At the Mount Sinai Beth Israel (MSBI) Psychiatry Residency, we offer comprehensive research training to all residents. You can begin a research project as early as the PGY-1 year. You learn about opportunities during the Biological Psychiatry Research Seminar.
All PGY-2 residents attend a Summer Research Seminar where they learn about all research projects in the department. At the end of this seminar each resident chooses a mentor and a research project. You can join an existing project or start your own, under your mentor’s guidance. Residents work with research volunteers and graduate students, who can assist with submissions to the Institutional Review Board. Statistical consultants are available within the department and hospital wide.
Most residents select projects that involve some aspect of data collection, though you may also choose to work on a comprehensive literature review. We support and encourage our residents in presenting work at a national meeting and/or publish it. If you are presenting at a meeting, departmental funds are available to pay for your travel to the meeting.
During the PGY-4 year, we provide all residents with significant protected time to complete your research projects. In your final year of training, you present your research at the departmental Grand Rounds. Prior to this, we train you in giving PowerPoint presentations and in presenting research findings.
Bipolar Research Center
Igor Galynker, MD
Ongoing research projects include:
Family Inclusive Treatment: By incorporating the family into treatment, we can improve adherence to medication and reduce challenges within the family. In the ongoing study, we explore the relationship among family members’ understanding of bipolar disorder, stigma of mental illness, coping styles, and personality and the course of the illness, as well as different aspects of the illness burden on the family.
Suicide in Bipolar Disorder: Patients with bipolar disorder have some of the highest suicide rates of any psychiatric patients, and our ability to identify those at risk for near-term suicide is less than chance. Our ongoing evaluation of suicidal ideation and behavior in bipolar disorder patients is meant to improve our ability to diagnose acutely suicidal individuals and reduce suicide risk.
Clinical Correlates of Cannabis Use in Bipolar Disorder. Cannabis use is a frequent comorbidity in bipolar illness. Although research has demonstrated the relationship between cannabis use and psychosis, we know much less about the effects of cannabis use on mood and anxiety in mood disorders. This ongoing project aims to clarify various aspects of this relationship.
Personality and Trauma
Lisa Cohen, PhD
Association of Childhood Trauma and Personality Disorder Traits in Psychiatric Inpatients. This study uses a large dataset (n=296) to assess mediators and moderators in the association between different types of childhood maltreatment and various forms of adult personality pathology.
Relationship Between Mood and/or Psychotic Disorders and Personality Disorders: Psychological Correlates. This ongoing study (n=182) looks at the role psychometric battery (assessing mood, trauma, impulsivity, sexual fantasies, suicidality, and other domains) in psychiatric inpatients.
Characteristics of Self-Identified Minor Attracted Persons Living in the Community: The B4U-Act Survey Study. Completed survey study (n=750) of broad range of psychological, attitudinal, biographical, and psychiatric domains in population of self-identified minor attracted persons, with particular focus on those who successfully refrain from sexual engagement with children or under-age adolescents.
Suicide Prevention Research Program
Igor Galynker, MD, PhD
Identifying the Acute Suicidal Syndrome. Risk factors for suicide are well known but cannot predict imminent suicide. Our research group has been working at describing the syndrome of the acute suicidal state, the suicide trigger state, which is predictive of near-term suicide. We are currently conducting research to refine the boundaries of this syndrome and examine the associated suicide risk.
Modular Assessment of Risk for Imminent Suicide. Most suicide victims have seen a health professional within six months of their suicide, yet currently no valid tool predicts imminent suicide. To have wide-reaching impact on clinical work, such an instrument must be accurate, brief, and simple, so it can be used without special training or equipment. We are conducting several interconnected studies of an innovative, multi-informant (patient and clinician) approach called Modular Assessment of Risk for Imminent Suicide.
Implicit Suicide Risk Assessment. Acceptability of suicide as a valid solution to life’s problems may play a significant role in individual capability for suicide. We are assessing the role of explicit and implicit attitudes towards suicide in increasing suicide risk.
The Crisis Suicide Model of Suicidality. Suicidality is exceedingly complex and no current model accounts for all the aspects of suicidal behavior. The Crisis-Narrative Model of suicidal behavior emphasized evolution of suicidal process to the acute suicidal state through suicidal narrative. We are conducting data analyses to test this model’s ability to predict suicidal behavior.
Genetic Biomarkers of Acute Suicidal State. Most suicide victims have pre-existing mental disorders and had seen a clinician within six months prior to suicide, yet, at present no instrument has demonstrated clinical value in assessing imminent (within two months) suicide risk. We are working on a genetic study of stress-responsivity-related genes as possible potential biomarkers for the acute suicidal state.
Using Functional Magnetic Resonance Imaging (fMRI) to Diagnose Acute Suicidal State. Since fMRI has shown potential for diagnostic differentiation in depression, as a first step toward finding a biomarker for acute suicidal state, we are working on an fMRI imaging study of subjects with recent suicide attempts. In accord with a growing body of research, we are exploring disturbances in reward processing as indicated by anhedonia and entrapment.
Division of Addiction Psychiatry
Lily Awad, MD, Melinda Lantz, MD, Amy Swift, MD, Daniel McGovern MD
The Relationship between Childhood Trauma and Family History of Substance Use and the Severity of Substance Use Disorder. Several risk factors have been recorded for the development and severity of a substance use disorder. They are divided into biological risk factors, such as family history; psychological risk factors, such as childhood trauma; and social risk factors, such as peer influence. Most studies have looked at many different risk factors; however, only few have looked at the effect of the combination of risk factors simultaneously. The study aims to understand the simultaneous role of family history and childhood adversities in the development and severity of substance use disorders.
