Division of Mental Health and Addiction Medicine

Introduction | Mission | Advisory Committee |
Research Topics | Achievements | Members

Research Topics

Research Ward

This 20-bed psychiatric research ward, located at TCPC, will be the first of its kind in Taiwan. It represents a unique facility that is rarely available, even in the most "resource rich" countries, such as the U.S. The unit will be staffed with attending psychiatrists, research fellows, resident(s), research nurses, in addition to regular staff, and its operation will be assisted by an advisory committee.It will serve as the basis for the systematic search for effective intervention methods, particularly for the "treatment-resistant" patients, who still are prominently represented in the psychiatric patient populations despite remarkable progress in modern psychiatric therapeutics. Examples of innovative interventions include the use of glutamatergic agents with schizophrenic patients; the use of cognitive enhancing agents such as Gingko biloba for treating neurocognitive deficits of chronic psychiatric patients; studies on the mechanisms for weight gain and hyperglycemic effects of atypical antipsychotics; the role of "neuroleptic threshold" in the management of psychotic patients with typical neuroleptics; the use of neurprotective agents; pharmacokinetic/ pharmacodynamic studies; and studies focusing on various proposed endophenotypes (biomarkers).In collaboration with pharmaceutical companies, the unit also aims at participating in Phase I and II of the development of new drugs.

Taiwanese Psychiatric Research Network (TPRN)

Modeled after NHRI's Taiwan Cooperative Oncology Group (TCOG), as well as a number of highly successful nationwide research networks in the U.S. (e.g., NIH/NCI clinical trial networks; NIH Women's Initiative; NIDA's clinical trial networks; NIMH's Clinical Antipsychotic Trials of Intervention Effectiveness [CATIE] and Sequenced Treatment Alternatives to Relieve Depression [STAR*D]), this also will be the first in Taiwan to systematically coordinate psychiatric clinical researchers in order to achieve a higher level of synergy and benefit from economy of scale. Such an infrastructure will ensure consistency in research methodology, recruitment of subjects, adherence with protocols, the maintenance of good clinical practice, conformity to the requirements of governmental and regulatory requirements and ethical standards, as well as the uniformity, reliability, accuracy and validity of clinical assessment, data collection and processing.

As with TCOG, the TPRN also will be governed by an executive committee, under which quality control committee and intervention committee and various disease committees, will be established as needed.In addition to generating research protocols and determining priorities, these committees also will play a key role in formulating expert consensus and practice guidelines with special relevance to Taiwanese populations.

TPRN will enable researchers to examine various issues of practical and theoretical import. For example, although various antipsychotics and antidepressants have been shown to be highly efficacious, it is at present unclear as to which particular agent might be best suited for which patient, how these medications work in the "real life" clinical settings, what might be the best dosing strategies for individual patients, and how might serious side effects be avoided or minimized.TPRN also will serve as the basis for research on the clinical application of new advances in pharmacogenomics, contributing towards the realization of "personalized medicine" (see below). In addition, such an infrastructure should also be useful for other research projects requiring long-term, ongoing collaborative designs, such as studies on the nature course and phenomenology of psychiatric and addictive disorders.It should also serve to attract Phase III studies (controlled randomized trials) that are essential for pharmaceutical industry's efforts in bringing new drugs to the market.

Side by side with the establishment of TPRN, the Division also will explore with leaders in clinical psychiatry the feasibility and utility of establishing specialty clinics for the assessment and treatment of groups of patients with unique clinical features, such as patients particularly "resistant" to available treatment ("treatment resistant schizophrenia" and "treatment resistant depression"); or, conversely, those with particularly favorable outcome (e.g., definitive schizophrenic patients with complete recovery and good functioning levels and adjustment).

Research Laboratories

Research laboratories will be established both at TCPC and at NHRI's headquaters in Zhunan, for the purposes of supporting the Division's PIs in their works, for achieving the Division's goals, and for collaborative purposes. The laboratory at the TCPC site will be primarily devoted to supporting clinical and translational research, and will include a cold room, specimen processing and storage facilities (benches, freezers), genomic and cell biology laboratory research facilities.Facilities needed primarily for basic and mechanism oriented research will be located in Zhunan or other appropriate locations. These include high throughput facilities, research involving the use of transgenic animal models or neurimaging facilities.

Research Training Programs

Mechanisms for support will be offered to students, trainees, clinicians and researchers at different levels of their career paths to acquire needed skills and experiences for pursuing clinical, translational and basic research in clinical psychiatry and neuroscience. Most of these mechanisms have been established by NHRI. Information about their availability and relevance for psychiatrists, neuroscientists and behavioral scientists will be widely distributed. These mechanisms include support for medical students and residents for research experiences, research fellowship, career awards and support for oversea research training experiences. Possibility and feasibility of collaborative arrangement with universities will be explored for the development of specific training program(s) leading to Ph.D. and/or Master's degrees. Similar training and career development programs will be established for neuroscientists, behavioral scientists, research nurses and other research oriented mental health specialists.

