John M. Oldham, MD, MS Senior Vice President and Chief of Staff The Menninger Clinic
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Behavioral Health Forum: Integrating the Science and the Practice for the Future University of Texas MD Anderson Cancer Center Houston, TX – June 8, 2012 John M. Oldham, MD, MS Senior Vice President and Chief of Staff The Menninger Clinic Professor and Executive Vice Chair Menninger Department of Psychiatry and Behavioral Sciences Baylor College of Medicine; Immediate Past President, American Psychiatric Association
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Behavioral Health Forum: Integrating the Science and the Practice for the Future University of Texas MD Anderson Cancer Center Houston, TX – June 8, 2012. John M. Oldham, MD, MS Senior Vice President and Chief of Staff The Menninger Clinic Professor and Executive Vice Chair - PowerPoint PPT Presentation
Transcript of John M. Oldham, MD, MS Senior Vice President and Chief of Staff The Menninger Clinic
Behavioral Health Forum:Integrating the Science and the Practice for the FutureUniversity of Texas MD Anderson Cancer CenterHouston, TX – June 8, 2012
John M. Oldham, MD, MSSenior Vice President and Chief of StaffThe Menninger ClinicProfessor and Executive Vice ChairMenninger Department of Psychiatry and Behavioral SciencesBaylor College of Medicine;Immediate Past President, American Psychiatric Association
Changing Stages in the Field of PsychiatryEra Predominant Influence1940s – 1970s Psychoanalytic (psychogenic)
1960s – present Psychopharmacological (chemical imbalance)
1980s – present Biopsychosocial
1990 – 2000 Decade of the Brain (NIMH)(Bidirectional Gene-Environment Interaction)
2000 - 2010 Decade of Discovery (NIMH)(Genomics, proteomics, molecular neurobiology, “neuropsychotherapy”)
Rethinking Mental Disorders• Mental disorders are brain disorders• Mental disorders are developmental
disorders• Mental disorders result from complex
genetic risk plus experiential factors
- T Insel, 2012
Mental Disorders are Chronic and Disabling
WHO 2008
Annual U.S. Cost of Brain Disease• 2012 estimated medical and long-term costs
related to brain disease = $515B (19% of total national health expenditures)
• 2012 estimated medical, non-medical, and long-term costs = $934B
- Michael Thompson, Price Waterhouse Cooper, 2012
Mental Disorders: Mortality• Over 36,000 suicides per year in the U.S.
(CDC, 2008)• For context:
18,000 homicides 33,000 traffic fatalities
- T Insel 2012
Mental disorders are the chronic diseases of the young
The Most Costly Conditions
Insel, JCI, 2009
High Heritability of Mental Disorders
Insel, Sci Am, 2010
Hopelessness, helplessness, suicidal thoughts, anorexia, loss of libido, sleep disturbance
Depression as a Brain Disorder
Frasure-Smith N et al. JAMA. 1993;270:1819-1825.
0
5
10
15
20
25
30
0 1 2 3 4 5 6Months After Heart Attack
Mor
talit
y (%
)
Depressed (n = 35)Nondepressed (n = 187)
Cumulative Mortality for Depressed and Non-depressed Patients Following Heart Attack
Modified from Duman, Heninger, Nestler, AGP
54(7):597-606, 1997Other neuronal insults:• Hypoxia-Ischemia• Hypoglycemia• Neurotoxins• Viruses
Genetic Factors
Increased Survival and Growth
Atrophy/Death of Neurons
Normal Survival and Growth
Glucocorticoids Serotonin and NE
BDNF
GlucocorticoidsBDNF
Normal Stress + Heritable Risk Depression
Antidepressants and/or
Psychotherapy
500
400
300
200
100
50 55 60 65 70 75 80 85 90 95 00
Dea
ths
per
100,
000
Year
~ 514,000 ActualDeaths in 2000
~ 1,329,000 ProjectedDeaths in 2000
Impact of Research on Heart Disease
•63% decrease in mortality
•~ 1 million early deaths averted per year
•$2.6 trillion in economic return
•New, effective treatments and prevention strategies
Milli
ons o
f Peo
ple
1971 1986 1990 2003
9
6
3
Number of Survivors
Impact of Research on Cancer• For the first time in
recorded history, annual cancer deaths in the United States have fallen
• 10 million survivors
Impact of Research on Mental Illness• Diagnosis is by observation, detection is late,
prediction is poor.• Etiology is unknown; prevention is not well-
developed for most disorders.• Treatment is trial and error – no cures, no
vaccines.
Bottom line:• Prevalence has not decreased for any illness.• Mortality has not decreased for any illness.
- T Insel, 2012
Molecule Cell System Individual SocialGWASSequencingTransgenicsEpigeneticsDatabases
Stem CellsRNAseqProteomicsOpticalimagingDatabases
Electrode arraysConnectomicsImagingDatabases
SensorsEye gazeCognitivetoolsEpidemiologyDatabases
Web 2.0Knowledgemanagement
NIMH Research Domain Criteria (RDoC):Transforming Diagnosis
Cost of Genomic Sequencing
- T Insel, 2012
YEAR COST TIME1 Million Bases: 2001 $6,000 Several weeks
2012 19 cents Several hoursEntire Genome: First $3 Billion 12 years
Today $1000 2 days sequence, 9 days analysis
The Menninger Mental Health Epicenter
Goal: “The MD Anderson of Mental Health”
New Directions at The Menninger Clinic• Vice President and Medical Director
• Susan Hardesty, M.D.• Comprehensive Psychiatric Assessment Service
• Benjamin Weinstein, M.D.• Professional Assessment Service
• Christopher Flynn, M.D.• Research
• Outcomes (Allen)• Suicide (Greene, Ellis, Jobes)• Addiction (Kosten, Flack)• Mentalization (Fonagy, Bleiberg, Allen)• Personality Disorders (Skodol, Oldham, Bender, Morey)• Translational – e.g. “neuropsychotherapy” (future
Menninger/Baylor studies)• Admissions Service
• James Flack, M.D.• Future research, educational, and clinical partnerships with
Baylor
Proposed Menninger / Baylor Neuroscience Project• Standardized clinical diagnosis on all adult
patients (SCID I & II)• Specialized brain imaging • Gene sequencing to identify heritable risk
factors
(Provisionally approved, Baylor IRB)
Thank you for your interest
