmental Epidemiology (Drs. Adrian Angold, E. Jane Costello, William Copeland, Michael DeBellis, Helen Egger and Nancy Zucker) The Center for Developmental Epidemiology is working to advance the understanding of the origins, course, and prevention of mental illness across the course of life.  Our longest-running study, the Great Smoky Mountains Study, is a longitudinal assessment of the development of psychiatric and substance abuse disorders and access to mental health care in a representative sample of 1400 children and adolescents living in the southeastern United States. Other studies include the Duke Early Childhood Study and the Preschool Health and Wellbeing Study.

Center for Eating Disorders (Drs.Christian Mauro, Rhonda Merwin and Nancy Zucker) Dr. Zucker’s lab studies individuals who have difficulty detecting, interpreting, and/or using signals from their body and using this information to guide adaptive behavior, particularly in interpersonal contexts. Several conditions are of particular focus due to the presence of profound deficits in interoception or/and integration of internal arousal: anorexia nervosa, a disorder notable for extreme, determined, rigid, and repetitive behaviors promoting malnourishment and the inability to use signals of interoception and proprioception; pediatric binge eating, a model of appetitive dysregulation marked for its early occurrence in the life cycle; and childhood feeding disorders (“picky eaters”), children who evidence early disturbance in the range of foodstuffs they are willing to sample.

Center for Integrative Medicine (Dr. Jeffrey Greeson) Integrative Medicine conducts studies the effect of mindfulness meditation and other integrative medicine approaches on a variety of disorders, including insomnia, stress-related disorders, and cardiovascular disorders.

Center for Neuroscience of Late Life Depression (Drs. Marc Caron, William Wetsel, Miguel Nicolelis), supported by the NIMH, focuses on understanding neurobiological mechanisms of depression in late life using both animal models and human neuroimaging and genetic studies.

Center for Smoking Cessation (Drs. Jed Rose and Ed Levin) works to develop and evaluate new smoking cessation treatments, and to find new applications and combinations of existing treatments. The CSC conducts both human and animal subject studies that probe the mechanisms underlying nicotine addiction and apply this knowledge to further cessation treatments.

Center for Pharmacometabolomics (Dr. Rima Kaddurah-Daouk) is the Coordinating Center for the NIGMS-funded Pharmacometabolomics Research Network, is a collaborative network of over 15 academic centers with the goal of integrating the rapidly evolving science of metabolomics with molecular pharmacology and pharmacogenomics to move toward the creation of a new discipline – “Pharmacometabolomics.”

Center for Spirituality, Theology and Health (Dr. Harold Koenig) The Center for Spirituality, Theology and Health is based in the Duke Center for Aging and focuses on conducting research and training others on spirituality, religion, and health as related to public health and clinical practice.

Duke Center for the Study of Suicide Prevention and Intervention (CSSPI)  (Drs. David Goldston, John Curry, and Karen Wells) Research at CSSPI focuses on understanding the emergence and maintenance of adolescent suicidal and self-harming behaviors, and on the prevention and treatment of suicidal behaviors. Studies have examined the course and risk for suicidal behavior from adolescence through young adulthood, the emotional and behavioral outcomes of high-risk youths, and the impact of adolescent suicidal behavior on parents’ well-being and involvement in youths’ treatment.

Duke Institute for Brain Sciences (Dr. Michael Platt, Director) The Duke Institute for Brain Sciences was created in 2007 as a cross-school, campus-wide, interdisciplinary Institute with a commitment to building an interactive community of brain science research and scholarship. DIBS encourages innovation and collaborations that transcend the boundaries of traditional disciplines, bringing together a diverse community of academics from the biomedical sciences, social sciences, physical sciences, humanities, law, business, public policy, mathematics, computer science and engineering. 

Duke Institute for Brain Sciences is advancing discoveries of brain function by supporting innovative approaches to problems of nervous system function that lie at the boundaries of traditional disciplines.

The four interdisciplinary research themes are:

·         Neurotechnology:  creating and developing new techniques for visualizing and regulating the activity of neural circuits will bring about a better understanding of the normal function of the nervous system and much more effective treatments for neurological and neuropsychiatric disorders.

