Bridging bench and practice: translational research for schizophrenia and other psychotic disorders

A Second Wave for the Neurokinin Tac2 Pathway in Brain Research

Despite promising advances in basic research of the neurokinin B/Tac2 pathway in both animals and humans, clinical applications are yet to be implemented. This is likely because of our limited understanding of the action of the pathway in the brain. While this system controls neuronal activity in multiple regions, the precise impact of Tac2-induced cellular responses on behavior remains unclear. Recently, elegant studies revealed a key contribution to stress-related behaviors and memory. Here, we discuss the crucial importance of bridging the gap between the Tac2 pathway's involvement in cell physiology and cognition to comprehend its role in health and disease. We propose that a better understanding of the Tac2 pathway in the brain could provide an essential perspective for basic investigations, which in turn will feed clinical research.

Mapping the evolving definitions of translational research

OBJECTIVE

Systematic review and analysis of definitions of translational research.

MATERIALS AND METHODS

The final corpus was comprised of 33 papers, each read by at least 2 reviewers. Definitions were mapped to a common set of research processes for presentation and analysis. Influence of papers and definitions was further evaluated using citation analysis and agglomerative clustering.

RESULTS

All definitions were mapped to common research processes, revealing most common labels for each process. Agglomerative clustering revealed 3 broad families of definitions. Citation analysis showed that the originating paper of each family has been cited ~10 times more than any other member.

DISCUSSION

Although there is little agreement between definitions, we were able to identify an emerging consensus 5-phase (T0-T4) definition for translational research. T1 involves processes that bring ideas from basic research through early testing in humans. T2 involves the establishment of effectiveness in humans and clinical guidelines. T3 primarily focuses on implementation and dissemination research while T4 focuses on outcomes and effectiveness in populations. T0 involves research such as genome-wide association studies which wrap back around to basic research.

CONCLUSION

We used systematic review and analysis to identify emerging consensus between definitions of translational research phases.

Where You Live Matters: Quality and Racial/Ethnic Disparities in Schizophrenia Care in Four State Medicaid Programs

OBJECTIVE

To determine whether (a) quality in schizophrenia care varies by race/ethnicity and over time and (b) these patterns differ across counties within states.

DATA SOURCES

Medicaid claims data from California, Florida, New York, and North Carolina during 2002-2008.

STUDY DESIGN

We studied black, Latino, and white Medicaid beneficiaries with schizophrenia. Hierarchical regression models, by state, quantified person and county effects of race/ethnicity and year on a composite quality measure, adjusting for person-level characteristics.

PRINCIPAL FINDINGS

Overall, our cohort included 164,014 person-years (41-61 percent non-whites), corresponding to 98,400 beneficiaries. Relative to whites, quality was lower for blacks in every state and also lower for Latinos except in North Carolina. Temporal improvements were observed in California and North Carolina only. Within each state, counties differed in quality and disparities. Between-county variation in the black disparity was larger than between-county variation in the Latino disparity in California, and smaller in North Carolina; Latino disparities did not vary by county in Florida. In every state, counties differed in annual changes in quality; by 2008, no county had narrowed the initial disparities.

CONCLUSIONS

For Medicaid beneficiaries living in the same state, quality and disparities in schizophrenia care are influenced by county of residence for reasons beyond patients' characteristics.

Reconsideration of animal models of schizophrenia and other psychiatric disorders with evolutionary perspective

Studies utilizing animal models for understanding biological mechanisms of such psychiatric disorders as schizophrenia have been now flourishing. Animal models are a essential part of translational research, and without them, it is not possible to develop therapeutic strategies to treat psychiatric disorders. Accordingly, importance of animal models has been increasingly emphasized. However, on the other side, limitations of such an animal model approach have been growingly deceptive. The aim of this review article is to discuss limitations of translational research utilizing animal models, and propose a new direction of research with evolutionary perspective to understand psychiatric disorders.

Person-centred medicine and mental health

This paper discusses an integrated approach to person-centred medicine and its role in the future of mental health care. The origins and current status of this emerging field are revised with special attention to the contributions made from psychiatry and to the implications for psychiatric diagnosis and evaluation of the three pillars of the Person-centred Integrative Diagnosis (PID) model: its conceptual domains (health status, experiences and contributors to ill and good health), the related evaluative procedures, the partnerships needed and the existing links and differences with people-centred care and personalised medicine. In spite of their striking complementarities person-centred medicine and personalised medicine do not yet have substantial bridges built between them. Knowledge transfer and coordination should be established between these two models which will cast medical evaluation and care in the upcoming future.

