Tag Archives: Medical College of Georgia

Study explores whether sleeping pills reduce insomniac’s suicidal thoughts

Dr. Vaughn McCall and Maryanne RileyResearchers want to know whether a sleeping pill reduces suicidal thoughts in depressed patients with insomnia.

“The more we look at it, the more it looks like insomnia by itself is a predictor of suicide so the next question becomes: Why not treat insomnia strategically as a focus of care and see if that reduces suicidal thinking,” said Dr. W. Vaughn McCall, Chair of the Medical College of Georgia Department of Psychiatry and Health Behavior at Georgia Regents University.

McCall is principal investigator on a $1.2 million National Institute of Mental Health grant to objectively assess patient response to this strategy. The study at GRU, Duke University and the University of Wisconsin is enrolling 138 adults over four years. To help ensure their safety, all participants will receive the anti-depressant fluoxetine for the eight-week trial while half will also get the sedative-hypnotic zolpidem.

It’s a complex treatment conundrum that the study hopes to unravel. Some physicians are understandably concerned about giving sleeping pills to people with suicidal thoughts. “We are faced very commonly with a patient who is not sleeping, is depressed, is suicidal and the treating physician is understandably concerned about giving that patient sleeping pills,” McCall said.

In fact, some sleep experts routinely condemn sleeping pills, saying the pills are potentially deadly, independent of suicide. Other people with chronic insomnia never seek professional help, trying home or natural remedies while their negative thoughts about sleep escalate. If they do seek medical care as problems mount, they may find themselves with a doctor hesitant or even adamant about hypnotics, McCall said.

If researchers can show a direct link between insomnia treatment and reduced suicidal thinking, it could help mainstream targeted drug therapy as well as non-drug approaches such as cognitive behavior therapy, a structured talk therapy that targets faulty thinking such as, ‘I will never sleep again,’ said McCall, who also uses this approach.

Researchers have evidence that the intensity of insomnia correlates with the intensity of suicidal thoughts as well as a pilot study linking proactive hypnotic treatment to reduced suicidal thoughts. In fact, 31 studies have linked insomnia to suicidal thoughts, behavior or death. Still suicide risk factors and prevention often overlook insomnia, McCall said.

Acknowledging the very vulnerable population they study, there are numerous safeguards built into the research protocol such as participants only getting one week’s supply of sleeping pills for the first two weeks, then getting a two-week supply if their suicidal thoughts stabilize. Additionally, they will be asked to take the drug shortly before going to bed and to allow eight hours for sleep.

Sleeping pills such aszolpidem accentuate the body’s normal mechanism for sleep by targeting GABA, a neurotransmitter that essentially turns the brain’s metabolism down, McCall said. Existing antidepressants don’t affect GABA.  Many over-the-counter sleep aids are essentially anti-histamines; histamine is another neurotransmitter that helps keep you awake. In insomniacs, GABA tends to be underactive while histamine works overtime.

Insomnia is a symptom and about half of all cases are related to a mental disorder such as depression. About 90 percent of patients hospitalized for depression and 60 percent of those treated as outpatients also have insomnia, McCall said.  Not sleeping also can also be tied to personality, specifically hypervigilant individuals who are always “on.” “They just can’t relax,” said McCall, who admits to at least a small case of that himself. Others have life-issues, such as divorce or illness, that can cause transient insomnia. In others, it’s a long-standing problem with no obvious basis.

Patients with insomnia that persists over a year have a 30-fold increased risk of developing depression compared to the insomniac who gets treatment. “That is like the risk of cigarette smoking for cancer: it’s huge,” McCall said. This begs more questions about how insomnia causes depression and, if you’re already depressed, how insomnia aggravates suicide risk, he said.

He notes there is a subset of depressed people, particularly young people, who sleep too much, and that older people generally have a harder time falling and staying asleep.

Wake Forest University will assist in statistical analysis for the study. Individuals with sleep apnea as severe suicidal thoughts will be excluded. Participants will be referred for outpatient management at the end of the study.

For more information, contact Senior Research Assistant Mary Anne Riley at mriley1@georgiahealth.edu or (706) 721-1011.

MCG at GRU hosts international pathology research group

The Department of Pathology at the Medical College of Georgia at Georgia Health Sciences University is hosting the Winter meeting of the international Group for Research in Pathology Education today through Sunday, Jan. 20.

The 42-year-old organization represents more than 60 institutions across the world that teach undergraduate and graduate pathology.