·         Circuits and Behavior:  further progress in understanding the neural basis for brain functions such as perception, action, and cognition requires deciphering the complex synaptic interactions between identified populations of neurons that constitute functional neural circuits.

·         Brain and Society:  investigators from the School of Medicine, Arts and Sciences, and the Fuqua School of Business are combining their expertise in genetics, behavior, cognition, economics, and neuroscience to illuminate the neural basis of decision-making, communication, social cognition, social behavior, and affective processes in humans and animal models.

·         Neurological and Neuropsychiatric Disorders:  aims to coordinate the efforts of basic science and clinical investigators with a broad range of expertise, from the cellular and molecular aspects of neuronal function to the analysis of cognitive and behavioral performance. DIBS investigators work side by side in multidisciplinary teams that are focused on exploring the neural basis for a particular brain disorder and developing more effective treatment strategies.

 

The Institute for Genome Sciences & Policy (Drs. Redford Williams, Andrew Krystal, Anna Need, Avshalom Caspi, Terrie Moffitt, Ahmad Hariri ) IGSP brings together scientists, engineers, physicians, lawyers, policymakers, business leaders, economists, ethicists, humanists and students to explore the genome, embrace its potential and enrich the human condition.  For example, Dr. Ahmad Hariri uses molecular genetics and neuroimaging methods to identify specific biological pathways that help shape individual differences in temperament and personality as well as related risk for neuropsychiatric disease; his lab also employs pharmacological challenge fMRI paradigms and multimodal PET/fMRI neuroimaging to identify specific molecular mechanisms through which individual differences in behaviorally-relevant brain function emerges. 

 

Mental Illness Research, Education and Clinical Center (MIRECC) at the Durham VAMC.  (Dr. John A. Fairbank, Director, with Drs. Jean Beckham, Christine Marx, Richard Weiner, Rajendra Morey, Scott D. Moore, Patrick Calhoun ) MIRECCs were established by Congress with the goal of researching the causes and treatments of mental disorders and using education to put new knowledge into routine clinical practice in the VA.  The Mid-Atlantic MIRECC at the Durham VAMC is organized as a translational medicine center in which the overarching goal is the clinical assessment and treatment of post-deployment mental illness and related problems, and the development of novel mental health interventions through basic and clinical research. This MIRECC aims: (1) To determine whether early intervention in post-deployment mental health is effective in forestalling the development or decreasing the severity of post deployment mental illness, (2) To determine what neuroimaging, genetic, neurocognitive, or other characteristics predict the development of post-deployment mental illness, and (3) To assess the longitudinal course of post-deployment mental illness.

 

RESEARCH PROGRAMS

Addictions  (Drs. Ashwin Patkar, Tong Lee, Scott Swartzwelder, Amir Rezvani, Herb Covington) The Duke Addictions Program offers an integrated, comprehensive approach to substance abuse therapy for people of all ages who are dependent upon alcohol and/or drugs, including nicotine.  See Dr. Patkar at http://www.youtube.com/watch?v=wZOzg_tLlHA&feature=plcp.  Ongoing research includes pharmacological interventions for alcohol and opioid dependence.   Dr. Tong Lee investigates neurobiological alterations that may underlie chronic psychostimulant abuse in humans. These preclinical findings, in turn, are used to develop targeted strategies for the treatment of chronic psychostimulant abusers.    Dr. Scott Swartzwelder is particularly interested in adolescence as a developmental period of significance, both neurologically and psycho-socially with respect to the initiation of, and sensitivity to, drug use.  He uses single-cell neurophysiology, network neurophysiology, animal behavior, and human studies to address these issues.  Dr. Herb Covington studies the behavioral and neural consequences of social stress in rodent models of depression and addiction, utilizing such methods as in-vivo optogenetics, virally-mediated gene manipulations and intra-cranial drug deliveries, in brain areas important for emotional processing and decision making.