"Bi-Drectional" Translational Research

In congruence with NHRI's overall mission and strategies, the Division promotes the fullest degree of integration between clinical and basic researchers, with the belief that the interaction and collaboration among researchers with divergent orientation, approaches and talents are essential for solving practical and theoretical issues central for the promotion of health for any population. Mechanisms, formal and informal, will be established and maintained to ensure such interactions and integrations.Facilities and talents outside the Division (both within NHRI and inter-institutional) will be catalogued for their potential for collaboration.As stated above, translation should not be unidirectional (from bench to bedside), as is usually conceptualized.Rather, it should be bidrectional and problem oriented. Clinicians and clinical researchers, as well as other "stakeholders" ("consumers," including policy markets patients and their caretakers), should be centrally included in the process of identifying issues worthy of careful scientific scrutiny, as well as priority setting. Depending upon the nature of the questions raised, teams with divergent expertise would then search for the most appropriate and state-of-the-art tools and approaches to tackle these problems. Results from these efforts then would lead to the next level of enquires, hypothesis generation and hypothesis testing, continuing to move the field forward.

Clinical Pharmacogenomics and "Personalized Medicine"

Current pharmacological practices tend to ignore or minimize individual and cross-group variations, which often are extremely sizable.Textbooks and package inserts provided by pharmaceutical companies give a fairly narrow range for dosing recommendations.Consequently, medications prescribed in the clinical settings are way too little for some, and grossly excessive for others. This approach of one size fits all often is the reason for poor treatment response, non-compliance, severe adverse effects, unnecessary hospitalization, and even mortality.Pharmacogenetics and pharmacogenomics hold great potential for addressing these issues.In fact, while the field continues to progress with a lightening speed, with much more valuable information still forthcoming, a great deal is already known about factors governing both the pharmacokinetics and pharmacodynamics of many drugs, and the technology is already there to put these into clinical use. What is missing is a systematic effort to create and package a clinical testing panel that could be widely and routinely used in the clinical setting, with information that could then assist clinicians in their decisions in the choice of drugs and titration strategies. This could conceivably lead to significantly better patient care, reduction in morbidity and mortality, improved functioning and quality of life and ultimately saving in health care cost, by not only shortening time needed for reaching the optimal medication regimen, but also the avoidance of unnecessary hospitalization secondary to either severe untowards effects or treatment non-response.

There are two types of research that need to be conducted in order to convert pharmacotherapy form "one size fits all" and "trial and error" to practices that are increasingly more individualized and rational. On the one hand, we need to test and demonstrate the clinical utility of such a panel, as well as the cost-effectiveness of such an approach. Concurrently, a number of logistic issues need to be worked out before it could be applied widely and routinely.These include the need to provide clinicians with easy to use, computerized information matching genomic information with the type of drugs that they are considering; procedures to ensure the validity of genomic results; legal and confidentiality considerations; and, the education of clinicians,pharmacists and other personnel in terms of the correct use of the information. Thus, despite the apparent simplicity of the concept, the tasks involved in making it a reality could be daunting, which may be a major reason for the delay in the clinical application of advances in pharmacogenomics. With some of the unique features discussed earlier regarding the research, clinical and administrative environment in Taiwan, there are reasons to believe that it might be relatively easier to have these tasks accomplished here. If this indeed is the case, then we would be the first to develop a model that could revolutionalize the practice of medicine. This would put Taiwan on the map as a leader of innovation in health care on a global level.

Psychoneuroimmunopharmacology

Recent studies indicate that the immune systems, including their cellular (glia cells) and humoral (e.g., cytokines) components, play crucial roles in neurodevelopment as well as the pathogenesis and prevention of neurodegenerative disorders.Research in this direction shows promise in deepening and broadening the field's understanding of the function of the brain, as well as psychiatric disorders.At the same time, such investigations have also led to the identification of chemicals that may be neuroprotective because of their ability to inhibit the proliferation of glia cells or to modulate other immunological reactions in the central nervous system.

Pharmacoepidemiology and pharmacogenomics

Taiwan is blessed with the existence of a unique national health services data system.Coordinated by NHRI's Department of Research Resources, datasets derived from this system are available for approved research, and are of high quality, comprehensive, and appropriately processed for confidentiality.Datasets for mental health havebeen established, which should be very helpful for examining issues related to services utilization, cost of various types of services, and longitudinal follow-up of patients' health and treatment status.Equally important, if not even more so, is that the inclusion of longitudinal medication information side by side with clinical (psychiatric as well as non-psychiatric) data, should allow researchers to examine not only medication utilization patterns and their relationship, type and intensity of care, and associated cost (e.g., frequency and length of hospitalization), but also their relationship with serious health problems (e.g., metabolic syndromes, blood dyscrasias).

In conjunction with other institutions and appropriate authorities, NHRI plans to explore systematically the possibility of linking these national health insurance datasets to other major datasets, such as records of clinical laboratory tests and other official official records, such as death certificates, domicile records and reports of attempted suicide.If successful, these linked datasets would further expand the range of issues that could be explored by researchers with divergent backgrounds and orientations.