Dr. Diane Turnbull, MCG’s Director of Phase 2 Curriculum Development, is hosting the 2013 GRIPE Winter Meeting of about 60 participants today at the Robert B. Greenblatt, M.D. Library on GRU’s Health Sciences Campus. Presentations by many MCG educators will highlight today’s session, with a focus on curriculum, evaluation and pedagogy.  Remaining sessions will be at Augusta Marriott at the Convention Center.

Smith named Chair of MCG Department of Cellular Biology and Anatomy

By Toni Baker, Communications Manager, Medical College of Georgia

Dr. Sylvia Smith, Interim Dean of the College of Graduate Studies and Co-Director of the Vision Discovery Institute at Georgia Regents University, has been named Chair of the Medical College of Georgia Department of Cellular Biology and Anatomy.

Smith, a faculty member in the department for more than 20 years, assumes her new duties Feb. 1. Smith will maintain co-leadership of the Vision Discovery Institute with MCG Ophthalmology Chair Julian Nussbaum. GRU Provost Gretchen Caughman has selected Dr. Patricia Cameron, Acting Vice Dean of the College of Graduate Studies, to serve as the college’s Interim Dean while the national search for that position is completed.

“Sylvia already is an accomplished leader who inspires by the excellent example of her strong work ethic, upbeat nature and tireless sense of the importance of teamwork,” said Dr. Peter F. Buckley, MCG Dean.  “In her two decades with us, she has been an enthusiastic educator, a strong mentor and colleague. She takes the reins of a solid department with excellent faculty that was wonderfully managed by Dr. Sally Atherton who retired from MCG this month and is now Executive Director of The Association for Research in Vision and Ophthalmology.”

“Sylvia’s willingness to step up to serve our university as Interim Dean of Graduate Studies and the skill she has shown in that role are much appreciated and another clear gauge of her excellent leadership skills,” Caughman said. “We congratulate her on this new position.”

Smith, a retinal cell biologist and Fellow of the Association for Research in Vision and Ophthalmology, is renowned for her research on retinal function, particularly retinal degeneration. In 2010, she was one of 54 women in North America selected a Fellow in the Hedwig van Ameringen Executive Leadership in Academic Medicine, or ELAM, Program, the nation’s only in-depth national course preparing senior female faculty for leadership positions at academic health centers.

She received the GRU Research Institute’s 2007 Mahesh Distinguished Research Award for significant and sustained contributions to research, sustained external funding and outstanding mentoring and leadership. Smith, currently the principal investigator on two National Institutes of Health grants totaling more than $2.24 million, has been continuously funded by the NIH since 1992. She has served on numerous NIH Study Sections, is an editorial board member of the journal Ophthalmology and Eye Diseases and a guest editorial board member for Investigative Ophthalmology and Visual Science, Current Eye Research and Molecular Vision.

Smith is a member of MCG Faculty Appointments/Promotions/Tenure Committee and Pre- and Post-Tenures Committees. She also is a member of the M.D./Ph.D. Advisory Committee. She served as the medical school’s Associate Dean for Students from 2004-08. As a founding Co-Director of the Vision Discovery Institute, she has helped grow vision-related science and education at GRU in the past five years.

She completed postdoctoral training at NIH’s Laboratory of Retinal Cell and Molecular Biology.

 

Smith named Chair of MCG Department of Cellular Biology and Anatomy

Dr. Sylvia Smith, Interim Dean of the College of Graduate Studies and Co-Director of the Vision Discovery Institute at Georgia Regents University, has been named Chair of the Medical College of Georgia Department of Cellular Biology and Anatomy.

Smith, a faculty member in the department for more than 20 years, assumes her new duties Feb. 1. Smith will maintain co-leadership of the Vision Discovery Institute with MCG Ophthalmology Chair Julian Nussbaum. GRU Provost Gretchen Caughman has selected Dr. Patricia Cameron, Acting Vice Dean of the College of Graduate Studies, to serve as the college’s Interim Dean while the national search for that position is completed.

“Sylvia already is an accomplished leader who inspires by the excellent example of her strong work ethic, upbeat nature and tireless sense of the importance of teamwork,” said Dr. Peter F. Buckley, MCG Dean.  “In her two decades with us, she has been an enthusiastic educator, a strong mentor and colleague. She takes the reins of a solid department with excellent faculty that was wonderfully managed by Dr. Sally Atherton who retired from MCG this month and is now Executive Director of The Association for Research in Vision and Ophthalmology.”

“Sylvia’s willingness to step up to serve our university as Interim Dean of Graduate Studies and the skill she has shown in that role are much appreciated and another clear gauge of her excellent leadership skills,” Caughman said. “We congratulate her on this new position.”

