G. Richard Smith, M.D., who served as the Director of the Psychiatric Research Institute and Chairman of the University of Arkansas for Medical Sciences’ Department of Psychiatry for 14 years,

recently stepped down as Dean of UAMS’s College of Medicine. Dr. Smith is being recognized for his 30-plus years of leadership with an endowed chair. The G. Richard Smith, M.D., Distinguished Chair in Personalized Medicine will be a tribute to the man who has meant so much to the scores of patients, students and faculty members he has helped during his career. It will also be a means of continuing his efforts to find new and more effective methods of treating mental illness.

The endowed chair will be the culmination of a $1.5 million campaign that is being conducted by PRI to fund research that could eventually change the way psychiatric disorders are treated. A patient’s genetic information has proven to be a valuable part of prevention, diagnosis, and treatment in mental disorders. PRI’s physicians are on the cutting edge of using genetic analysis to customize care for patients with refractory depression, which is the failure to improve despite multiple therapies with different types of anti-depressant medications. Using samples of DNA,

obtained by a simple saliva test, our physicians can generally determine why previously prescribed anti-depressants failed and predict which medications are most likely to work in the future. Genomic analysis will aid in shaping personalized strategies for treating these patients and increase the probability of successful outcomes.

Jeff Clothier, PRI’s Medical Director, who will be the first holder of the Smith chair, expects to use the funds raised to continue to support the Institute’s precision medicine program. “I think it will allow us to eventually identify biomarkers (measurable substances in an organism whose presence is indicative of a disease) for depression and other mental disorders,” says Dr. Clothier. “It will also allow us to personalize our treatment approaches for patients.”

PRI Development Director Betty Tucker says, “Rick has been a leader in the fight to reduce the stigma of mental illness, a forceful advocate for making evidence-based therapies the standard of care for behavioral health disorders, and an early proponent for the use of genetic analysis in the diagnosis and treatment of mental illness. We believe that history will point to Rick Smith as the national pioneer of the modern day comprehensive psychiatric research institute, and that endowing a Distinguished Chair in his name is the most appropriate way to commemorate his legacy.”

Anyone interested in making a donation to the G. Richard Smith, M.D., Distinguished Chair in Personalized Medicine can contact Betty Tucker at (501) 526-8134 or BATucker@uams.edu.

SPRING 2015 - A PUBL ICAT ION OF UAMS PSYCHIATRIC RESEARCH INST ITUTE

Endowed Chair to Honor Former Director of Psychiatric Research Institute

The G. Richard Smith, M.D., Distinguished Chair in Personalized Medicine is named after G. Richard Smith (above), the former director of the Psychiatric Research Institute.

The wintery mix of snow and ice in February and March left many Arkansans yearning for sunshine and warmer temperatures. I am proud to say that PRI’s faculty and staff did a remarkable job of maintaining our usual level of quality care despite the harsh weather and

less-than-favorable road conditions. That says a lot about the dedication of our team at PRI.

With spring upon us, many of us are turning our attention to the outdoors, and at PRI, we are no different. Even though PRI has been open over six years, one important component has remained uncompleted until now. We recently broke ground on the healing garden located outside PRI’s dining hall on the basement level, an area that has remained undeveloped but not forgotten. With the help of some very generous donors, Donna and Sen. Percy Malone and Vic Jacuzzi, the garden is on the verge of becoming a reality.

Gardens have always been associated with health and healing. Green, in fact, was a sacred color in ancient Egypt because it represented the hope of spring that brought new vegetation and life. One of the first programs to use plants in a therapeutic setting was established in 1879 at Philadelphia’s Friends Hospital after a physician noticed that psychiatric patients working in the hospital’s fields and flower gardens were calmer and that the gardens had a “curative” effect on them.

Research has shown that gardens such as the one we will soon have at PRI offer relief from symptoms, reduce stress and improve patients’ overall sense of wellbeing and hopefulness. Gardens also promote serenity and social interaction.

PRI is a unique facility, unlike any other of its kind, and this garden will be unique in the strength and warmth it will provide everyone who visits it. A lush, green location like the Donna and Senator Percy Malone Healing Garden will allow those who visit it to recognize the beauty that life offers and the value of social interaction.Best wishes,

Pedro L. Delgado, M.D.Director, Psychiatric Research Institute

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Not all scars are visible to the naked eye. Some are hidden under layers of pain, doubt and

discomfort. Those are the scars that Michael Cucciare, Ph.D., a psychologist with the Psychiatric Research Institute’s Division of Health Services Research, looks for in patients of the Burn Center at Arkansas Children’s Hospital. The only specialty facility of its kind in Arkansas, the Burn Center treats adult and pediatric patients as well as other complex wound and skin diseases.

