October 16, 2000

The brain, the control center for the body's activities and thoughts, relays messages through the spinal cord and nerves; allows the person to move, speak, sense, think, feel, understand, learn, and remember; and regulates automatic functions - the heart, the lungs - keeping the person alive. Yet this highly complicated organ weighs only about three pounds.

Studying and treating the brain, its neurological functions, its role in behavior, and how each affects the other, is intriguing. The brain presents acadmics and clinicians alike opportunities for extensive and varied research and treatments.

In the Health Center's Strategic Plan 2000, the brain and human behavior are identified as one of four signature programs that capitalize on research strengths and clinical applications.

The program is divided into two areas, mental health and neurovascular. It is headed by Richard Simon, professor of surgery, former chief of the division of neurosurgery and interim chairman for the Department of Surgery.

"This is an opportunity for us to offer comprehensive programs in medical areas that are underserved in this region," says Simon. "Translating our research in the areas of basic neuroscience, substance abuse, psychiatric disorders, biomedical imaging, genomics and vascular biology to our clinical programs presents an undertaking we plan to meet head-on.

"We have the expertise here. We are already strong in translational research - bringing research from the test tube to a clinical trial. These initiatives are good for our patients and will make the Health Center stronger and even more valuable to the community it serves," Simon says.

The line-up: Leslie Wolfson, chairman of the Department of Neurology, will head the clinical piece of the neurovascular side. Richard Mains, chairman of the Department of Neuro- science, will head the research side. The mental health clinical component will be led by Leighton Huey, chairman of the Department of Psychiatry, and Andrew Winokur, professor of psychiatry and pharmacology, will lead the research. Shirley Crall will provide administrative support for the program.

On the neurovascular side are plans for a comprehensive Stroke Center. "We want to combine basic and applied science to develop improved treatments for stroke, and then integrate that with a clinical program emphasizing stroke management," says Wolfson. "Management would include prevention, acute and long-term care, as well as outcome prediction and analysis."

Pinpointed for expansion in research and clinical care are ischemic stroke, which involves diminished blood supply to the brain, and hemorrhagic stroke, bleeding in the brain. Researchers will explore the core issues of stroke damage, developing new protective agents, and providing maintenance for patients to prevent further strokes. As research progresses, new clinical treatments will evolve.

The stroke center isn't just theoretical - the infrastructure exists. Already in place is the only functional magnetic resonance imaging machine in the region, which provides high-quality stroke images and tracks locations in the brain. Neurologists, radiologists, internists, geriatricians, and nursing, social service and emergency room staffs are all part of the existing "stroke team."

"There is a clearly defined clinical path for the management of stroke," says Wolfson. "We want to increase our regional role in delivery of stroke care and capitalize on our unique-ness as an academic health center."

Research, development, clinical trials and clinical intervention are nothing new at the Health Center. But the stroke center would become the central point for coordinating and converting research to state-of-the-art clinical services.

"We are in the final stages of recruiting outstanding clinicians who will provide modern care to patients," says Simon. "The stroke center will be able to provide services that will result in shorter hospital stays and get patients into rehab faster."

Simon says the plan incorporates key elements of a successful stroke center, as identified by the National Institute of Neurologic Disorders and Stroke and recently published in the Journal of the American Medical Association, including acute stroke teams, stroke units, written care protocols and an integrated emergency response system, as well as administrative support, strong leadership and continuing education.

For the mental health component, plans have been formulated for a Center for Bio-Behavioral Health. "We will be different from conventional psychiatric systems," says Huey, "by integrating research into the clinical frame- work in the development of new approaches in care and treatment; establishing new standards for community education; placing more emphasis on rehabilitation and recovery; and training future mental and behavioral health professionals."

Gerontological and neurological psychiatry, and adolescent psycho- pharmacology, especially in children and adolescents, are key psychiatric initiatives in the development of the center and expansion of the clinical, research and training systems across the life cycle, he says. These are mental health areas of great interest today and the areas of psychiatry that offer exceptional opportunities for better mental health care in the future.

• Geropsychiatry will focus on dementia, late-life depression, medical-psychiatry co-morbidity issues in the elderly; sleep and circadian rhythm problems and late-life substance abuse.
  
  
• Neuropsychiatry will focus on traumatic brain injury, cerebral vascular disease, seizure disorders; central nervous system diseases, brain tumors, infectious and inflammatory diseases of the central nervous system, alcohol and other substance-induced organic disorders and developmental disorders affecting the brain. Links will be made between conditions: for example, Parkinson's disease and the clinical depression that often accompanies it.
  
  
• The adolescent psychopharmacology component recognizes the importance of prevention, early identification and intervention at an early age. Still in its early planning stages, it will focus on an academic adolescent program in clinical research.
  
  

"The significance of the signature program in bio-behavioral health is the integrated approach to leverage clinical and scientific endeavors to advance mental health in the 21st century," says Huey. Currently most mental health programs are crisis-oriented.

According to Simon, the philosophy of the bio-behavioral health initiative is to focus on the continuum of life by not only providing care after a mental health episode but also anticipating and thus preventing a recurrence. "We're doing research in basic endocrinology, neuroimaging, receptor functions and their influences on mental health and psychiatric disorders," he says. For example, development of diagnostic measurements and effective treatments for adult attention deficit disorder are under way, using some of these research applications.

"Such programs are the underpinnings of support for a mental health system that starts with prevention and ends with long-term maintenance," says Simon, "and provides appropriate, focused care for everything in between."

Jane Shaskan