Anxiety and Traumatic Stress (Dr. Raj Morey, Christine Marx, David C. Rubin).  Dr. Raj Morey studies brain changes in posttraumatic stress disorder (PTSD). He’s interested in the role fear, threat, guilt and other emotions along with their interaction with cognitive functions such as working memory, attention, and episodic memory in PTSD. Functional MRI employing cognitive challenge tasks, pharmacological challenges, emotion regulation strategies, as well as structural MRI, candidate gene, genome wide association studies, and gene expression are converging methodologies for understanding mechanisms of PTSD.  Dr. Christine Marx studies neurosteroids and their relevance to the neurobiology and therapeutics of psychiatric and neurological disorders - including schizophrenia, PTSD, traumatic brain injury, smoking cessation, and Alzheimer's disease. Investigations range from studies in rodent models of PTSD to proof-of-concept randomized controlled trials investigating neurosteroids as pharmacological interventions.  Dr. David Rubin studies long-term memory for real world events in PTSD and its neural basis with brain imaging and behavioral studies.  Dr. Michael DeBellis directs the Developmental Traumatology Research Center, which studies the causes and consequences of maltreatment on brain development.  Active studies include 1) Factors Influencing Childhood Brain Development, 2) Life Events and Childhood Brain Development, and 3) Treatment of Pediatric Posttraumatic Stress Disorder.

Attention-Deficit/Hyperactivity Disorder (ADHD) Program (Dr. Scott Kollins). This program provides comprehensive diagnostic evaluations for children, adolescents and adults, including psycho-educational testing for learning disorders.  Dr. Kollins’ lab studies the neuropsychopharmacology of Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents and adults over a wide range of areas, including molecular genetics, neuroimaging, and clinical trials, with a particular focus on understanding the comorbidity between ADHD and smoking/nicotine dependence.

Child and Adolescent Anxiety Program (Drs. Helen Egger and John March) includes research focusing on functional imaging of early childhood anxiety disorders, as well as pharmacological and behavioral interventions.  Dr. March directs the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), which follows the sample of children and adolescents (N=488) with anxiety disorders that participated in the successful multi-site collaboration of the Child/Adolescent Anxiety Multi-modal Study (CAMS). CAMELS examines the long-term psychiatric, physical, and functional outcomes of youth with anxiety disorders who were randomized to one of four treatment conditions (i.e., cognitive behavioral therapy (CBT), sertraline (SRT), pill placebo, or combined CBT + SRT to inform the field about the preventive effects of successful treatment (both psychosocial and medication) on the development of later psychopathology and treatment durability.  Hear a talk by Dr. March at: http://www.youtube.com/watch?v=zF3C2-mIsMA&feature=relmfu

Cognitive-Behavioral Research and Treatment Program (Drs. Moria Smoski, Zach Rosenthal) The CBRTP and the Sensory Processing and Emotion Regulation Program aim to improve treatments for some of the more-difficult-to-treat psychiatric problems, including borderline personality disorder and major depression.  Investigations include questions such as:  1) what types of digital media can be best used to help people regulate their emotions when emotionally distressed?  2) can virtual reality and cell phones be used to directly train new coping in response to triggers for cocaine use?  3) what can neuroimaging reveal about brain mechanisms underlying the dysregulation of arousal and emotion?

Electroconvulsive Therapy Program (Drs. Richard Weiner, Sarah H. Lisanby).  Duke’s ECT Program is a world leader in providing this state-of-the-art therapy to people 18 and older.  The program provides a full range of diagnostic, consultative, evaluative, clinical, and case management services.  Ongoing research includes optimizing maintenance treatments in ECT, in outcomes of elderly depressed patients treated with ECT, and comparing ECT with magnetic seizure therapy.

Evidence-based Practice Implementation Center (EPIC) (Dr. Lisa Amaya-Jackson, Director) EPIC is dedicated to closing the gap between research and practice. Duke EPIC offers comprehensive guidance, training, and support to organizations and systems that wish to provide and sustain the most effective interventions to the populations they serve. EPIC uses face-to-face and web-based training platforms, adult learning principles, and small tests of change (STOCs) to help partners implement and monitor evidence-based therapies and practices in an effective, sustainable way.  Major projects have focused on community dissemination of trauma-focused therapies for children.

Dementia:  Program in Epidemiology of Dementia (Dr. Brenda Plassman) conducts research on the prevalence and incidence of dementia, along with the genetic and non-genetic causes of cognitive decline and dementia.  Currently, there are two principal studies in the program, the Duke Twins Study of Memory in Aging and the Aging, Demographics, and Memory Study (ADAMS).  The research aims to discover new information about memory and the aging process.