Cucciare is part of a multi-disciplinary team consisting of physicians, nurses, social workers and physical and occupational therapists that relies on him to determine the mental well-being of the unit’s patients. Along with an intern, Cucciare sees as many as a dozen patients a week at ACH. It’s his job to evaluate the patients for mental health issues, such as depression, acute stress and post-traumatic stress disorder, commonly associated with their injuries.

“We try to identify any psychological issues that may be present and then support them in obtaining appropriate care whether in clinic or referral to an outside agency,” says Cucciare, who joined PRI’s faculty in 2013. “My job is also to support patients in managing their wounds and follow recommendations made by the medical team, like stretching an area with scarring, wearing garments, or engaging in appropriate wound care.”

The burn unit is actually composed of three clinics, all of which refer patients to Cucciare. The first is the acute inpatient unit, which provides care to individuals from Arkansas and surrounding states who have been recently injured. The second clinic is an outpatient clinic, where patients who have been discharged from the hospital but are still in need of medical care are seen. The last, the plastics clinics, teaches patients about health behaviors like scar management and provides special garments designed to minimize scarring.

“We will often see patients within a day or two after they have arrived on the unit,” says Cucciare. “The clinical staff does a wonderful job of including mental health as an integral component of the overall treatment plan and involving us, when needed, as soon as possible.”

Pain Just Part of the ProblemPsychologist Helping Burn Victims Overcome Issues Related To Injuries

Following his evaluation, Cucciare will look into methods of treatment best suited to that patient’s needs. Some may require brief interventions such as relaxation training to help manage anxiety about a procedure, while others may require more intensive intervention including cognitive behavioral therapy for pain management or depression.

“Cognitive therapy is often helpful for those patients dealing with the adjustment of getting back to their lives after an injury. Not being able to do things they used to do like working or engaging in leisure activities can lead to depression, and I try to help them deal with that.”

One recent patient was hospitalized after receiving burns to more than 50 percent of his body. He spent several weeks in the hospital before being discharged and returning home to heal. After

being used to working up to 10 hours a day, the patient could only perform minimal tasks and soon began to display signs of depression, according to Cucciare.

“I tried to educate him about why he was feeling this way, that his feelings were due to the fact that he couldn’t do a lot of the things that brought him pleasure,” says Cucciare, who encouraged the patient to try some new activities that he could participate in while healing. Because of the patient’s limited mobility, Cucciare also recommended that he reach out to friends and family to ask them to visit him “since he couldn’t go to them.” He added that the patient is currently undergoing counseling in his community as well as seeing Cucciare at ACH every three or four months.

Younger patients, some no more than a few years old, may suffer from nightmares or outbursts of anger as a result of their injuries, says Cucciare. “We often work with parents, talking with them about their child’s emerging behaviors,” he says, adding that in some cases he refers these families to PRI’s Child Study Center for further evaluation.

It’s not unusual to see stress or depression show up a year or two after a severe injury, says Cucciare. Those patients may need to see a therapist on a regular basis, so Cucciare tries to handle any questions they may have before referring them to a counselor in their hometown.

“Our goal is to address the wounds they have, no matter what they are, and start them on the pathway to getting the help they need.”

Dr. Michael Cucciare (right) talks to intern Hugo Morais about a patient in one of the Burn Center’s exam rooms.

Patients in need of an organ transplant must undergo a wealth of tests to determine if they are a suitable candidate, but not all of those tests are related to physical health. PRI’s neuropsychologists, Jennifer Gess, Ph.D., ABPP, and Jennifer Fausett, Ph.D., ABPP, and clinical psychologist Joshua Cisler, Ph.D., work with the transplant teams at UAMS to assess the mental and cognitive soundness of patients seeking transplants.

Gess and Fausett work with liver transplant candidates while Cisler handles patients seeking kidney transplants. According to Gess, there’s a greater risk for cognitive impairment in liver patients, making it important to have neuropsychologists involved in that evaluation process.

Because of the shortage of donor organs, the mental health evaluation is extremely important to ensure that patients will benefit from receiving a transplant. The neuropsychological and psychological evaluations are conducted to not only make sure that the patient understands the transplant process but that they don’t have any psychiatric or cognitive problems that might adversely affect the surgery’s outcome. The transplant team also relies on the evaluation to better understand the candidate’s strengths and coping skills before and after their surgery.

“The psychological evaluation consists of a one-hour clinical interview to assess mental and medical health history, and about one-and-a-half hours of psychological and personality testing,” says Cisler. “The purpose is to make sure there are not any psychological factors that might interfere with a successful (kidney) transplant.”

Liver patients undergo a similar process

with Gess and Fausett, with an interview followed by two hours of testing to assess psychological functioning and cognitive skills, i.e., attention, memory, processing speed, etc.

“Someone who has significant cognitive impairment or dementia

and who is without support may not be able to remember to take their medications or make appointments,” says Gess. “We have to make sure they will be able to manage their post-transplant care, which can be very complicated.”

