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New York State Psychiatric Institute 

New York State Psychiatric Institute, established in 1895 in New York City, was one of the first institutions in the United States to integrate teaching, research, and therapeutic approaches to the care of patients with mental illnesses. Due to consistent support from New York State and its intimate partnership, beginning in 1925, with the Psychiatry Department at Columbia University Medical Center, New York Psychiatric Institute has made fundamental and abundant contributions to our knowledge of psychiatry. <> History New York State Psychiatric Institute (NYSPI) was originally established as The Pathological Institute of the New York State Hospitals when the New York legislature decided to take responsibility for all chronically mentally ill individuals in the state. The Institute was founded to serve all state hospitals as a central pathology laboratory. However, the Institute’s first director, Ira Van Gieson, had grander visions for the facility. At a time when the mentally ill were isolated in bucolic surroundings to recover, or warehoused in crowded facilities that provided custodial care, Van Gieson persuaded the New York State Commission in Lunacy to allow him to study psychiatric disorders from multidisciplinary perspectives. He then recruited top scientists to pursue research in neurobiology, genetics, epidemiology, psychology, and related fields. Van Gieson’s tenure ended after four years because many politicians believed that basic research was a luxury irrelevant to clinical care and education. However, Theodore Roosevelt, then governor of New York, hired a new Commissioner who changed the course of events. Consequently, under the leadership of director Adolph Meyer, the Pathological Institute was renamed New York State Psychiatric Institute, added education as one of its missions, and collaborated with state hospitals to conduct research. These changes eventually sparked the groundbreaking recognition of the connection between mental and physical states when researchers at NYSPI and the Rockefeller Institute for Medical Research discovered that psychosis—a mental state—might have a tangible cause—in this case, a syphilis infection. Knowing the origin of the syphilis-induced psychosis enabled other scientists to find a cure, namely treatment with penicillin. Subsequent heads of NYSPI included August Hoch, George Kirby, Lawrence Kolb, Edward Sachar, Herbert Pardes, and its current director, Jeffrey Lieberman. In 1925, NYSPI became officially affiliated with Columbia University and Presbyterian Hospital, and moved to Washington Heights in Manhattan to be near them. As part of this arrangement, the Director of the Institute also served as the Chair of the Department of Psychiatry of Columbia University and Chief of Psychiatric Services at NewYork Presbyterian Hospital. Further, Columbia legitimized almost all of NYSPI’s educational programs, giving faculty appointments to teachers and diplomas to residents. As NYSPI’s research agenda, training programs, and extramural funding grew, the Institute expanded geographically, adding new buildings in 1983 and 1998. Structure NYSPI has over a thousand research scientists and faculty members, encompassing 22 Research Divisions, an Education Division, over a dozen Centers, and 17 research clinics. Research Divisions The Research Divisions cover the breadth of psychiatric medicine, from basic to applied (translational) research, in ways that overlap in terms of subject and methods of investigation. For example, many divisions use imaging and epidemiological research methods. Historically, Divisions have sometimes acted like fiefdoms, but there is also much collaboration between and among faculty in different Divisions on substantive projects, as [summaries of the Divisions current projects] reveal. Further, the Division of Biostatistics and Data Coordination, directed by Naihua Duan, supports NYSPI investigators on a wide range of tasks, from conducting analyses of statistical power to analyzing data in addition to producing findings about biostatistical methodologies of relevance to psychiatric research. From Childhood to Old Age NYSPI Divisions cover the lifespan from birth to old age. Bradley Peterson’s Child and Adolescent Psychiatry Division has an extensive program with state-of-the-art neuroimaging; therapeutic trials with medication and psychotherapy; and epidemiological studies. One of the Division’s significant discoveries in 2009 was that individuals whose parents or grandparents had depression tended to have a thinning of the right cortical region of their brains, which might indicate a risk for this disorder. <> The Geriatric Psychiatry Division, under Devangere Devanand, conducts pioneering work on dementia. Recent work shows how olfactory deficits can serve as an early diagnostic marker of Alzheimer’s disease and how neurogenesis is necessary for the therapeutic effects of antidepressants. Diagnosis and Treatment NYSPI Divisions also study diagnosis and treatment. The Division of Clinical Phenomenology, headed by Jean Endicott, continues to define psychopathology and develop tests to measure it. The Division also conducts research on eating disorders, depression, bipolar disorder, schizophrenia, and substance use disorders. The Division of Clinical Therapeutics, directed by Timothy Walsh, focuses on anxiety, eating disorder, Lyme disease, and other