Research

Research training for residents is an important component of training at HSS. All residents are expected to become savvy consumers of research, expert at assessing the rapidly expanding body of science that underpins our clinical practice. For those who have as a career goal going beyond “scientific literacy” to explore the possibilities of a research career, the Resident Pathways to Research provides a graded introduction to research skills under the guidance of a mentor. For all residents the opportunity exists for mentor-guided scholarly work as an elective.

HSS draws on the resources of both Harvard University and the Department of Veterans Affairs to provide unparalleled options for resident research career development.

Mental Health Research at Harvard Medical School

HSS residents have access to a remarkable array of scholars, teachers, and researchers at Harvard Medical School, including and beyond the Department of Psychiatry. Links that may be of interest to provide a sense of the breadth, depth, and opportunities in the Harvard research community include:

Mental Health Research and the Department of Veterans Affairs

Research and education are two of the core missions of the VA nationally. This is reflected in extensive support for residency training, and a wide variety of opportunities for research funding at all levels of career development, from fellowship through senior faculty status. The portfolio of VA research spans basic neurobiology to health services research and dissemination to ensure maximal public health impact of new treatments. Throughout the US, major medical schools have affiliated with VA medical centers to develop unparalleled academic partnerships; in fact, approximately 3 of 4 US medical graduates have trained in VA medical centers. The VA Boston Healthcare System (VABHS) , is one of the largest VA medical centers in the US. VHBHS, trains over 1,000 residents per year in various disciplines and over 2,700 total trainees per year. Importantly for career development, the VA nationally provides a funding stream in parallel to that of the National Institutes of Mental Health that is open to VA trainees and researchers. Of particular interest to residents and medical students are these links:

VABHS-Based National Centers of Excellence:

This National Center of Excellence of the VA Health Services Research and Development Service (HSR&D) focuses on three areas of research: innovative management practices that promote quality of care; management practices that effectively implement organizational change, particularly change involving evidence-based clinical practices; and the development and role of leadership in health care organizations.

Geriatric Research, Education and Clinical Center (GRECC)

This National Center of Excellence is the home of research and education programs that span molecular to psychosocial aspects of aging. Areas of particular relevance to mental health include cognition and neuropsychological aspects of memory failure, functional assessment, impact of comorbidity on outcome in Alzheimer’s disease, and health policy.

The Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC)

The VA Cooperative Studies Program (CSP) is the Division of VA Research and Development responsible for the planning and conduct of large multicenter clinical trials and epidemiologic studies in the Department of Veterans Affairs. CSP established the MAVERIC in 1997 as a National Center of Excellence, one of three epidemiological research centers (ERICs) within the VA that conducts observational, population-based research. MAVERIC’s mission is to improve the health of veterans and enhance health care delivery in the Veterans Health Administration (VHA) by promoting the conduct of VA-based population research relevant to the needs of veterans; facilitating the transfer of vital epidemiological information to VHA providers and administrators; and educating the next generation of population researchers. In addition, MAVERIC has supported and participated in several national and local educational activities to develop clinical and scientific researchers practicing in their field.

National Center for Post-Traumatic Stress Disorder

The VA’s National Center for PTSD consists of seven divisions across the country, of which two are headquartered at VA Boston Healthcare System (VABHS): the Behavioral Science Division and the Women’s Health Sciences Division The Behavioral Science Division, directed by Terry Keane, Ph.D., specializes in development and testing of treatment interventions for use with various trauma-exposed populations; longitudinal studies of people after exposure to trauma; psychophysiology, information processing and basic mechanisms of PTSD; and development of assessment instruments. The Women’s Health Science Division focuses on the special issues of women and PTSD, and especially on effective treatments. The Division has pioneered research on the psychological impact of military service on women veterans. Such initiatives include development of psychological assessment techniques, studying the impact of sexual assault and military sexual trauma, and determining the effect of PTSD on women’s health and medical problems. There is also a major focus on treatment dissemination and training.