Because liver problems are associated with a large number of diseases, Gess and Fausett see young patients in their 20s as well as those in their 70s. “A 20-year-old with liver disease could have as hard a time with his or her memory as someone with dementia,” says Gess, pointing out that mental confusion is one of the primary symptoms of advanced liver disease due to dysregulation of ammonia and sodium in the bloodstream.

Certain moods and personality factors are taken into consideration in determining a candidate’s potential for success, says Gess, one being their attitude toward their health-care team. “We want to know how likely they are to follow their advice,” says Gess. “We want to know if they are going to be able to take care of the organ. Emotional instability or cognitive decline, those are the primary things that we are looking for.”

Gess, who describes her group’s role as “one small cog in this transplant wheel,” says the neuropsychological and psychological evaluations are done to uncover anything that could get in the way of a successful transplant. “We don’t provide the defining yes or no,” says Gess, whose reports to the transplant team often include recommendations for treatment of any cognitive limitations. “Our job is to point out potential roadblocks to a good outcome.”

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PRI Team Charged With Evaluating Transplant Candidates

Jennifer Gess, Ph.D. Jennifer Fausett, Ph.D. Joshua Cisler, Ph.D.

Salomon Latest Addition To PRI Faculty

Ron Salomon, M.D., a former associate professor at the Feinberg School

of Medicine of Northwestern University, joined the PRI faculty on March 16. He is seeing patients on an outpatient basis as well as serving as a consultation liaison psychiatrist with the UAMS Medical Center. He will also be conducting research in several areas, including brain imaging and transcranial magnetic stimulation.

A graduate of the Massachusetts Institute of Technology, Salomon received his medical degree from the ’Université de l’État à Liège in Belgium. He completed his psychiatric residency in 1987 at the University of Connecticut, where he served as an assistant professor. He would later join the Department of Psychiatry at Yale University, where he worked with PRI Director Pedro Delgado, M.D. Salomon joined the faculty of the Vanderbilt University School of Medicine in 1995, eventually becoming an associate professor, a position he held until he went to Northwestern in 2014.

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Information on GivingBetty Tucker, J.D., Senior Development Director of PRI (501) 526-8134 or batucker@uams.edu.

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New Interventions For Depression

Depression is more than just a feeling of sadness, it is a serious medical condition that affects one in 10 adults in this country. There are numerous methods of treating depression, most of which involve a combination of medication and cognitive therapy.

Now a drug approved by the U.S. Food and Drug Administration as an anesthetic is being used to treat patients with major depression, and PRI’s Jeff Clothier sees it as a quick and effective means to treating those who have not responded to other treatments.

“The bottom line is that depression is one of the most prevalent disabling conditions in the world right now,” says Clothier, PRI’s medical director. The American Psychiatric Association estimates that 80 to 90 percent of depressed patients show some response to treatment, but for those that don’t, ketamine offers an alternative, says Clothier.

PRI is one of less than two dozen facilities in the United States currently prescribing ketamine for patients with severe depression. The drug was developed in the early 1960s and is used as an anesthetic in surgical settings, where it has a remarkably safe track record. The difference between ketamine and commonly prescribed antidepressant drugs, says Clothier, is the response level.

“We’ve seen patients respond to ketamine within a half hour to three days,” he says. The first cases at PRI involving ketamine, which is administered through an intravenous infusion, saw the moods of patients change within minutes, says Clothier. “We had patients who had their infusion in the morning ask to be discharged in the afternoon.”

Research is ongoing as to the

manner in which ketamine relieves depressive symptoms. Studies from Yale University and the National Institute of Mental Health have shown that the drug appears to cause a burst of new connections to form between nerve cells in the parts of the brain that involve emotion and mood. At least 30 patients at PRI in the last year have received ketamine, many of whom were suffering from suicidal thoughts. At least 80 percent of those patients showed dramatic success, says Clothier.

“I’ve had more than one patient tell me it’s been lifesaving.”

One of the reasons that ketamine is not used in more cases is that insurance companies have yet to agree to include it in their coverage. Another is that its effectiveness is short-lived, its effects lasting no more than one to two weeks, says Clothier.

“Because it acts so quickly, we can use ketamine to treat patients in need of quick relief, like those who are threatening to commit suicide, and then come up with some other medications that will provide a more durable effect.”

Another option for those dealing with

depression may be transcranial magnetic stimulation (TMS). Unlike ketamine, TMS is covered by many insurance health plans, is non-invasive and uses precisely targeted magnetic pulses rather than medication. PRI, which recently purchased a TMS apparatus, hopes to be offering TMS as a treatment alternative later this year, according to Clothier.

Mind Matters is published by the UAMS Psychiatric Research Institute in partnership with UAMS Communications & Marketing. Tim Taylor, Editor. Designed by UAMS Creative Services.