Geriatric Epidemiology (Dr. Dan Blazer, Director) Psychiatric geriatric epidemiology of late life psychiatric disorders has a long and distinguished history at Duke. The studies began with two longitudinal panels initiated during the 1950s focused upon normal functioning in later life, providing a baseline for understanding mental health conditions in the elderly. These studies were followed by the Older Americans Resources and Services study begun in the 1970s and then the Epidemiologic Catchment Area (ECA) Study funded in 1981 and the Established Populations for the Study of the Elderly (EPESE) project initially funded in 1984. Through a combination of these base community studies (later supplemented by many others, such as the Cache County Study) coupled with secondary analysis of many other studies, Duke established itself as a national leader in geriatric epidemiology.  Currently, Dr. Gerda Fillenbaum is working to improve diagnostic distinctions among the dementias, to develop computer-based assessments suitable for epidemiological surveys, and tools to assess the functional status of the elderly by illiterate informants.

Geriatric Mood Disorders and Cognitive Neuroscience Research Program (Drs. John Beyer, Moria Smoski, Martha Payne, Guy Potter, and Lihong Wang).  GEMCOG is a group of researchers examining mood and cognitive outcomes of late life depression using structural and functional imaging, genetics, and nutritional assessment methods.  Specific areas of research include cognitive control of emotional response, unipolar and bipolar depression, attentional control in depression, calcium intake and processing and cerebrovascular disease in depression, and genetic correlates of brain changes.

Global Mental Health (Drs. Julie Adams, Kristen Shirey, Brandon Kohrt, Christina Meade, Kathleen J. Sikkema, Karen O’Donnell)  Global Health investigators are engaged in studies that reflect the diversity of Duke researchers and range from clinical research to large population based studies, from South Africa to South Asia, and are active in cross-disciplinary and cross-campus collaborations, with strong ties to both the Duke Global Health Institute and the Center for Health Policy & Inequalities Research, among others.   For example, Dr. Sikkema is currently involved in three South African studies, one to evaluate the effectiveness of a family-based intervention to increase resiliency among children with HIV-positive mothers, another to develop a risk reduction intervention for adolescents in biomedical prevention trials, and a multimethod, multilevel longitudinal study of innovative intervention approaches related to gender and alcohol use.

Health Behavior Neuroscience Research Program (Dr. Joseph McClernon, Director) The Duke HBNRP investigates the neural basis of behaviors that affect human health (e.g., addiction, nutrition, exercise) through the use of psychology, neuroscience and behavioral pharmacology theory and techniques. It is our hope that the results of our investigations will ultimately lead to more effective treatments for addiction and obesity.

Insomnia and Sleep Research Program (DISRP, Drs. Andrew Krystal and Xavier Preud’homme) is a leading center for sleep research and for the clinical treatment of patients with sleep disorders. The DISRP is dedicated to carrying out research to better understand the functions of normal sleep, to delineate the mechanisms of sleep disorders and to develop better treatments for sleep disorders. The primary areas of research carried out in the DISRP include: behavioral and pharmacologic treatment of insomnia, validating insomnia diagnostic systems, the treatment of narcolepsy, the treatment of patients with daytime sleepiness due to obstructive sleep apnea, the treatment of insomnia in patients with fibromyalgia, the treatment of insomnia patients with chronic fatigue syndrome, the treatment of insomnia in patients with chronic low back pain, and the pathophysiology of nocturia.

Memory (R. Alison Adcock) Dr. R. Alison Adcock explores the intersection between motivation, emotion, and memory. She seeks to understand how internal states like excitement, desire, and craving shape long-term memory, giving some experiences more power than others to affect future behavior.  Dr. Adcock’s lab studies brain systems that release modulatory neurotransmitters, environmental stimuli that turn them on, their effects on plasticity in other brain regions, and our ability to control them.   Hear her talk about memory “If I could take good advice, I wouldn’t need a prescription” at:   http://www.youtube.com/watch?v=oB8xgfHLPXY

Mindfulness, Stress and Health Lab (Dr. Jeffrey Greeson, Director) The MSH lab investigates the health benefits of mindfulness and conducts studies of Mindfulness-Based Stress Reduction.

