James Potash on the Path from Gene to Patient Care in Psychiatry at Johns Hopkins

Institutional Feature, February 2011

James Potash

Photo credit: Johns Hopkins Medicine.

In Essential Science IndicatorsSM from Clarivate Analytics, Johns Hopkins University ranks at #29 among the 405 institutions comprising the top 1% in the field of Psychiatry & Psychology. JHU's current record in this field includes 1,868 papers cited a total of 28,227 times between January 1, 2000 and October 31, 2010.

The interdisciplinary nature of this field is evident when one looks at the papers contributing to the Johns Hopkins citation record in this field: there are oncologists studying the psychological impacts of cancer, neurologists studying the brain, and psychiatrists publishing on all manner of topics from schizophrenia treatment recommendations to families with obsessive-compulsive disorder to the diagnosis and treatment of mood disorders.

ScienceWatch.com correspondent Gary Taubes talks with Dr. James Potash, the Director of Mood Disorders Research Programs and Associate Professor of Psychiatry and Behavioral Sciences, about JHU's work in this field.

SW: You are the director and a driving force behind the Mood Disorders Center at Johns Hopkins. What did you hope to accomplish with this relatively new institution?

In 2003 Ray DePaulo became chairman of our psychiatry department at Johns Hopkins. At the time, he handed over the reigns of the research program that he had been leading to me. What we decided about two or three years ago was that, whereas the department was excellent in mood disorders studies in a number of different ways—in clinical care, for instance, and in our genetics program—we wanted to do more than that. We wanted to work on mood disorders from more angles.

One of the things that galvanized me was that we had a patient with bipolar disorder, and her father, said to me, "You're trying to find genes that predispose to bipolar disorder; well, suppose you find one, how is that going to help my daughter?" It was a good question and the answer wasn't and isn't immediately obvious.

So it got me thinking, how do we get from the genes to making a difference for patients? I realized there were a whole lot of steps involved. We have to work at the level of neuroscience, to see what those genes are doing in the brain. Then we have to work at the level of neuropharmacology; we have to identify the pathways in the brain in which the genes work and places in the pathway where compounds might interrupt it.

Then we have to come up with novel drugs to do that, and we need a clinical trials group ready to test new compounds, these potential new drugs. And then we have to think about the issue of education, of dissemination of clinical information. Suppose we get a new drug; how do we make people aware and teach them how to use it?

"Johns Hopkins is one of the premier places in the country for psychiatric genetics and epigenetics research."

So the idea of the Mood Disorders Center was to fill in some of those gaps, to do more things that can help in this path from gene to helping the patient. That has been the work of the last three years. We're in the process of developing that. We do have a clinical trials group now and we have collaborations with several neuroscientists, and we've just started a group devoted to brain-imaging of mood disorders.

SW: Is the Center going to do more epigenetics research of mood disorders, as that's one focus of your own research?

Yes it is. We do have a Medical Epigenetics Center here at Johns Hopkins. It's run by Andy Feinberg, one of the top epigenetics researchers in the world. His center works on epigenetic research in a variety of diseases, including a number of psychiatric diseases such as schizophrenia. We work closely with Andy, and we are also developing independent projects in several areas, including the epigenetics of stress.

SW: What do you think is driving the recent increase in citations for the Department of Psychiatry at JHU?

To be honest, I'm not entirely sure. It depends on what numbers you're talking about, and the way you define psychiatry obviously makes a big, big difference.

SW: What do you mean by the way we define psychiatry? How does that have an effect?

Well, I was looking at the list of highly cited papers in psychiatry at Hopkins, and a lot of people on that list are in other departments—neuroscience, for example. Take Solomon Snyder. He is a superstar neuroscientist—he's won the Lasker Award. And, yes, he was trained originally as a psychiatrist, but he's in the neuroscience department here and chaired that neuroscience department for many years. He continues to do great work, and our citations in psychiatry are benefitting from his work in what is really neuroscience.

SW: Are there particular researchers in the psychiatry department itself who are doing particularly influential work and driving the citation numbers?

Kostas Lyketsos is on a bunch of these highly cited papers. He is head of the Neuropsychiatry Division in the Psychiatry Department. He does a lot of work on Alzheimer's disease and on depression in the setting of Alzheimer's disease, largely from a clinical epidemiology standpoint. He's been involved in the CACHE County study, a study of Alzheimer's genetics epidemiology, which shows up a few times on the list.

Obsessive-compulsive disorder is another disorder in which we're strong here, and it shows up numerous times on the list. Our group in that area is very good, and it's headed by Gerald Nestadt, a very prominent guy in the field. He is actually the head of a multi-site national study on the genetic basis of obsessive-compulsive disorder. Some of the papers cited come from that study.

We also have great work coming from two neurobiology groups in our department, both of whom show up on the highly cited list. One is headed by Chris Ross, a psychiatrist and neuroscientist, whose work has focused on the molecular mechanisms underlying neurodegenerative diseases. The other is headed by Akira Sawa, also a psychiatrist and neuroscientist, who is a world leader in the neurobiology of schizophrenia.

SW: Is it fair to say that because Hopkins is so strong in genetics and epigenetics research, as researchers in psychiatry became more interested in those areas, this could fuel some of the increase in citations for the JHU psychiatry department?

Yes. It's fair to say that Johns Hopkins is one of the premier places in the country for psychiatric genetics and epigenetics research. As those areas became more and more central to psychiatric research, our position has improved because of the University's prominence there.

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