Smith, a retinal cell biologist and Fellow of the Association for Research in Vision and Ophthalmology, is renowned for her research on retinal function, particularly retinal degeneration. In 2010, she was one of 54 women in North America selected a Fellow in the Hedwig van Ameringen Executive Leadership in Academic Medicine, or ELAM, Program, the nation’s only in-depth national course preparing senior female faculty for leadership positions at academic health centers.

She received the GRU Research Institute’s 2007 Mahesh Distinguished Research Award for significant and sustained contributions to research, sustained external funding and outstanding mentoring and leadership. Smith, currently the principal investigator on two National Institutes of Health grants totaling more than $2.24 million, has been continuously funded by the NIH since 1992. She has served on numerous NIH Study Sections, is an editorial board member of the journal Ophthalmology and Eye Diseases and a guest editorial board member for Investigative Ophthalmology and Visual Science, Current Eye Research and Molecular Vision.

Smith is a member of MCG Faculty Appointments/Promotions/Tenure Committee and Pre- and Post-Tenures Committees. She also is a member of the M.D./Ph.D. Advisory Committee. She served as the medical school’s Associate Dean for Students from 2004-08. As a founding Co-Director of the Vision Discovery Institute, she has helped grow vision-related science and education at GRU in the past five years.

She completed postdoctoral training at NIH’s Laboratory of Retinal Cell and Molecular Biology.

 

Eliminating useless information important to learning, making new memories

Dr. Joe Tsien
Dr. Joe Tsien

AUGUSTA, Ga. – As we age, it just may be the ability to filter and eliminate old information – rather than take in the new stuff – that makes it harder to learn, scientists report.

“When you are young, your brain is able to strengthen certain connections and weaken certain connections to make new memories,” said Dr. Joe Z. Tsien, neuroscientist at the Medical College of Georgia at Georgia Regents University and Co-Director of the GRU Brain & Behavior Discovery Institute.

It’s that critical weakening that appears hampered in the older brain, according to a study in the journal Scientific Reports.

The NMDA receptor in the brain’s hippocampus is like a switch for regulating learning and memory, working through subunits called NR2A and NR2B.  NR2B is expressed in higher percentages in children, enabling neurons to talk a fraction of a second longer; make stronger bonds, called synapses; and optimize learning and memory. This formation of strong bonds is called long-term potentiation. The ratio shifts after puberty, so there is more NR2A and slightly reduced communication time between neurons.

When Tsien and his colleagues genetically modified mice that mimic the adult ratio – more NR2A, less NR2B – they were surprised to find the rodents were still good at making strong connections and short-term memories but had an impaired ability to weaken existing connections, called long-term depression, and to make new long-term memories as a result. It’s called information sculpting and adult ratios of NMDA receptor subunits don’t appear to be very good at it.

“If you only make synapses stronger and never get rid of the noise or less useful information then it’s a problem,” said Tsien, the study’s corresponding author. While each neuron averages 3,000 synapses, the relentless onslaught of information and experiences necessitates some selective whittling. Insufficient sculpting, at least in their mouse, meant a reduced ability to remember things short-term – like the ticket number at a fast-food restaurant – and long-term – like remembering a favorite menu item at that restaurant.  Both are impacted in Alzheimer’s and age-related dementia.

All long-term depression was not lost in the mice, rather just response to the specific electrical stimulation levels that should induce weakening of the synapse. Tsien expected to find the opposite: that long-term potentiation was weak and so was the ability to learn and make new memories. “What is abnormal is the ability to weaken existing connectivity.”

Acknowledging the leap, this impaired ability could also help explain why adults can’t learn a new language without their old accent and why older people tend to be more stuck in their ways, the memory researcher said.

“We know we lose the ability to perfectly speak a foreign language if we learn than language after the onset of sexual maturity. I can learn English but my Chinese accent is very difficult to get rid of. The question is why,” Tsien said.

Tsien and his colleagues already have learned what happens when NR2B is overexpressed. He and East China Normal University researchers announced in 2009 the development of Hobbie-J, a smarter than average rat. A decade earlier, Tsien reported in the journal Nature the development of a smart mouse dubbed Doogie using the same techniques to over-express the NR2B gene in the hippocampus.

Doogie, Hobbie-J and their descendants have maintained superior memory as they age. Now Tsien is interested in following the NR2A over-expressing mouse to see what happens.

Tsien is the Georgia Research Alliance Eminent Scholar in Cognitive and Systems Neurobiology. The research was funded by the National Institutes of Health and the GRA.