Director’s Blog
On This Page…
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Three Principles for Clinical Research (July 30, 2010)
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Reducing Disparities in Mental Health Equity: Closing the Gaps (June 18, 2010)
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More on Public Trust and Conflict of Interest (June 15, 2010)
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NIMH — Reducing Conflict of Interest, Ensuring Public Trust (June 07, 2010)
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Turning the Corner, Not the Key, in Treatment of Serious Mental Illness (June 01, 2010)
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NIMH’s BRAINS Awards—In Support of Creativity (May 17, 2010)
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NIMH Basic Science Support: Busting Myths (May 12, 2010)
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May 6th: Children’s Mental Health Awareness Day (April 26, 2010)
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What’s in a Name? — The Outlook for Borderline Personality Disorder (April 19, 2010)
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Diagnosis: Pediatric Bipolar Disorder? (April 08, 2010)
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Who Will Develop the Next Generation of Medications for Mental Illness? (March 30, 2010)
July 30, 2010
Posted by
Thomas Insel
During the week of July 12, NIMH hosted two meetings with broad implications
for our clinical research portfolio. The first was a progress report on Cognitive
Neuroscience Approaches to the Treatment of Impaired Cognition in Schizophrenia
(CNTRICS), the NIMH initiative to develop tools for defining the cognitive
deficits in schizophrenia. The second was the inaugural meeting of the Research
Domain Criteria (RDoC), the NIMH initiative to build a new framework for classification
for research purposes. This meeting focused on working memory, exploring
the idea of cognitive science as a potential tool for defining clinical categories
independent of our current classification system. While it may sound as if
the two meetings were mostly academic discussions of esoteric topics, both
led to important conversations about how we support clinical research.
One implication was the need for standardized, web-based cognitive measures.
In the early 2000s, the Institute supported the creation of the Measurement
and Treatment of Research to Improve Cognition in Schizophrenia (MATRICS) battery
as a neuropsychological toolbox for assessing cognitive deficits in schizophrenia.
This standardized assessment has been widely adopted. But the measures, most
of which predate modern cognitive neuroscience, appear to be less sensitive
and less specific than current assays.1 And because
the battery is not web-based, there is no opportunity for integrating data
seamlessly from many sites.
More recently, the NIH Blueprint for Neuroscience Research supported the development
of the NIH Toolbox, a
collection of web-based measures. While this will be useful for standardizing
tests of sensory and motor function, it does not have the capacity to probe
cognitive control, working memory, and other aspects of what is often called
executive function. It also lacks measures of affective regulation. A third
effort, the Cognitive Atlas project ,
is creating a knowledge base or ontology on the web for the entire community,
linking cognitive tools to the emerging database on genes, cells, and circuits.
The success of each of these three projects points to the need for a new initiative:
a neurocognitive toolbox that includes standardized, web-based assessments
of the many aspects of executive function and affective regulation that can
be assessed efficiently in clinical practice as well as in the research lab. "Standardized"
refers to consistency in the way the tests are administered as well as how
they are used. The actual items can be adapted by the computer according to
the testing situation or the performance. Web-based approaches allow tests
of reaction time as well as accuracy. Most importantly, the implementation
of a panel of validated tests, as currently being developed by the CNTRICS
group, will ensure that our funding supports research that can be integrated
across research sites, rather than resulting in a collection of non-comparable
results.
Of course, a standardized battery must not stifle innovation. Ultimately,
NIMH might expect all grantees to use a specific panel for neurocognitive assessment,
but this is not a limit to developing new and better tools beyond this core
group.
For me, what emerged from these meetings were three core principles: standardization,
integration, and sharing. While these principles have been adopted already
in the world of genomics, they have not become part of the wider culture of
clinical research. The lesson from genomics is clear: There is strength in
numbers.
Going forward, to increase the impact of our clinical research, NIMH hopes
to instill these principles in the studies we support: standardized measures
(including standardized protocols), integration across sites (and, in a different
sense, across levels of analysis), and broad sharing of data. The first step
will be the development of the core battery of tests, as currently being done
by the CNTRICS team for cognition. This effort can be expanded to other domains
under the auspices of RDoC.
1 Cohen JD and Insel TR. Cognitive neuroscience and schizophrenia:
translational research in need of a translator. Biological Psychiatry. 2008
July. 64(1):2-3.
Carter CS, Barch DM, Gur R, Pinkham A, Ochsner K. CNTRICS final task selection:
social cognitive and affective neuroscience-based measures. Schizophrenia Bulletin.
2009 Jan.35(1):153-162.
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NIMH, Clinical Research and Trials.
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NIMH, Clinical Research and Trials.
June 18, 2010
Posted by
Thomas Insel
Soon after the first Surgeon General’s Report on Mental Health was published in 1999, a supplement entitled “Mental Health: Culture, Race, and Ethnicity” detailed what was known of the relationship between race and mental illness and mental health care in the United States. This supplement identified critical needs for further investigation into these relationships and for the provision of culturally sensitive mental health care. As noted in the report, health care must continually adapt to meet the needs of the ever-changing population that it serves. Mental health care has no exception from this requirement. While one of America’s greatest strengths is its racial and cultural diversity, this diversity produces complex mental health care issues due to the heterogeneity of the population to be served.