Mental Health Services Research in the VA Boston Healthcare System (selected programs)

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Mental health research spans the Brockton, Jamaica Plain, and West Roxbury Campuses of the VA Boston Healthcare System (VABHS), each of which provides opportunities for resident research experience Mental health research comprises a broad range of areas ranging from basic neurobiology to health services research. These areas of research are well-funded through the VA and NIH, with more than $25 million in peer-reviewed, competitive awards. Several VA National Centers of Excellence are housed at VABHS, including centers for PTSD, geriatrics, schizophrenia, epidemiology, and organizational research. A sample of these research programs and centers follows.

Schizophrenia Center

Dr. McCarley directs an extensive multidisciplinary research center in schizophrenia. The goal of the clinical neuroscience lab and schizophrenia research is to understand brain structure and function in schizophrenia by using the most advanced neuroimaging techniques (i.e., event related potentials, computer assisted tomography, structural magnetic resonance imaging (MRI), functional magnetic resonance imaging, and diffusion tensor imaging).

Dr. Margaret Niznikiewicz, Associate Professor, is director of the Brockton Cognitive Neuroscience Laboratory and directs the work in electrophysiology. Dr. Kevin Spencer, Associate Professor, has a special interest in abnormalities of gamma band EEG oscillations in schizophrenia. Dr. Jim Levitt, Associate Professor, has a special interest in neuroimaging of the basal ganglia and teaches a neuroscience course for the PGY II and III residents, which Dr. McCarley co-teaches. Dr. Chandlee Dickey, Assistant Professor, has a special interest in neuroimaging of the schizophrenia spectrum disorder, schizotypal personality disorder. Dr. Ron Gurrera, Associate Professor, has a special interest in the neurobiological basis of personality function in schizophrenia spectrum disorders, and is also a recognized expert in neuroleptic malignant syndrome.

Psychiatric Neuroimaging Laboratory

Dr. Martha Shenton, Schizophrenia Center Co-Director and Professor, is also the director of the Psychiatric Neuorimaging Laboratory (PNL), which represents a collaboration between researchers at VABHS and Brigham & Women’s/ Faulkner Healthcare System. The PNL is one of the world’s leading neuroimaging centers, especially in diffusion tensor imaging.

Basic Neuroscience Research on Addictions and Serious Mental Illness

Dr. Gary Kaplan, Professor and Director of Mental Health, Boston University, at VABHS, directs both animal and clinical research focusing on the neurobiology of addictions and the treatment of serious mental illness, especially schizophrenia and PTSD. For example, Dr. Kaplan’s animal work focuses on the neurobiology of reward mechanisms in mice, while a clinical project linked with the Schizophrenia Center studies the effect of medication intervention in schizophrenics who smoke, and another investigates the implementation of evidence-based psychosocial interventions on outcome.

Health Services Research in Serious Mental Illness

Dr. Mark Bauer maintains an active research program in developing and disseminating treatments for the seriously mentally ill, particularly individuals with bipolar disorder. His work, involving nationwide networks of clinicians and researchers, has established that programs that reorganize care systems and enhance illness self-management skills for individuals with severe bipolar disorder can improve clinical outcome and function at little to no cost. Additional intervention trials have demonstrated that the principles underlying these specific interventions are robust and adaptable. Dissemination studies are underway to implement these interventions in general clinical practice both within and outside of the VA. He also serves as Associate Director for the VA Center of Excellence, The Center for Organization, Leadership and Management Research (COLMR) and directs COLMR’s Post-Doctoral Health Services Research Fellowship Program for Physicians. He also directs the A National Bipolar Disorders Telehealth Program.

Evidence-Based Mental Health Treatment

Dr. David Osser, Associate Professor and Director of the Psychopharmacology Algorithm Project based at HSS has an international reputation as a developer of algorithms for medication treatment of psychiatric disorders. He has been consulted internationally for assistance in developing treatment guidelines, most recently in China. He teaches psychopharmacology courses for PGY I – IV residents and has collaborated with many HSS residents on scholarly work presenting and updating psychopharmacology algorithms.

