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John M. Oldham, MD, MS Senior Vice President and Chief of Staff The Menninger Clinic

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

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John M. Oldham, MD, MS Senior Vice President and Chief of Staff The Menninger Clinic

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  1. Behavioral Health Forum:Integrating the Science and the Practice for the FutureUniversity of Texas MD Anderson Cancer CenterHouston, 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

  2. Changing Stages in the Field of Psychiatry

  3. 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

  4. Mental Disorders are Chronic and Disabling WHO 2008

  5. 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

  6. 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

  7. Mental disorders are the chronic diseases of the young

  8. The Most Costly Conditions

  9. High Heritability of Mental Disorders Insel, JCI, 2009

  10. Depression as a Brain Disorder Hopelessness, helplessness, suicidal thoughts, anorexia, loss of libido, sleep disturbance Insel, Sci Am, 2010

  11. Cumulative Mortality for Depressed and Non-depressed Patients Following Heart Attack 30 Depressed (n = 35) Nondepressed (n = 187) 25 20 15 Mortality (%) 10 5 0 0 1 2 3 4 5 6 Months After Heart Attack Frasure-Smith N et al. JAMA. 1993;270:1819-1825.

  12. Normal Stress + Heritable Risk  Depression Antidepressants and/or Psychotherapy Glucocorticoids Serotonin and NE BDNF BDNF Glucocorticoids Normal Survival and Growth Atrophy/Death of Neurons Increased Survival and Growth Modified from Duman, Heninger, Nestler, AGP 54(7):597-606, 1997 • Other neuronal insults: • Hypoxia-Ischemia • Hypoglycemia • Neurotoxins • Viruses Genetic Factors

  13. 500 ~ 1,329,000 Projected Deaths in 2000 400 300 Deaths per 100,000 200 ~ 514,000 Actual Deaths in 2000 100 95 50 55 60 65 70 75 80 85 90 00 Year Impact of Research on Heart Disease • 63% decrease in mortality • ~ 1 million early deaths averted per year • $2.6 trillion in economic return • New, effective treatments and prevention strategies

  14. Number of Survivors 9 6 Millions of People 3 1971 1986 1990 2003 Impact of Research on Cancer • For the first time in recorded history, annual cancer deaths in the United States have fallen • 10 million survivors

  15. Impact of Research on Mental Illness • Diagnosis is by observation, detection is late, prediction is poor. • Etiology is unknown; prevention is not well-developed 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

  16. NIMH Research Domain Criteria (RDoC):Transforming Diagnosis GWAS Sequencing Transgenics Epigenetics Databases Stem Cells RNAseq Proteomics Optical imaging Databases Electrode arrays Connectomics Imaging Databases Sensors Eye gaze Cognitive tools Epidemiology Databases Web 2.0 Knowledge management Molecule Cell System Individual Social

  17. Cost of Genomic Sequencing - T Insel, 2012

  18. The Menninger Mental Health EpicenterGoal: “The MD Anderson of Mental Health”

  19. 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

  20. 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)

  21. Thank you for your interest

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