Clinical Neuroscience Center

Longitudinal And Brain Bank Studies In Schizophrenia

Since 1988 the CNC has assessed a patient cohort of over 1500 elderly schizophrenic patients who have been followed longitudinally. These efforts have resulted in many important publications which have defined the course and outcome of schizophrenia in late age for the field.

In parallel with the clinical characterization and longitudinal neuropsychological study of of these patients Mount Sinai has been maintaining an ever expanding brain bank accrued, in large part, through Pilgrim. 675 brain specimens banked from this effort have been neuropathologically characterized and distributed to associated projects. Over the past 19 years this arm of the Mount Sinai brain bank has provided a unique collection of brain tissues for multiple other individual grants and projects within the Mount Sinai community and laboratories within and outside the US. Many important research findings have resulted from the study of these specimens. Most recently, a new conceptualization of the pathophysiology of schizophrenia based on changes in oligodendrocytes and myelin has resulted from studies of these brain tissue samples.

Clinical Trials Program

The focus of the CNC's clinical trials program is twofold: 1) the evaluation of adjunctive cognitive enhancing drugs to improve outcome in schizophrenia and, 2) the evaluation of treatment strategies for patients with schizophrenia refractory to standard antipsychotic treatment. The inclusion of large numbers of patients treated with clozapine has established a platform for the CNC to provide extensive education and assistance to the medical staff in the use of cutting edge clozapine treatment practices. These interventions have led to the discharge of a numerous inpatients from the facility who had been continuously hospitalized for 20 years or more.

Neuroimaging Studies

The CNC is conducting a number of NIH funded neuroimaging studies which include MRI, PET, DTI, and fMRI studies. Through collaborations with other Mount Sinai investigators and independent studies the CNC maintains ongoing access to the 3T head dedicated MR system in the department of Radiology at Mount Sinai.

Genetics Studies

Recently, in the field of human genetics, much attention has been given to the hypothesis that structural variation of the genome including large insertions or deletions of DNA, collectively termed Copy Number Variants (CNVs), contribute to a major proportion of genetic difference in humans. Moreover, there is increasing evidence that CNVs may significantly contribute to the genetic risk for complex diseases such as schizophrenia. Therefore, in a collaboration with the Department of Human Genetics at the University of Nijmegen in the Netherlands the CNC is conducting genome wide studies of individuals with complex presentations of schizophrenia in order to identify novel structural variants important to the development of schizophrenia.

The CNC As a Center For Training In The Assessment of Patients

The CNC has become a center for the training of Pilgrim and Mount Sinai staff in the use of sophisticated psychometric assessments tools. Many new investigators and research associates involved in schizophrenia research at Mount Sinai and all fellows, psychology interns, residents and medical students working with the CNC receive training from expert raters in the following assessment instruments:

1. Positive and Negative Syndrome Scale (PANSS)
2. Comprehensive Assessment of Symptoms and History (CASH)
3. Extrapyramidal Symptom Rating Scale (ESRS)
4. Specific Level of Functioning Scale (SLOF)
5. Clinical Dementia Rating (CDR)
6. CERAD Neuropsychological Battery (Consortium To Establish a Registry for Alzheimer's Disease)
7. Multiple individual neuropsychological assessments in addition to the WAIS battery (Weschler Adult Intelligence Scale)

Psychiatry Fellowship and Psychology Internship Programs

The CNC has two psychiatry fellowship positions, one an ACGME accredited Geriatric fellowship line, and the other a psychopharmacology/research fellowship line. Fellows have opportunities to become co-investigators in any of the ongoing treatment, neuro-imaging, genetics or longitudinal studies. The CNC Fellows are also responsible for the basic psychobiology and psychopharmacology curriculum for the psychology internship program.

The CNC has created a specialized Psychology Internship line as part of the larger Psychology internship program at Pilgrim. This line incorporates both clinical and research training and experience.