subjects. It participated in the “Sequenced Treatment Alternatives to Relieve Depression” (STAR*D), a major NIMH clinical trial that found that people with persistent depression can get well if they try several treatments, but the more treatments people try, the worse their chances for recovery. Other Divisions also consistently make discoveries that influence treatment in psychiatry. Sarah Lisanby’s Division of Brain Stimulation and Therapeutic Modulation specializes in the use of emerging electromagnetic means of modulating brain function, such as deep brain stimulation (DBS), electroconvulsive therapy (ECT), and vagus nerve stimulation (VNS), to probe the circuitry underlying brain-based disorders. The FDA recently gave transcranial magnetic stimulation (TMS) an indication for treatment-resistant depression based on the research of this Division. Herbert Kleber’s Substance Abuse Division focuses on the antecedents and consequences of substance use and abuse, with an emphasis on the development and testing of new approaches to treatment. A major strength of this Division is its ability to conduct safety and effectiveness trials with human laboratory models, and then to use the results of these studies to inform the design of larger scale clinical trials--an asset leading to its rank as one of the top three in the country. Human Behavior Divisions that contribute directly to our understanding of human behavior include Behavioral Medicine, the HIV Center, and Developmental Neuroscience. Richard Sloan’s Behavioral Medicine Division strives to understand the contributions of psychological, psychosocial, and behavioral factors to the onset, progression, and management of physical and mental disease; identify the relevant pathophysiological mechanisms of linking psychological states to disease; and develop treatments targeting these mechanisms. Anke A. Erhardt’s HIV Center for Clinical and Behavioral Studies, one of the oldest and most productive continuously funded AIDS research centers in the United States, focuses on sexual risk behavior and gender to design interventions to reduce HIV risk among children and adolescents, heterosexual women and men, persons who engage in same-sex behavior, and people with mental illness. Its goal is to help HIV+ individuals, especially those at greatest risk and often disenfranchised, cope with infection. Michael Myers’ Developmental Neuroscience Division focuses on processes involved in the development of behavior and fundamental relationships between behavior and biology using novel animal models to investigate the neurobiological substrates of separation anxiety, fear responses, and pain regulation. Studies involving human subjects examine the role of pre- and post-natal experiences on fetal, infant, child, and maternal behavior and physiology. Neurosciences NYSPI’s preeminence in the neurosciences is due to Divisions which study the brain-behavior connection at the molecular, cellular, and neural levels. They include some of the Divisions described above, as well as the Divisions of Integrative Neuroscience, Molecular Therapeutics, Neurobiology and Behavior, Cognitive Neuroscience, and Translational Neuroscience, headed by Rene Hen, Jonathan A. Javitch, Michael Goldberg, Edward E. Smith, and Anissa Abi-Dargham respectively. Integrative Neuroscience uses animal models to find out how antidepressants create new neurons in the hippocampus, which causes the medications to work; how structural changes in the amygdala during adolescence increase the risk for anxiety and addiction disorders; how neurodegenerative diseases, such as Alzheimer’s disease, might be prevented; and many other connections between pathophysiology and psychiatric illness. Molecular Therapeutics focuses on understanding molecular and cellular processes that underlie behavior, with an emphasis on existing or novel targets for therapeutic intervention in psychiatric disorders. The Division has a specialized expertise in dopaminergic signaling and its role in schizophrenia and drug abuse. Neurobiology and Behavior uses experimental, theoretical, and computational techniques to investigate learning and memory, attention, perception, and affective behavioral traits that may be involved in a wide range of disorders. Recent discoveries with practical applications include the finding of Nobel laureate Eric Kandel and Daniela Pollak that conditioning mice to associate a specific noise with protection from harm, a behavior called “learned safety,” produced a behavioral antidepressant effect comparable to medications. Cognitive Neuroscience investigates brain-behavior relationships and the cognitive and neurobiological mechanisms underlying psychiatric disorders. Research involves both laboratory-based assessment and clinical trials, and ranges from defining the impact of patient and doctor expectations on the outcome of antidepressant clinical trials to the neurophysiology of memory deficits in schizophrenia. One recent significant finding is that EEG measures are of potential value for predicting whether a depressed patient will benefit from treatment with an SSRI antidepressant. Molecular Imaging and Neuropathology spans the research spectrum from basic cell biology to in vivo imaging, molecular genetics and treatment trials. It emphasizes translational research and employs a multidisciplinary approach to psychiatric research to examine the biological substrate of mental illness at multiple levels. Specific work