Medical Student Research Fellowship for Summer 2012
Mentor: E. Sherwood Brown, M.D., Ph.D.
Department: Psychiatry
Room number: FL8.832 (Paul M. Bass Administrative and Clinical Center)
Mail Code: 8849
Phone number: 214-645-6950
E-mail: sherwood.brown@utsouthwestern.edu
Project title: Antidepressant Treatment at an Inner City Asthma Clinic
Human subjects IRB approved project number (where applicable): 072010-235
Animal subjects IRB approved project number (where applicable): NA
Project Type patient-based research
Brief Description of Project: Asthma is a common, severe, and debilitating medical condition. The prevalence of asthma and asthma-related morbidity and mortality has increased in recent years. Data suggests that depressive symptoms and disorders are common in asthma patients and may be a risk factor for asthma-related morbidity. However, minimal data are available on the treatment of persons with depression and asthma
We are conducting a definitive antidepressant trial in outpatients with asthma and major depression based on pilot study information gained regarding effect sizes, predictors of response, and sensitivity of outcome measures. A 12-week randomized, double-blind, placebo-controlled, acute phase trial of escitalopram is ongoing in 80 outpatients with asthma and major depression with a baseline Hamilton Rating Scale for Depression score of ≥ 20 and who frequently require oral corticosteroids and in a group of 142 depressed asthma patients with less severe depression and/or less frequent corticosteroid use. A 12-week continuation phase for depression responders is included. Changes in Asthma Control Questionnaire scores (primary outcome measure), oral corticosteroid use, depressive symptoms, quality of life, and asthma medication adherence are assessed as well as the relationship between changes in depressive and asthma symptom severity. The findings will have implications for asthma treatment.
Project title: Reversing Corticosteroid-induced Memory Impairment
Human subjects IRB approved project number (where applicable): 082010-100
Animal subjects IRB approved project number (where applicable): NA
Project Type patient-based research
Brief Description of Project: In animals and humans, stress and corticosteroid excess is associated with changes in memory and hippocampal structure. A consistent finding during corticosteroid exposure is a decline in performance on declarative memory tasks. The human literature is quite limited. In animals, hippocampal changes secondary to corticosteroids can be attenuated with agents that modulate excitatory amino acids. Histological changes can be prevented and reversed with phenytoin, a glutamate release inhibitor, or an N-methyl-D-aspartate (NMDA) receptor antagonist.
We are conducting a randomized, double-blind, placebo-controlled pilot study of lamotrigine in 50 outpatients receiving chronic oral corticosteroid therapy. We hypothesize that the group receiving lamotrigine will show improvement in declarative memory relative to the placebo group. We also assess NAA and glutamate using spectroscopy and hippocampal and amygdala volume using structural magnetic resonance imaging. The findings will have implications for patients with major depressive disorder and the millions treated each year with prescription corticosteroids.
Project title: Citicoline for Bipolar Disorder and Cocaine Dependence
Human subjects IRB approved project number (where applicable): 122007-039
Animal subjects IRB approved project number (where applicable): NA
Project Type patient-based research
Brief Description of Project: Drug abuse or dependence is extremely in common in patients with bipolar disorder and is associated with increased rates of hospitalization, poor outcome during hospitalization, violence towards self and others, and non-adherence to bipolar disorder treatment. The abuse of cocaine and other stimulants is particularly common in patients with bipolar disorder. However, minimal data are available on the treatment of these patients. We are conducting a 12-week randomized, double-blind, placebo-controlled, add-on trial of citicoline (2000 mg/day) in 130 outpatients with bipolar I disorder and cocaine dependence. Participants are evaluated three times each week for cocaine use with urine drug screens, weekly for assessment of self-reported cocaine use and craving, and weekly for depressive and manic/hypomanic symptom severity. Executive functioning, attention, and working and declarative memory are assessed at baseline and weeks 3, 6, and 12. Medication adherence is monitored by self-report and with metered dosing caps. Manual based cognitive-behavioral therapy specifically designed for people with bipolar disorder and substance abuse is provided to both treatment groups. Concomitant medication changes, when necessary, are managed using a treatment guideline. We hypothesize that citicoline therapy will be associated with decreased cocaine use and improvement in cognition.
Previous Research Activities or Publications with Medical Students:
Jacob Moore (MSII, UTSW) Summer 1999
Zielinski TA, Brown ES, Nejtek VA, Moore JJ, Rush, AJ: Depression in asthma: Prevalence and clinical implications. Primary Care Companion to the Journal of Clinical Psychiatry. 2:153-158 (2000).Nejtek VA, Brown ES, Khan DA. Moore JJ, Van Wagoner J, Perantie DC: Prevalence of mood disorders and relationship to asthma severity in patients at an inner-city asthma clinic. Annals of Allergy, Asthma & Immunology 87:129-133 (2001).