Clinical Presentation of Patients with Synthetic Cannabinoid Use in an Inpatient Population. Knowledge about the effects of synthetic cannabinoids is limited. Case reports and case series in the literature report psychotic symptoms, irritability, agitation, anxiety, depression, and suicidality, in addition to medical emergencies such as acute renal failure, cardiac arrest, and sudden death. In this research study, we review psychiatric presentations of patients admitted to MSBI with synthetic cannabinoid use.
Relationship Between Cannabis Use and BDNF Level in Patients with Psychosis. The association between cannabis use and psychosis is well known. However, the biological effect of cannabis on the brain is controversial and there is a debate over the direction of causality between psychosis and cannabis use. This research project investigates the relationship between psychosis and levels of the BDNF gene in cannabis users.
Identifying High-Risk Patients on Benzodiazepines in an Outpatient Population. The goal of this study is to develop a policy to reduce benzodiazepine treatment and evaluate its effect on patients’ clinical presentation. With mandatory e-prescribing coming down the line in the next year or so, our clinic decided it would be useful to get a better idea of our benzodiazepine prescribing practices. We hope to implement a new clinical policy regarding benzodiazepine use and prescription with an eye to decreasing its long-term use. We will collect data of prescribing practices at a point in time after implementing the new clinical policy and see if prescribing has changed and if it helped mitigate any risk in the high-risk group.
Geriatric psychiatry
Melinda Lantz, MD, Kecia-Ann Blissett, DO
Reduction of Benzodiazepine Use. The dangers of benzodiazepine use, especially in geriatric patients, include an increased risk of falls, hip fractures, and cognitive impairment, as well as a significantly increased risk of dementia. However, reducing and eliminating use of these agents in geriatric patients with a history of chronic benzodiazepine use poses many clinical challenges. These include patient preference, fear of inducing withdrawal, and the lack of a well-recognized clinical guideline for the reduction or elimination of benzodiazepines. This study will develop clinical pathways to guide both the clinician and patient in a path of safe and effective treatment.
We have formulated an action plan and clinical pathway for reducing benzodiazepine use in outpatient geriatric psychiatry patients and have implemented it with a number of patients. Results show successful reductions and/or elimination of benzodiazepines from their medications regimen. Several patients were unable to successfully reduce their benzodiazepine use despite repeat attempts and the addition of other agents with psychotherapy. This project will explore the patient factors that may correlate with successful reductions in benzodiazepines.
Elimination of Seclusions and Restraints. As the use of restraints and seclusion is inherently an unplanned, emergency event, the development of protocols to reduce the use of such physically restrictive measures to deal with agitated patients has been difficult. The goal of this project is to develop new guidelines for care that emphasize prevention and promotion of environmental modifications, staff communication, and patient comfort.
Psychosomatic Medicine and Consultation-Liaison Psychiatry
Seema Quraishi, MD, C. Elizabeth Casasnovas, MD, Joel Wallack, MD, Kenneth Ashley, MD, Daniel Safin, MD
Corrected QT Interval (QTc), Medical Illness and Management of Psychiatric Symptoms in the Medically Hospitalized Patient. There is much discussion about cardiac risk factors, QTc prolongation, and Torsades de Pointes in patients receiving psychotropic medications. Various projects and research presentations, completed by the Division, have focused on use of these medications in hospitalized, acutely ill medical patients. Currently the group is exploring data from a large sample of hospitalized patients, with a goal of further defining the clinical factors to consider when prescribing psychiatric medications to the medically ill.
Health Behaviors in Bipolar Disorder Patients. Patients with bipolar disorder have higher rates of obesity and cardiovascular and pulmonary disease and die younger than the general population. Health behaviors such as sleep, exercise, diet, and medical follow up may ameliorate some of these medical co-morbidities. The Division has an ongoing project exploring these behaviors as noted by the patient themselves. This work has led to findings that even severely ill patients feel healthy behaviors and lifestyle can affect psychiatric and medical illness. The goal of the current research is to better define these behaviors, allowing physicians to target behaviors that will assist in maintaining the overall health of patients with bipolar disorder.
The Management of Disruptive and Potentially Violent Patients on Inpatient Medical Units. As efforts across the country focus on enhanced safety for patients, staff, and visitors in the medical/surgical setting, the Division has been working on projects related to preventive and acute response approaches to these issues. From exploration of the documentation by psychiatric consultants for behavioral risk factors, to acute response teams and their integration into the various medical and surgical services, the Division is collecting data and presenting the research to foster a national dialogue related to patient safety.
Case Reports Presentations. The Division is frequently consulted on unusual case presentations that are turned into poster presentations and written up as case reports. Recent topics have included management of potentially lethal skin-picking disorder in the acute medical setting; psychiatric and neurologic presentation of idiopathic basal ganglia calcification; and how to use psychiatric medications for patients with Brugada pattern on electrocardiogram, which is a risk for sudden cardiac death.
Neurobehavioral Psychiatry
Todd Feinberg, MD
Delusional misidentification syndromes (DMS)
Anosognosia and somatoparaphrenia
Neuropsychoanalysis
The neurobiological basis of consciousness