Basic Neuroscience Research on Sleep

The basic neuroscience lab, also directed by Dr. McCarley, has focused on how the brain controls behavior, especially that of sleep and wakefulness. The rapid eye movement (REM) sleep phase is present in all mammals and is of special interest to psychology and psychiatry because of its relationship to dreaming and to mood disorder. This lab has been important in discovery of its brainstem control mechanisms, both its promotion by the reticular and cholinergic activity and its inhibition by aminergic activity.

Dr. Radhika Basheer, Associate Professor, has been investigating how the second messenger and molecular consequences of elevated adenosine may be useful in explaining “sleep debt”, the long-term consequences of sleep restriction/deprivation. An intracellular cascade, triggered by adenosine acting at the A1 receptor, leads to increased adenosine A1 receptor production, further enhancing adenosine’s sleep promoting effects. Dr. Robert Strecker, Associate Professor, has recently developed an animal model of the consequences of sleep apnea, both sleep interruption and intermittent hypoxia, and is developing behavioral methods for measuring the cognitive effects of sleep loss in animal models. Dr. Ritchie Brown, Assistant Professor, is studying the neurophysiological mechanisms by which the neuropeptide orexin acts to control REM sleep and wakefulness, as well as basal forebrain mechanisms of sleep wake control; his in vitro work uses a genetically altered mouse that has GABAergic neurons that can be easily identified through their expression of a green fluorescent protein.

Dr. Brown teaches neuroscience to HSS residents, including one-on one teaching of core concepts in neuroscience.

Substance Abuse Research

Substance abuse research, under the direction of Professor Timothy O’Farrell, is internationally known for its studies in the treatment of substance abuse, including an innovative behavioral couples therapy (BCT) approach. This specialized form of substance abuse counseling developed by O’Farrell and colleagues to support the patent’s abstinence and improve relationship functioning. Studies by O’Farrell and colleagues show that BCT produces greater abstinence, happier relationships, fewer separations, and greater reductions in social costs, domestic violence, and emotional problems of the couple’s children than typical individual-based treatment. BCT also improves compliance with recovery-related medications, including disulfiram for alcoholism and naltrexone for alcoholism and for opioid addiction. Virtually all recent reviews of research on psychosocial treatments for alcoholism and drug abuse cite BCT as an empirically supported method for treating alcoholism and drug abuse.

Family process research by Dr. O’Farrell has targeted domestic violence, expressed emotion, and other processes. Dr. O’Farrell showed for the first time that domestic violence is reduced after treatment for alcoholism; in fact, violence is almost nonexistent among those alcoholics who remain abstinent after treatment. These findings led to ongoing research examining the natural history and explanatory models of domestic violence among men and women with alcoholism. He also showed for the first time that spouses’ negative expressed emotion (mainly high levels of criticism) predicts subsequent relapse among alcoholics as it does in schizophrenia, mood and eating disorders. Other work has examined marital and sexual adjustment among substance abusing patients and the adjustment of the children in these families.

Geriatrics: Decisional Capacity

Another important area of clinical research is flourishing under the guidance of Dr. Jennifer Moye, Associate Professor. She and her group have been funded to study current methods of assessing treatment decisional capacity, its neuropsychological correlates, and how it is affected by dementia and major psychiatric disorders. A current focus of their work is the development of a more reliable structured assessment procedure.

Vertically-Integrated Translational Research in PTSD

Directed by Ann Rasmusson, M.D., this research program, in conjunction with the National Center for PTSD, investigates the neurobiological substrates, psychophysiology, and neuroimaging of PTSD, with a specific focus on integrating these lines of research vertically within the patients and studies. For example, one study assesses levels of GABAergic as well as glutamatergic neurotransmitters and neuroactive steroids in the CSF and plasma of women (across the menstrual cycle) and men with PTSD. Another study investigates the relationship between these excitatory/inhibitory neurotransmitters and neuromodulators and brain excitatory/inhibitory tone using transcranial magnetic stimulation.