Wendy Chamberlain (MS II UTSW) Summer 2001, Pooja Peranjpe (MS II Summer 2002)
Brown ES, Chamberlain W, Dhanani N, Paranjpe P, Carmody T, Sargeant M: An open label trial of olanzapine for corticosteroid-induced mood symptoms. Journal of Affective Disorders 83:277-281 (2004)
Jason Longoria (MSII, UTSW) Summer 2002
Longoria J, Brown ES, Perantie DC, Bobadilla L, Nejtek VA: Quetiapine for alcohol use and craving in bipolar disorder. Journal of Clinical Psychopharmacology, 24:101-102 (2004)
Jennifer Lee (MSII, UTSW) Summer 2002
Lee JW, Brown ES, Perantie DC, Bobadilla L: A comparison of single-item visual analog scales with a multi-item likert-type scale for assessment of cocaine craving in persons with bipolar disorder. Addictive Disorders & Their Treatment 1:140-142 (2002).
Tonia Yee (MS II, UTSW) Summer 2003
Yee T, Perantie D, Dhanani N, Brown ES: Drug dreams in patients with bipolar disorder and cocaine dependence. Journal of Nervous and Mental Disease 192:238-242 (2004).
Yee T, Perantie DC, Dhanani N, Brown ES: Are dreams about drugs, substances, or treatment the royal road to prediction of treatment outcome?: reply to Gerevich and Meggyes. Journal of Nervous & Mental Disease 192: 720 (2004).
Sandra Bolanos (MS I UTSW) Summer 2003
Bolanos SH, Brown ES, Khan DA, Hanczyc M, Bauer MS, Dhanani N: Assessment of mood states in patients receiving chronic corticosteroid therapy and in controls with patient-rated and clinician-rated scales. Annals of Allergy, Asthma, & Immunology 92: 500-505 (2004).
Rattapol Srisinroogruang (MS II UTSW) Summer 2003
Srisinroongruang R, Dhanani N, Bauer MS, Brown ES: Comparison of the internal state scale to clinician-administered assessments in patients with bipolar disorder and alcohol abuse or dependence. Journal of Dual Diagnosis 1:61-69 (2005).
Felicia Akingbala (MS II UTSW) Summer 2003
Akingbala F, Dhanani N, Brown ES: Impulsivity in patients with bipolar disorder and cocaine or amphetamine dependence given lamotrigine. Journal of Dual Diagnosis 2: 73-83 (2006).
O. Lizette Solis (MS II UTSW) Summer 2004
Solis OL, Khan DA, Brown ES: Time of onset of major depression in inner-city adults with asthma. Psychosomatics 47: 330-32 (2006).
Joshua Mitchell (MS I UTSW) Summer 2004
Mitchell JD, Brown ES, Rush AJ: Comorbid disorders in patients with bipolar and concomitant substance dependence. Journal of Affective Disorders 102:281-287 (2007).
Rebecca Oppedal (MS I UTSW) Summer 2004
Oppedal,RJ, Khan DA, Brown ES: Hypothyroidism in Patients with Asthma and Major Depressive Disorder. The Primary Care Companion to the Journal of Clinical Psychiatry . 9: 467-468 (2007).
Giacomo Meeker (MS II UTSW) Summer 2005
Brown CK, Meeker G, Brown ES: Examination of a possible interaction between prednisone and newer antidepressants. Primary Care and Community Psychiatry 10:143-147 (2005).
Elizabeth Tucker (MS I UTSW) Summer 2005
Osuji IJ, Tucker E, Brown ES: Declarative memory in patients with bipolar disorder and stimulant abuse given lamotrigine. Journal of Dual Diagnosis 4:303-319 (2008).
Justin Wolfshol (MS II UTSW) Summer 2006
Brown ES, Wolfshohl J, Shad MU, Vazquez M, Osuji IJ: Attenuation of the effects of corticosteroids on declarative memory with lamotrigine. Neuropsychopharmacology 33:2376-2383 (2008).
Kim-Chi Nguyen (MS I, UTSW) Summer 2007
Nguyen K-C, Brown ES: “Psychotic Disorders in Women with Substance Abuse” in Women and Addiction: A Comprehensive Handbook, Brady K, Back S, Greenfield S, eds. The Guilford Press, New York, NY 257-268 (2009).
Shuchi Desai and Sadia Khanani (MS I UTSW) Summer 2008
Desai S, Khanani S , Shad MU, Brown ES: Attenuation of amygdala atrophy with lamotrigine in patients receiving corticosteroid therapy. Journal of Clinical Psychopharmacology 29:284-287(2009). Brown ES, Denniston D, Gabrielson B, Khan DA, Khanani S*, Desai S*: Randomized, double-blind, placebo-controlled trial of acetaminophen for preventing mood and memory effects of prednisone bursts. Allergy & Asthma Proceedings 31: 4, 331-336 (2010).
Sumuel Kuzminski (MS I UTSW) Summer 2006
Husain S, Kuzminski S, Shad MU, Gabrielson B, Bret ME, Osuji IJ, Brown ES: Cognition and dorsolateral prefrontal cortex volume in corticosteroid-treated patients given lamotrigine. Stress and Health 27: 18-22 (2011).
Minh-Tu Hoang (MS 0 UTSW) Summer 2010
Hoang MT, DeFina LF, Willis BL, Leonard DS, Weiner MF, Brown ES: Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: The Cooper Center longitudinal study. Mayo Clinic Proceedings 86:11, 1050-1055.