PGY-IV Psychiatry Research Elective

The Maryland Psychiatric Research Center (MPRC) offers Clinical Research Electives in schizophrenia research. Residents who wish to begin this training may do so in the PGY-IV year.

The goals of the elective are:

To introduce the trainee to the principles and methods of clinical research
To facilitate trainee participation in ongoing schizophrenia clinical research
To guide the trainee in selection of a particular research topic or study for emphasis in the program where he/she is located.
As a result of these experiences the trainee will be better able to identify future
research opportunities, meaningfully participate in clinical research, critically review the psychiatric research literature, and have a fuller clinical understanding of the treatment rationales for schizophrenia patients.
Time Requirements and Duration of the Elective

The duration of the PGY-IV elective is for 3 -12 months and could serve as the beginning of a two-year research fellowship if desired. Residents who are interested in extending their research elective into a schizophrenia research fellowship should contact Dr. Ikwunga Wonodi (410-402-6830) to explore possible arrangements.

During the MPRC elective, residents are assured of protected time to attend the Thursday didactic seminars at the training office, follow long-term psychotherapy patients, and to complete any other training requirements, including on-call coverage at University. The precise schedule of required hours is negotiated with the Program Chief.

Description of Duties

PGY-IV trainees will be located in one of four MPRC programs: 1) Outpatient Research Program (ORP); 2) Schizophrenia Related Disorders Program (SRD); 3) Treatment Research Program (TRP); or 4) The Functional Neuroimaging Laboratory (FNL). The ORP and SRD are outpatient programs, and the TRP is an inpatient program. Residents can opt for elective time in the Functional Neuroimaging Laboratory (FNL), a specialized program that recruits schizophrenia subjects from the outpatient and inpatient programs for the conduct of research protocols employing functional imaging paradigms. The programs are involved in clinical research with schizophrenia patients and healthy volunteers. A primary mentor, in collaboration with the program chief will supervise the clinical assignments and the daily research activities of the trainee. Virtually all patients in the programs participate in research protocols, and thus there are minor program responsibilities outside of those associated with the care of the research patients.

Trainees work directly with faculty investigators in treating patients and implementing research protocols. Specialized techniques such as eye tracking, neuropsychological testing, electrophysiologic testing (e.g., PPI, P50), functional neuroimaging (fMRI and PET scanning), and standardized clinical interviews and rating scales are employed. Trainees could also participate in genetic studies in schizophrenia. Specialized didactic seminars in research design, measurement and statistics, and ethics are held. Journal Club and research seminars presented by faculty and visiting scientists are held on a weekly basis. Reliability meetings are held on a regular basis at the MPRC. Interested trainees who participate in reliability training would become familiarized in the use of behavioral rating scales.

An effort is made to have a trainee identify and develop a research interest of his or her own and would spend extra time working in that area. This may result in a manuscript acceptable as the Academic Project.

Supervision

In addition to the direct supervision provided at each of the programs, trainees have ample opportunities to interact with other clinical and basic science faculty as well as with William T. Carpenter, Jr., M.D., Director of the MPRC.

On the individual programs, there are Program Chiefs, faculty investigators and research fellows as well as a complement of specialized technical and support staff.

Outpatient Research Program (ORP):

Robert W. Buchanan, M.D., Chief (410.402.7876)

The Outpatient Research Program provides comprehensive clinical care to patients with schizophrenia. The major area of research is in clinical trials with focus on the development of new pharmacological treatments for treatment-resistant patients, patients with prominent negative symptoms and cognitive deficits; the use of fMRI to examine the neuroanatomical basis of schizophrenia symptomatology; and neurobehavioral assessments of cognitive impairments.

The ORP has three equally important missions:

To study the pathophysiology, course, and treatment of schizophrenia and related disorders
To provide the highest quality of care available in order to improve social and occupational functioning, reduce symptoms, increase autonomy, and prevent re-hospitalization
To educate patient’s families and the community about the manifestations, course and management of schizophrenia

Schizophrenia Related Disorders Program (SRD):

Gunvant Thaker, M.D., Chief (410.402.6821)

The SRD is dedicated to the compassionate and up-to-date treatment of individuals with schizophrenia and other psychotic disorders. The program provides care to individuals with recent onset of psychotic illness, performs extensive diagnostic work-up, and provides family support. The program also provides consultation and evaluation services to patients who develop motor side effects, such as antipsychotic-induced tardive dyskinesia. This service was recently expanded to include the examination of metabolic and cardio-vascular side effects of antipsychotic agents in children and adolescents. The major research focus of the program is the search for etiological factors of schizophrenia, early identification of at-risk subjects, treatment intervention in individuals with schizophrenia related disorders, and novel treatments of different aspects of the schizophrenia syndrome.

Research in the SRD Program is conducted in the following areas:

Genetic studies of schizophrenia and spectrum personality disorders.
Comprehensive evaluation of oculomotor function in schizophrenia and related disorders.
Study of putative vulnerability markers of schizophrenia in biological relatives of schizophrenia individuals and volunteer subjects with schizotypal personality disorder.
Acute psychopharmacological probe studies in healthy volunteers and in individuals with schizotypal personality disorder.

Treatment Research Program (TRP):

Deanna Kelly, Pharm.D., BCPP, Chief (410.402.6861)

The Treatment Research Program is dedicated to the study and treatment of people with schizophrenia. The Program as a whole incorporates a diverse scope of research including, clinical trials, brain imaging, clinical biochemistry, and outcome studies. The Program also includes an Office of Research Compliance and Oversight, and works with other affiliated clinical programs and scientists.

Program Goals:

To give persistently ill patients an opportunity to receive new medications and/or to determine the optimal pharmacologic treatment for each patient
To determine the efficacy of the new medications and the impact of these drugs on symptoms of the illness
To evaluate the reasons that traditional therapies and treatment are not effective with certain individuals
To evaluate the latest brain imaging techniques to help determine how medications work in the brain
To study and address the rehabilitation need of patients whose life management and social skills may have deteriorated as a result of their illness
To ensure that all necessary research requirements are met and maintained throughout the course of a research study so that the rights of the research participants are protected and the integrity of the research is preserved

Functional Neuroimaging Laboratory (FNL):

Malle Tagamets, Ph.D. (410.402.6028)

The Functional Neuroimaging Laboratory uses a variety of state-of-the-art neuroimaging techniques in order to study the function, structure, and physiology of the brain in schizophrenia, Parkinson’s, and Huntington’s diseases. These methods include positron emission tomography (PET), functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI). A particular emphasis of research in the FNL is on integrating multiple behavioral, theoretical, and imaging methods that examine the brain as a highly interactive system.

Research activities in the FNL include:

Cognition and the brain, including learning and memory, language, and executive systems
fMRI and PET studies of cognitive function and pharmacology
MRS studies of brain tissue integrity and glutamatergic function
DTI methods for relating large-scale brain circuits to function
Computational methods for understanding the circuit dynamics that underlie imaging results
fMRI studies of brain activity changes underlying development of behavioral symptoms such as mood disorders and executive dysfunction in neurological disease

Funding

PGY-IV positions are usually funded from state lines in the residency program.