To study the cultural and racial influences on mental health, NIMH initiated the Collaborative Psychiatric Epidemiology Surveys (CPES), including the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL), and the National Latino and Asian American Study (NLAAS). The NCS-R was a nationally-representative survey of 9,282 individuals including face-to-face structured diagnostic interviews. The NSAL focused on black Americans, including 6,199 African Americans, Caribbean blacks, and white individuals. The NLAAS included interviews with 4,649 Latino and Asian Americans. Taken together, these studies yield an unprecedented map of mental illness in America. Among many intriguing findings, perhaps what is most striking are not the variations in prevalence but the variations in care. Thus, for mental illness in America, the challenge is health equity; that is, achieving equal and optimal health care for all populations.
To better understand the context of mental health inequities, the new NIMH Office for Research on Disparities and Global Mental Health recently convened a summit of leaders from academic and research centers, community organizations, and government agencies with expertise ranging from genetics, epidemiology, medical anthropology, and cultural neuroscience to psychiatric education, service delivery, and policies. In addition to making recommendations for research priorities, the group’s lively discussion also highlighted a need to rethink traditional study designs and measures. Some suggestions included focusing more on incidence and burden rather than prevalence; enhancing communication and engagement between researchers, community members, and clinicians, as well as between government agencies with similar goals; and developing a workforce capable of studying the complex, interdisciplinary nature of mental health inequities.
Clearly, there is much work that remains to be done in reducing and reversing disparities in mental health care. But the wealth of knowledge and innovation that currently exists in the mental health community is encouragement enough to be bold in our research undertakings and, together with our like-minded colleagues at other NIH institutes, SAMHSA, and AHRQ to strive towards closing the gap in mental health care.
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Diversity and Ethnic Groups.
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June 15, 2010
Posted by
Thomas Insel
Dr. Insel addresses recent misconceptions pertaining to financial conflict of interest.
Continue reading “More on Public Trust and Conflict of Interest“…
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Research Funding.
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Research Funding.
June 07, 2010
Posted by
Thomas Insel
Dr. Insel discusses progress in the approaches for identifying and preventing financial conflicts of interest.
Continue reading “NIMH — Reducing Conflict of Interest, Ensuring Public Trust“…
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Research Funding.
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Research Funding.
June 01, 2010
Posted by
Thomas Insel
People with a major mental illness have a shorter than average life expectancy and each year there are nearly twice as many suicides as homicides in the U.S. A new report now documents that people with mental illness are three times more likely to be in the criminal justice system than hospitals because of a failure to provide services within the mental health care system.
Continue reading “Turning the Corner, Not the Key, in Treatment of Serious Mental Illness“…
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NIMH.
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NIMH.
May 12, 2010
Posted by
Thomas Insel
NIMH has always and will continue to support cutting edge basic science research. Understanding normal functioning of brain-behavior relationships is critical to providing insight into abnormal brain-behavior relationships. To build a translational bridge we will need a very strong foundation in basic science. This foundation will need to be multidisciplinary and cut across species and levels of analysis.
Continue reading “NIMH Basic Science Support: Busting Myths“…
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Basic Research.
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Basic Research.
April 26, 2010
Posted by
Thomas Insel
May is Mental Health Month and this year NIMH teams up with SAMHSA to celebrate and promote Children’s Mental Health Awareness Day on May 6th. Dr. Insel talks about how mental illnesses are the chronic diseases of the young.
Continue reading “May 6th: Children’s Mental Health Awareness Day“…
Learn more about:
Attention Deficit Hyperactivity Disorder (ADHD),
Autism,
Schizophrenia.
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Autism.
April 19, 2010
Posted by
Thomas Insel
As currently defined, borderline personality disorder is considered a reflection of an essential aspect of a person’s character that influences his or her way of seeing and being seen in the world. Recent research, however, has shown that symptoms of the disorder aren’t constant and may not always be as enduring as some researchers and clinicians may think.
Continue reading “What’s in a Name? — The Outlook for Borderline Personality Disorder“…
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Borderline Personality Disorder.
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Borderline Personality Disorder.
April 08, 2010
Posted by
Thomas Insel
NIMH is working to better define the boundaries of pediatric bipolar disorder, discover its causes and develop more effective treatments for such mood related syndromes affecting youth. Cross-cutting comparisons of mania-related and other forms of irritability and functional brain imaging studies will help to disentangle these syndromes so that clinicians can provide children with the best care. Our goal is nothing less than pre-emtive interventions and cures.
Continue reading “Diagnosis: Pediatric Bipolar Disorder?“…
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Bipolar Disorder.
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Bipolar Disorder.
March 30, 2010
Posted by
Thomas Insel
Today’s treatments for mental illness may be good but they are not good enough. As industry pulls back, NIMH will have to step in and play a bigger role in fostering development of a new generation of evidenced-based medications for people with mental illness.
Continue reading “Who Will Develop the Next Generation of Medications for Mental Illness?“…
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Research Funding.
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Research Funding.