includes neuroanatomical mapping, quantitative morphometric and gene expression studies in brain, postmortem brain studies of psychiatric disorders, and the provision of neuropathology services to the New York State Office of Mental Health. The Division maintains an archival collection (brain bank) of these specimens as well as other brain specimens collected for research purposes. In addition, the Division has three centers: Moody Center for the Study of Early Onset Bipolar Disorder; the Suicide Intervention Center; and the Silvio O. Conte Center for the Neuroscience of Mental Disorders: The Neurobiology of Suicidal Behavior. Psychiatric and Medical Genetics The Division of Psychiatric and Medical Genetics, headed by Nikki Erlenmeyer-Kimling, elucidates the mechanisms and genetic liabilities underlying psychiatric disorders and other behavioral anomalies. This Division has made many significant discoveries since the1930s in its search for specific risk factors--including neurocognitive and other biobehavioral endophenotypes--that may predict schizophrenia, bipolar disorder, and other neurobehavioral disorders. Recently, Division researcher Nancy Wexler led a study in Venezuela of the world's largest family with Huntington's disease, developing a pedigree of over 18,000 individuals and collecting over 4,000 blood samples. This helped to identify the Huntington's disease gene at the tip of human chromosome 4. Wexler’s study was the first time DNA markers had been used to locate genes. Her approach became widely used to investigate the genetic basis of other inherited diseases and helped launch the Human Genome Project. Epidemiology Other Divisions that use epidemiological approaches include the Divisions of Epidemiology, Epidemiology of Substance Abuse, and Social Psychiatry. Epidemiology studies the risk of psychiatric disorders associated with genetic, social, and environmental factors, and develops interventions and programs to reduce these risks. Research methods, sometimes used in collaboration with colleagues from other Divisions, include genetic studies, community surveys, and imaging, to advance our knowledge of four related areas: genetics/high risk research; epidemiology/health services; prevention/therapeutics; and international mental health. Recently Division Chief Myrna Weissman, long a pioneer in the epidemiology of depression, showed, with her colleagues, that the remission of depression in mothers had long-lasting positive effects on their children, and that there was a connection between early onset recurrent depression and chromosome 15q25-q26. Epidemiology of Substance Abuse, headed by Denise Kandel, investigates the natural history of drug involvement, the risk factors and consequences of drug abuse, and comorbidity of substance abuse with problem behaviors and psychiatric disorders among adolescents and adults. Research focuses on cigarette smoking and nicotine dependence, and involves epidemiological studies based both on general population samples and secondary analyses of national data sets. <> Social Psychiatry, led by Bruce P. Dohrenwend, studies major substantive and methodological issues in psychiatric epidemiology. The methodological research centers on how to conceptualize and measure major stressful life events as risk factors for the development of these disorders. The substantive research focuses on the role of adversity and stress in the onset and course of psychiatric disorders differentially related to gender, ethnic/racial background, and socioeconomic status. Studies on stigma, mental illness, violence, and their interrelationships, headed by Bruce G. Link, influence the way epidemiologists view these phenomena. <> Ethics and Policy in Mental Health Services The Division of Law, Ethics and Psychiatry, headed by Paul S. Appelbaum, focuses on the practice of psychiatry (including psychiatric research), and on the role of psychiatry in the legal process. Subjects of study include Internal Review Board (IRB) function, adequacy of informed consent to research, physician participation in lethal injection, and the influence of advances in genetics on the decision making of physicians. The Division is extensively involved in the education of students, faculty and staff through collaborations with the Irving Institute for Clinical and Translational Research and the Columbia Law School. The Division of Mental Health Services and Policy Research, established as a partnership with the New York State Office of Mental Health in 2007, and led by Susan Essock, examines the structure, content, and outcomes of services as they occur in real world settings. Researchers study what interventions help most in allowing people to maximize their recovery from mental illnesses. This includes examining what interventions work, how well they work, for whom they work best, the cost of these interventions, and the organizational and financing strategies that allow effective interventions to be implemented and sustained. Research topics include the impact of Timothy’s Law, PSYCKES (an award-winning, web-based application to upgrade the quality of psychotropic prescribing practices), ACT, metabolic monitoring in state psychiatric hospitals, violence and the mental ill, and many other challenging and critical issues. Education The NYSPI and the Columbia University College of Physicians and Surgeons have a single residency program, which is one of the finest in the world. <> Centers

