Behavioral Health Forum:
Integrating the Science and the
Practice for the Future
University of Texas MD Anderson Cancer
Center
Houston, Texas – June 8, 2012
Stuart C. Yudofsky, M.D.
D.C. and Irene Ellwood Professor and Chair;
Distinguished Service Professor; and
Drs. Beth K. and Stuart C. Yudofsky Presidential
Chair of Neuropsychiatry
Menninger Department of Psychiatry and
Behavioral Sciences
Baylor College of Medicine
What is Psychiatry?
1. A specialty of medicine…
2. Dealing with dysfunctions and illness…
3. That affect behavior, mood, thought and
perception…
What is the “organ” of Psychiatry?
Houston…
1. We’re not urologists
2. We’re not cardiologists
The Human Brain
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100 billion nerve cells-mostly neurons
Hundreds of trillions of synapses
60 known neurotransmitters
300 putative neurotransmitters
Enzymes
– Synthesis
– Degradation
Transport mechanisms, storage, and release
2 to 10+ receptor subtypes
Second messenger systems
Ion channels-binary action potentials of axons
THE DSM-IV-TR
1. Utilizes objectifiable clusters of signs and
symptoms
2. To define specifically over 300
psychiatric illnesses
3. Common diagnostic language worldwide
among mental health professionals
Biopsychosocial Approach
1. Biological features
a. Genetic predispositions
b. Brain lesions and disorders
c. Endocrine dysfunctions
d. Toxins (e.g. alcohol)
e. Somatic disorders (e.g. diabetic
Ketoacidosis)
Biopsychosocial Approach
2. Psychological features
a. Life experience
b. Memory stores
c. Unconscious processes
d. Thinking patterns
Biopsychosocial Approach
3. Social features
a. Cultural effects
b. Family setting
c. Occupation
d. Interpersonal relationship
e. Spiritual life
f. Values
The Human Costs of Mental
Illness and Addictive Disorders
-StigmaStigma
Stigma, fear, and embarrassment are
universally associated with mental illness.
Many Americans with treatable psychiatric
disorders refuse to seek care.
A survey conducted by the National
Mental Health Association (NHMA)
of 1022 adults found:
1. Half of American adults reported that they or a
family member have suffered from depression.
2. Forty-three percent see depression as a
“personal weakness,” with another 11%
uncertain whether it is a personal weakness or
a health problem.
3. Two-thirds of those suffering from depression
will not seek treatment.
Public Perceptions of Mental Illness
Due to Emotional Weakness
71%
Caused by Bad Parenting
65%
Victim’s Fault;
Can will it Away
45%
Incurable
43%
Consequence of
Sinful Behavior
Has Biological Basis;
Involves the Brain
35%
10%
The Good News About Mental
Illness and Psychiatry
• Through neuroscience discovery, important
knowledge is being gained about the causes and
effective treatments of psychiatric disorders.
• Examples: 70% of the people with manic
depression respond dramatically to lithium
treatment.
• The use of lithium has been estimated to have
saved $6.5 billion annually in treatment costs
alone.
The Good News About Mental
Illness and Psychiatry
• Between 80-90% of individuals suffering
from major depression respond fully to
psychiatric treatment that includes both
medications and counseling.
The Good News About Mental
Illness and Psychiatry
• Increasingly neuroscience research is
shedding light as to the causes of such
illnesses as Alzheimer’s disease,
schizophrenia, and even alcoholism and other
substance use disorders.
• These discoveries open the way to innovative
pharmacologic and other types of biological
interventions.
The Promise of Biological
Research
1. Genetics
a. Localization on chromosomes of the genetic
bases of specific psychiatric illness
b. Unlock physiological processes by which
genes “trigger” psychiatric disorders
c. Development of tests to diagnose people at
risk of transmitting severe psychiatric
disorders
d. Development of more specific interventions
The Promise of Biological
Research
2. Neuroscience Discovery
a. Major technological advances in neuroscience
research will be applied to psychiatric questions
such as the development of pharmacologic and
electrophysiologic treatments.
b. Example-Deep Brain Stimulation for major
depression and OCD.
The Promise of Biological
Research
3. Brain Imaging
a. Magnetic Resonance Imaging (MRI)
b. Regional Cerebral Blood Flow (RCBF)
c. Positron Emission Tomography (PET)
d. Single Photon Emission Computer
Tomography (SPECT)
Views of the Brain
Left Motor Cortex Activation