Translational epidemiology in psychiatry: linking population to clinical and basic sciences

Translational research generally refers to the application of knowledge generated by advances in basic sciences research translated into new approaches for diagnosis, prevention, and treatment of disease. This direction is called bench-to-bedside. Psychiatry has similarly emphasized the basic sciences as the starting point of translational research. This article introduces the term translational epidemiology for psychiatry research as a bidirectional concept in which the knowledge generated from the bedside or the population can also be translated to the benches of laboratory science. Epidemiologic studies are primarily observational but can generate representative samples, novel designs, and hypotheses that can be translated into more tractable experimental approaches in the clinical and basic sciences. This bedside-to-bench concept has not been explicated in psychiatry, although there are an increasing number of examples in the research literature. This article describes selected epidemiologic designs, providing examples and opportunities for translational research from community surveys and prospective, birth cohort, and family-based designs. Rapid developments in informatics, emphases on large sample collection for genetic and biomarker studies, and interest in personalized medicine--which requires information on relative and absolute risk factors--make this topic timely. The approach described has implications for providing fresh metaphors to communicate complex issues in interdisciplinary collaborations and for training in epidemiology and other sciences in psychiatry.

Critical gaps in knowledge of the epidemiology and pathophysiology of healthcare‐associated infections

The past decade has witnessed an intense interest in healthcare‐associated infections as well as increases in legislation and reporting requirements aimed at decreasing the number of these costly infections. In the next decade, healthcare epidemiology must address major gaps in understanding of the epidemiology and pathogenesis of healthcare‐associated infections and in knowledge of the efficacy of interventions for healthcare‐associated infections and the efficacy in implementing such interventions.

Translating experimental neuroscience into treatment of eating disorders: two examples

Anorexia nervosa (AN) is a serious mental disorder with impaired functioning including not only the cognitive and socio-emotional but also physical domains. Improved treatments, especially for adults with AN, are urgently needed. The insights gained from basic research in experimental animal models and the advent of cognitive neuroscience have produced major advances in our understanding of the condition, but translating these into clinical research or practice remains a challenge. We describe here what the eating disorders field can gain from schizophrenia research in this area. We use the example of socio-emotional impairments in AN to describe the iterative process between basic research and intervention development for neurobiologically informed and based treatments for this condition and briefly touch on some other examples that stem from translational science.

Looking to the future of research in pediatric anxiety disorders

OBJECTIVE

The rapid emergence of translational developmental neuroscience as the key driver in understanding the onset of mental illness, the restructuring of academic health science centers on the NIH Roadmap, and dramatic shifts in drug, biological, device, and psychosocial intervention development all have important consequences for pediatric anxiety disorders as a field.

METHOD

This article, which tracks the final presentation at a day-long symposium on pediatric anxiety disorders at the 2010 annual meeting of the Anxiety Disorders Association of America (ADAA), will try to outline where the field will head over the next decade as these forces combine to shape research and practice.

RESULTS

After 20 years of large comparative treatment trials that have defined the place of current generation treatments, the field is shifting toward interventions that will emerge from the revolution in translational developmental neuroscience and that herald the dawn of stratified and ultimately personalized medicine. With a much more efficient discovery to translational continuum, intervention development and dissemination will benefit from the concurrent transformation of the clinical and clinical research enterprise.

CONCLUSION

Dramatic advances in science and changes in the structure of medicine will condition the future of clinical research across every therapeutic area in medicine. For the field of pediatric anxiety disorders to thrive it will be important to embrace and actively participate in this revolution so that anxious youth are viewed as a key target population and, consequently, preemptive, preventive, and curative interventions will be developed for children by first intent.

Child and adolescent psychiatry for the future: challenges and opportunities

In this article, the authors focus on three particularly salient sets of issues that face the field of child and adolescent psychiatry as a sub-specialty of general psychiatry today-those related to workforce, public perception, and professional identity. In an article directed at the general psychiatrist, the authors present possibilities for refocusing the activities of the child and adolescent psychiatrist to emphasize consultative and collaborative roles. The authors embrace working in systems of care with communities and families as partners. Finally, they discuss the training implications of such shifts in professional identity, and the need to maintain the centrality of a scientifically-based developmental biopsychosocial formulation.

NIMH initiatives to facilitate collaborations among industry, academia, and government for the discovery and clinical testing of novel models and drugs for psychiatric disorders

There is an urgent need to transform basic research discoveries into tools for treatment and prevention of mental illnesses. This article presents an overview of the National Institute of Mental Health (NIMH) programs and resources to address the challenges and opportunities in psychiatric drug development starting at the point of discovery through the early phases of translational research. We summarize NIMH and selected National Institutes of Health (NIH) efforts to stimulate translation of basic and clinical neuroscience findings into novel targets, models, compounds, and strategies for the development of innovative therapeutics for psychiatric disorders. Examples of collaborations and partnerships among NIMH/NIH, academia, and industry are highlighted.