Division of Biological/Research
The division is headed by Igor Galynker, MD, PhD, who has dual appointments in psychiatry and radiology. The division is staffed by a research coordinator and several research assistants, and conducts imaging studies using fMRI, PET, and SPECT methodology, as well as related studies in descriptive psychiatry and psychopharmacology.
Residents have the opportunity to learn both clinical and research applications of functional brain imaging throughout their residency training. Each resident can learn about the indications for ordering brain SPECT scans and the neuroradiological findings associated with common psychiatric and neuropsychiatric disorders. At the weekly Biological Psychiatry Research Seminar residents discuss the new trends in biological psychiatry and learn how to critically read original scientific publications in psychiatric journals.
Research Interests
The Department of Psychiatry has an extensive commitment to clinical research. Areas of current research include:
Below are detailed descriptions of other active initiatives:
Predicting suicidal behavior: Internal consistency and predictive validity of Suicide Trigger Scale
The goal of this study is to develop a scale to operationalize and measure a clinically identified emotional “trigger state” that puts individuals with suicidal ideation at increased risk of acting on these ideations. In patients who attempted suicide we have identified a clinical “trigger” state (termed suicidal trigger state) which preceded the suicide attempt and is characterized by fear of entrapment, dread, confused thinking, pain or pressure in the head, and a sense of disconnection from reality. In our preliminary work we have developed the Suicide Trigger Scale (STS) to measure this state and have found that patients with higher scores on the STS are more likely to have had prior suicide attempts while those with low scores are more likely to have had only suicidal ideation. We are now working on developing and refining the STS in order to determine its reliability in a high-risk patient population drawn from an emergency room setting and to establish its ability to predict future suicide attempts in this setting.
Neural representation of attachment and treatment response to psychotherapy in mood disorders using fMRI.
Our current research uses functional brain imaging (fMRI) to better understand the neural mechanisms underlying attachment processes in women with and without unipolar depression. We are interested in how this information might elucidate the neurobiological basis of the interaction between attachment and depression and how this relates to psychotherapy treatment response. Continuing research will focus on how psychotherapy in mood disorders might be optimized and treatment outcome quantified using our imaging protocol
Panic and risk of suicide attempts in depressed suicidal ideators.
Identifying patients with risk factors associated with increased odds of suicide attempt compared to just suicidal ideation represents a current clinical challenge. In response to this dilemma, our research looks at the relationship between panic attacks and suicidality using multiple logistic regression analysis of a national epidemiological database (NESARC), a representative sample of 43,093 U.S adults. Using this statistical method and epidemiological sample we are able to isolate the unique contribution of panic attack while controlling for multiple clinical and socio-demographic factors.
We are also very actively involved with randomized controlled clinical trials including the following:
1. A Prospective Sixteen-Week, Double-Blind, Placebo-Controlled Trial of Quetiapine in Combination with Treatment as Usual in Patients with GAD and Remitted Comorbid Opiate Dependence
In collaboration with Astra-Zeneca, we are engaged in a study of the effectiveness of quetiapine in treating generalized anxiety disorder in patients with comorbid opiate abuse. Reasoning that untreated anxiety symptoms in some individuals recovering from opiate abuse/dependency may be a trigger to repeated uncontrolled addictive opiate use, we initiated a study of the effectiveness of quetiapine to treat symptoms of generalized anxiety disorder in recovering opiate addicts. Quetiapine has been previously shown to be effective in treating anxiety symptoms in patients without comorbid drug dependency. This study asks a) is quetiapine effective in treating anxiety symptoms in these subjects, and b) does treatment with quetiapine in recovering opiate addicts with comorbid generalized anxiety disorder prolong opiate abstinence. The study seeks to enroll 40 subjects in a double-blind, placebo controlled trial of 16 weeks’ duration. To date, 37 subjects have been screened, and 12 subjects have initiated treatment with the study medication.
2. A 38-week, Multicenter, Randomized, Double-blind, Active-controlled Study to Evaluate the Efficacy, Safety, and Tolerability of an Intramuscular Depot Formulation of Aripiprazole (OPC-14597) as Maintenance Treatment in Patients with Schizophrenia “ASPIRE EU” (Aripiprazole Intramuscular Depot Program in Schizophrenia)
In collaboration with Otsuka Pharmaceuticals and Covance, we are engaged in a study of the safety and effectiveness of a long-acting injectable form of the antipsychotic medication Aripiprazole in the treatment of chronic schizophrenia. We are one of roughly 50 sites in the United States involved in this study. The study seeks to enroll approximately 1,000 patients with chronic schizophrenia. After demonstrating a robust clinical response to oral Aripiprazole, subjects are randomized to receive either active Aripiprazole or placebo via intramuscular injection every month for a duration of up to 38 weeks. To date, we have screened six patients, and two patients at our site are currently participating in the trial.
3. Title: A 52-week, Multicenter, Open-label Study to Evaluate the Effectiveness of Aripiprazole Intramuscular Depot as Maintenance Treatment in Patients with Schizophrenia “ASPIRE OPEN-LABEL” (Aripiprazole Intramuscular Depot Program in Schizophrenia)
This is an extension of the above study of long-acting intramuscular Aripiprazole formulation. The study seeks to determine the safety and effectiveness of IM Aripiprazole given over 52 weeks in an open-label design to patients with chronic schizophrenia. To date, we have not yet enrolled any subject in this study.
Residents are exposed to the ongoing research of the department and are encouraged to develop their own research projects early in their training. All residents are taught a formal course in research design during their PGY II year and begin to develop a supervised research project by the fall of the second year. The residents present their work at grand rounds at the end of their PGY-IV year. Many of these projects result in publications in psychiatric journals or presentations at national meetings.
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