Division of Mental Health and Addiction Medicine

Achievements

Reflecting recent trends of research in psychiatry and neuroscience, the Division has strived at bridging and integrating research methodologies derived from neurosciences, clinical psychiatry and epidemiology, to address important issues in the fields of psychiatry and substance abuse. Our main research themes fall in the following five categories:

  1. the Taiwanese Psychiatric Research Network (TPRN);
  2. Psychiatric Pharmacogenomics;
  3. Psychiatric Epidemiology;
  4. Psychiatric Molecular Genomics; and,
  5. Neuroscience/Psychoimmunology.

Building on insights derived from divergent fields, including neurosciences and epidemiology, we aim at encouraging collaborations among clinical researchers, clinicians, public health experts, neuroscientists, life science researchers, to promote bi-directional translational research. Under the auspices of the TPRN, we have established formal collaborative agreements for clinically-oriented research with nine major medical centers and psychiatric facilities, including the Taipei City Psychiatric Center, Lin-Kuo Chang Gung Medical Center, DOH Yuli Hospital, and more recently the McKay Memorial Hospital and the Far-Eastern Hospital. This network has been crucial for the initiation and implementation of a number of our multi-site studies for searching for predictors for treatment responses and adverse effects, as well as innovative approaches for maximizing therapeutic effects. It also provides the infrastructure for future large-scale clinical trials and clinical research, and is conducive for international collaborations. In addition, we also have established a therapeutic drug monitoring system for the measuring of the concentration of therapeutic agents and biomarkers. Together with the cell line repository and DNA bank, which also have been established this year, the system will enable us to examine the metabolism and disposition of medications, compliance (adherence), and the relationship between genetic factors and treatment response. Further, TPRN also enabled us to establish six consensus groups focusing on issues ranging from schizophrenia to disorders of childhood onset, which will result in summary reports serving as the basis for directing our future research efforts. A research theme that has emerged and become prominent is drub abuse.

During this year, the Division actively collaborated with the Department of Health, the Bureau of Controlled Substances and the Ministry of Justice, as well as a large number of researchers, searching for a better understanding of the characteristics of the abusers, patterns of use, risk factors associated with use and abuse, and the effectiveness and cost-effectiveness of intervention. In the process, we have established a viable program located in the prison housing substance abuse offenders who are predominantly opioid abusers with elevated risks for HIV infection. We have continued to make progress with the three pharmacogenomic projects focusing on antidepressant response, metabolic syndrome associated with antipsychotic exposure and tobacco cessation in schizophrenic patients. We also organized an international conference including collaborators from the U.S. and the Pacific-Asian region to discuss analysis strategies for an NIMH sponsored 5-year collaborative RO1 that was recently completed, as well as for the implementation of a new project being implemented in six countries including Malaysia and Korea. Also discussed were the establishment of pharmacogenomic panels, the use of bioinformatics and the possibility of moving from association to intervention, which together maybe crucial in moving the field towards the goal of individualized medicine.

With the new focus on substance abuse as a theme for the Division, we also have started exploring using pharmacogenomic tools to enhance our understanding of the effects of substances of abuse, such as some of the opioids and stimulants (e.g., methamphetamine). During this year, the two main molecular genomic projects, focusing on the identification of genes associated with aripiprazole (a brand new antipsychotic) response, and the sequencing of the glutamatergic genes, have been completed. Both are crucial for the understanding of schizophrenia and may contribute towards better treatment of such patients. Using new genomic and cytogenetic methodologies, new projects have also been formulated to identify genes that maybe associated with schizophrenia, autism and substance abuse. Animal models have been developed for the study of a number of neurodegenerative/neurodevelopmental disorders including Parkinson's disease and Alzheimer disease. Regulatory mechanisms and the developmental processes relevant to the pathogeneses of these disorders have been elucidated. Based on such insights, a number of proposals have been developed, including a project studying drug-induced dyskinesia that may have immediate clinical relevance, as dyskinesia remains one of the most intractable adverse effects confronting the use of antipsychotics. Models and facilities for the study of psychoimmunology, psychoneuroendocrinology, neurophysiology and neurogenesis also have been established, and studies in these domains are progressing well. Collaborations with investigators from the Stem Cells Research Center and with the Division of Bioengineering represent another promising directions for the Division. Lastly, we also are in the process of establishing a dual purpose animal behavioral research facility that will allow us to study phenomena related to schizophrenia (e.g., prepulse inhibition) and depression (e.g., forced swimming test). Utilizing the National Health Insurance Dataset (NHID), we have successfully studied the prevalence and correlates of major disorders in children and adolescents, identified rural-urban discrepancies in the help-seeking and services of autistic children, and delineated other determinants influencing services utilization patterns of such patients. Using NHID, we also have established a psychopharmacoepidemiology group that has primarily focused on issues related to benzodiazepine (BZD) use. The data showed alarmingly high rates of overall and inappropriate use of BZDs, especially in the elderly, leading to hip fracture and other medical consequencies, as well as elevated health expenditure. Preliminary data also suggest that BZD use maybe associated with the risk for dementia. NHID also has been used to examine the appropriate and inappropriate use of eletroconversive therapy (ECT), with data that maybe useful for formulating ECT use guidelines useful for formulating new health policies enhancing the proper use of this powerful method. Lastly, we have collaborated actively with the Bureau of Health Promotion for the analysis of two large, longitudinal datasets, namely, the National Health Interview Survey (NHIS) and the Taiwanese

Elderly Survey (the Survey of Health and Living Status of Middle Aged and Elderly in Taiwan), yielding preliminary results pointing to a strong association between depression and subsequent morbidity and mortality. The latter may serve as the foundation of a new institution-wide initiative on cohort research, further examining factors crucial for the mental health of these populations, as well as elucidating the complex relationship between mental health and other aspects of health and illness. In conclusion, the Division has progressed well during this year, not only in establishing research infrastructure and initiating focal research projects, but also in terms of academic productivity.

This is reflected in the publication of peer reviewed papers with 27 in press, 11 in preparation, and 17 published as abstracts and/or conference papers. We also have organized 3 major conferences, International Collaboration in clinical Mental Health Research. Together, these achievement will serves as foundations for further development and even more fruitful achievements for the years to come.