NYSPI has over a dozen Centers. Centers funded by the National Institutes of Health include: ACISR: Pediatric Psychiatry Disorders DCIPS: Intervention with High Suicide Risk Populations Pathological and Functional Impact of Tauopathy In Vivo Neurobiology of Dopamine in Schizophrenia Substance Abuse Medications Development Center Suicide and Mood Disorder Conte Center

Additional Centers include: Lieber Center for Schizophrenia Research and Treatment Psychoanalytic Center Reiner Center for Behavioral and Psychosomatic Medicine Ruane Center for Early Detection of Mood Disorders Sackler Center for Developmental Psychobiology The Morris W. Stroud III Center for Study of Quality of Life Imprints Center Center for Excellence in Cultural Competence Research Clinics NYSPI has 17 research clinics which offer free treatment or financial compensation in exchange for the participation of eligible patients in studies. Several clinics investigate depression, including the clinics for Mid and Late Life Depression. Special Resources The close relationship between NYSPI and the Columbia University Medical Center provides innumerable benefits. In addition to collaborations with faculty of the College of Physicians and Surgeons, these advantages include the availability of NewYork-Presbyterian Hospital’s clinical facilities, consulting physicians who provide medical and surgical care to NYSPI inpatients and outpatients, and an emergency service to manage crises. NYSPI can also supplement its commonplace MRI scanners with expensive, high-tech equipment from Columbia, such as PET scanners, a radiochemistry facility, Confocal Microscopes, Gene Microarray and Gene Sequencing Facilities, and a Transgenic Mouse Facility. Further, NYSPI can use the comprehensive collection of the Health Sciences Library next-door, with thousands of journals and thousands of books, as well as the Columbia University library system. At the same time that NYSPI has access to quantity, it benefits from an outstanding specialized library of about 7,000 psychiatry and neuroscience books. This collection, housed along with offices and laboratories in a minimalist modern glass skyscraper on the Hudson, includes carefully chosen, up-to-date books on psychiatry and neuroscience, as well as gems from the past: the first edition of Constantin von Economo’s Atlas of Cytoarchitectonics of the Adult Cerebral Cortex, one of the greatest—and rarest—classics in the neuroscience literature, and a five-volume Lifetime Editions of Emil Kraeplin’s best work that includes Dementia Precox and Paraphrenia, also in English. Finally, as a tribute to the founder of psychoanalysis and a history lesson for all visitors, regardless of their paradigms and prejudices, the library owns a generous selection of books from Freud’s personal library in Vienna, with the notes he wrote in the margins. Finally, as a measure of the breadth of NYSPI’s patrimony, the library inherited a generous selection of books from Freud’s personal library in Vienna, with the notes he wrote in the margins. Finally, the library’s holdings include a unique inheritance: a generous selection of books from Freud’s personal library in Vienna, with the notes he wrote in the margins. <> NYSPI Research: Past, Present, and Future Past and Present NYSPI influenced many aspects of psychiatry since its founding. For example, in diagnosis, George Kirby (NYSPI director 1917-1931) advanced the work of his predecessors, Meyer and Hoch, by preparing the first standardized descriptive outline of clinical classifications in the United States, the Statistical Manual for the Use of Hospitals for Mental Diseases, in 1918.1 This taxonomy was adopted by the American Psychiatric Association. Later, Robert Spitzer, Division of Clinical Phenomenology, spearheaded the effort to create a more exhaustive classification of mental illness, resulting in the DSM-III, and then the DSM-III-R. Members of the Department from different Divisions are collaborating with colleagues across the country to produce the DSM-V, scheduled for release in 2012. In treatment, NYSPI pioneered the use of psychotropic medication for mental disorders, such as giving antipsychotics to patients with schizophrenia. While sometimes criticized as having a bias for pharmacologic treatment, NYSPI developed and promoted psychosocial therapy, such as cognitive remediation, as well. Part of treatment sometimes involves early detection. NYSPI researchers built on the work of Franz Kallman, the first scientist to propose that vulnerability to the disorder was inherited, and Nikki Erlenmeyer-Kimling,2 who continued his long-term, prospective longitudinal study of the offspring of affected patients, to find precursors of the disorder. Then, after research on First Episode Psychosis showed that the duration of untreated psychosis resulted in negative outcomes, researchers at NYSPI focused on identifying precursors with the ambitious goal of preventing first episodes. This multi-faceted search used biostatistics to screen the genome and imaging techniques to look for genes, and is making progress towards its goals.3 <> Van Gieson’s vision of studying psychiatric disorders from multidisciplinary perspective has, and continues, to yield fruit. Future NYSPI continues to make steady advances in psychiatry and neuroscience, and every week faculty members publish significant papers in peer-reviewed journals and answer questions posed by the media. You can read about the latest advances at NYSPI here <>