Neurobehavioral Pharmacology Program (Dr. Ed Levin, Director) The Levin Lab investigates the neurobehavioral bases of cognitive, emotional and addictive function in rat, mouse and zebrafish models, with a focus on understanding the functional interactions of cholinergic systems with brain stem monoaminergic projections to the limbic system, cortex and thalamus, with recent forays into analysis of GABA/glutamate interactions as well.

Neuropsychocardiology Research Program (Dr. Wei “Jan” Jiang, Director).  The Neuropsychocardiology Program investigates the interaction between the mind and the cardiovascular system to identify means of reducing the adverse effects of mental illness on patients with cardiovascular disease and to extend the understanding of how the mind interacts with the human body.

Psychophysiology Lab (Dr. James Lane, Director) The Psychophysiology Lab has investigated many aspects of behavioral medicine over the past 30 years, including topics in caffeine pharmacology and psychophysiology, nicotine and smoking behavior, diabetes behavioral medicine, stress reactivity and type a behavior, psychophysiological methodology, complementary / alternative medicine, and antioxidants and oxidative stress.

Schizophrenia Research Group (Drs. Richard Keefe, Alison Adcock, Marc Caron, David Goldstein, Ranga Krishnan, Christine Marx, Ashwin Patkar, Marvin Swartz, Joseph McEvoy, Jeffrey Swanson and William Wetsel).  The Duke Schizophrenia Research Group is a collaborative of basic and clinical scientists dedicated to understanding the mechanisms of cognitive deficits in patients with schizophrenia and their treatment.  The group employs a variety of tools to help enhance the detection of a cognitive signal, such as functional and structural imaging, pharmacogenetics, cognitive neuroscience tasks, and metabolomics.  The group includes basic scientists whose work is devoted to translational research on the pharmacology of cognition and its relation to cognitive disorders in humans.  Patient populations are drawn from across the Duke and University of North Carolina Health Systems, and the Singapore Institute of Mental Health, the largest provider of mental health care in Singapore.  Dr. Joseph McEvoy’s group currently is conducting clinical trials comparing long-acting injected antipsychotic medications, examining the usefulness of added minocycline in patients with incomplete therapeutic response to clozapine, examining the effects of metformin and fish oil in mitigating the weight gain and metabolic effects associated with clozapine treatment, comparing once- versus twice-daily asenapine for acute psychotic exacerbations, and testing the utility of novel compounds on persistent negative, positive, and cognitive deficits in schizophrenia.

Services Effectiveness Research Program (Drs. Barbara Burns, Jeffrey Swanson and Marvin Swartz).
The
Services Effectiveness Research Program (SERP) conducts research in:   1) Treatment Effectiveness  - Evaluating the effectiveness of treatment modalities in 'real world' clinical settings to improve outcomes for children and adolescents with serious emotional disorders and adults with severe mental illnesses,  2) Mental Health Services/Policy - Examining the complex interaction between healthcare policy and psychiatric services and its effect on access to care, quality of care, treatment outcome, and financial cost when treating at-risk clinical populations,  3) Law and Mental Health - Investigating the impact of the legal system on treatment outcome of persons with severe mental illness and the risk and protective factors mediating the relationship between violence and mental disorder, and 4) Intervention /Dissemination /Training - Transferring clinical technology into clinical practice by training mental health professionals to utilize evidence-based practices and training empirical investigators in mental health services research.

Traumatic Brain Injury (Drs. Sean Acheson, Rajendra Morey, Bruce Capehart) Dr. Sean Acheson studies potential pharmacotherapies for TBI and the basic underlying mechanisms of recovery of function following acquired brain injury.  Dr. Raj Morey studies changes in mild traumatic brain injury using diffusion and structural imaging to better understand the role of clinical symptoms and mechanism of injury.

Virtual Reality (Dr. Kevin Labar) Return of fear following cognitive behavioral therapy is problematic for the treatment of anxiety. Specifically, cessation of anxiety appears to be specific to the context in which therapeutic intervention is conducted. The goal of this fear conditioning research is to better understand how the environmental context influences fear memory recall. The Duke Immersive Virtual Environment DiVE is used to provide three different fully immersive virtual environments in which healthy participants undergo fear acquisition, fear extinction, and finally fear renewal testing.

 

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