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
Changing Stages in the Field of Psychiatry
Era
Predominant Influence
1940s – 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
High Heritability of Mental Disorders
Insel, JCI, 2009
Depression as a Brain Disorder
Hopelessness, helplessness, suicidal thoughts,
anorexia, loss of libido, sleep disturbance
Insel, Sci Am, 2010
Cumulative Mortality for Depressed
and Non-depressed Patients
Following Heart Attack
30
Depressed (n = 35)
Nondepressed (n = 187)
Mortality (%)
25
20
15
10
5
0
0
1
2
3
4
Months After Heart Attack
5
6
Frasure-Smith N et al. JAMA. 1993;270:1819-1825.
Normal
Stress + Heritable
Risk  Depression
Glucocorticoids
Antidepressants
and/or
Psychotherapy
Serotonin and NE
BDNF
BDNF
Normal Survival
and Growth
Atrophy/Death of
Neurons
Other neuronal insults:
Genetic Factors
•
•
•
•
Hypoxia-Ischemia
Hypoglycemia
Neurotoxins
Viruses
Glucocorticoids
Increased Survival
and Growth
Modified from Duman,
Heninger, Nestler, AGP
54(7):597-606, 1997
Impact of Research on Heart Disease
• 63% decrease in
mortality
Deaths per 100,000
500
~ 1,329,000 Projected
Deaths in 2000
400
300
200
~ 514,000 Actual
Deaths in 2000
100
50
55
60
65
70
75
Year
80
85
90
95
00
• ~ 1 million early
deaths averted per
year
• $2.6 trillion in
economic return
• New, effective
treatments and
prevention strategies
Impact of Research on Cancer
• For the first time in
recorded history,
annual cancer deaths
in the United States
have fallen
• 10 million survivors
Millions of People
Number of Survivors
9
6
3
1971 1986 1990 2003
Impact of Research on Mental Illness
• Diagnosis is by observation, detection is late,
prediction is poor.
• Etiology is unknown; prevention is not welldeveloped 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
NIMH Research Domain Criteria (RDoC):
Transforming Diagnosis
Molecule
GWAS
Sequencing
Transgenics
Epigenetics
Databases
Cell
Stem Cells
RNAseq
Proteomics
Optical
imaging
Databases
System
Electrode
arrays
Connectomics
Imaging
Databases
Individual
Sensors
Eye gaze
Cognitive
tools
Epidemiology
Databases
Social
Web 2.0
Knowledge
management
Cost of Genomic Sequencing
1 Million Bases:
Entire Genome:
YEAR
COST
TIME
2001
$6,000
Several weeks
2012
19 cents
Several hours
First
$3 Billion
12 years
Today
$1000
2 days sequence,
9 days analysis
- T Insel, 2012
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
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Presentation - Texas Department of State Health Services