Collaborative Research on Mental and Neurological Disorders
Concept Clearance — August 2005
Presenter
Debra Babcock, M.D., Ph.D.
Chief, Neural Systems Psychopathology Program
Clinical Neuroscience Research Branch
Molecular, Cellular, and Genomic Research Branch
Division of Neuroscience and Basic Behavioral Science, NIMH
Description
Neurological and psychiatric symptoms are known to coexist in a number of patient populations. Depression and psychosis are not infrequently comorbid with Parkinson's disease, epilepsy, multiple sclerosis, and stroke, disorders that are usually viewed as the purview of neurologists. Similarly, cognitive impairment, psychomotor slowing, and executive dysfunction are commonly seen in major depression and schizophrenia, disorders that are traditionally viewed as the purview of psychiatrists. For valid reasons, most research has focused primarily on understanding or treating “pure” disorders, which either have no comorbid symptoms at all, or else control for a select comorbid symptom by ensuring that all subjects have the same one. However, substantial progress has been made in the understanding of both neurological and psychiatric conditions, which raises the possibility that research gains in one field could productively contribute to scientific advances in the other.
In order to encourage cross-fertilization of ideas and further progress, this announcement solicits research focused on the etiology and treatment of comorbid mental and neurological disorders. All applications must include significant participation from at least one mental health specialist (psychiatrist, psychologist, or basic scientist with a clear focus on mental health issues) and one neurological specialist (neurologist, neurosurgeon, or basic scientist with a clear focus on neurological issues) to be considered responsive. Two specific types of applications are invited:
First, applications addressing etiological questions are encouraged to use the relatively under-utilized approach of human “lesion models”. In broad terms, such an approach would focus on a neurological disorder that has some defined pathological feature(s) to answer questions about a mental health disorder that presents with similar symptoms but has poorly understood pathology. Although it is considered unlikely that any model could replicate the full clinical presentation of any particular mental disorder, models of key symptoms, such as executive dysfunction, mood dysregulation, abnormal reward processing, or impaired capacity for social interactions would be of great interest. Examples of potential applications include:
- Investigations seeking to identify mood-related neurocircuitry involved in Major Depression or Bipolar Disorder by modeling deep brain stimulation-induced mood changes in patient's with Parkinson's disease.
- Research to understand differences and similarities between the role of neurogenesis in seizures versus its role in stress-related disorders.
- Studies comparing the immunological and/or glial pathology of white matter lesions in patients with geriatric-onset depression versus patients with multiple sclerosis and depression.
- Comparisons of dysfunctional neurocircuitry in patients with post-stroke mania and patients with bipolar disorder.
Second, administrative supplement applications to support collaborations between mental health specialists and neurological specialists for the purpose of identifying effective treatments for patients with comorbid mental and neurological disorders. The intent of this solicitation is to provide additional resources to ongoing NIH-funded clinical trials for the purpose of diagnostic and/or treatment studies of mental disorders in patients who have neurological disease. Examples of potential applications include:
- Analysis of pharmacogenetic factors that may identify antidepressant responders who do and do not have comorbid stroke.
- Investigations into the diagnosis, and/or treatment of conversion disorders with neurological symptoms (e.g., psychogenic movement disorders).
- Studies to identify effective interventions for patients with comorbid epilepsy and depression.
Comments
Submit comments to Jean Noronha at jnoronha@mail.nih.gov.
