Behavorial Medicine
Richard P. Sloan, Ph.D., Director
Emilia Bagiella, Ph.D., Assistant
Professor
Ethan E. Gorenstein, Ph.D., Assistant
Professor
Kenneth S. Gorfinkle, Ph.D., Assistant
Professor
Edward S. Katkin, Ph.D., Visiting
Professor
Elizabeth S. Mezzacappa, Ph.D., Assistant
Professor
Catherine E. Monk, Ph.D.,
Assistant Professor
Daniel Seidman, Ph.D., Assistant
Professor
Felice Tager, Ph.D., Assistant
Professor
The department's research focuses on the contribution of psychological and behavioral factors to the onset, progression, and management of physical and mental disease. Projects range from the purely behavioral to the cellular, with new studies extending to gene expression. Our goal is to elucidate the mechanisms by which psychological and behavioral factors confer risk of physical and mental disease.
Cardiovascular Psychophysiology
In collaboration with Drs. Michael Myers in Developmental Psychobiology, Peter Shapiro in Consultation/Liaison Psychiatry, Jack Gorman in Clinical Psychobiology, and J. T. Bigger, Jr. in the Department of Medicine, Dr. Richard Sloan has pursued the mechanisms by which psychological risk factors such as hostility, depression, and anxiety contribute to the risk of heart disease. Departmental research explores a psychophysiological model of coronary disease that identifies the autonomic nervous system as the link between psychological factors and atherosclerosis. Specifically, the model suggest that by enhancing parasympathetic control of the heart, already known by cardiologists to promote survival following myocardial infarction, potentially pathogenic oscillations in blood pressure can be buffered. This model is the basis of several ongoing investigations funded by NIMH and NHLBI to explore factors which alter cardiac autonomic control: aerobic conditioning, cognitive-behavioral reduction of hostility, and surgical denervation.
Dr. Elizabeth Mezzacappa has extended this research. Following recently published evidence that the rate of heart-rate (HR) recovery after exercise stress-testing predicts mortality in patients with coronary artery disease, she has demonstrated that normal subjects with risk factors for heart disease, e.g., family history, have slower HR recovery after psychological challenge than normals without risk factors.
Cognitive-Behavioral Reduction of Anxiety in Older Adults
It is widely recognized that in older adults, use of anxiolytic medications, although effective, may pose problems due to the age-related reduced threshold for side effects, including oversedation, confusion, memory deficit, and falls. To address this problem, Dr. Ethan Gorenstein, in collaboration with Dr. Laszlo Papp of the Biological Studies Unit, has been exploring the capacity of short-term, cognitive-behavioral treatment (CBT) to reduce the dependence of older adults on anxiolytics. In this NIMH-funded study, elderly patients with Generalized Anxiety Disorder (GAD) and want to reduce dependence on anxiolytic medication are randomized either to receive CBT plus medical management for tapering anxiolytic medication, or medical management alone. Outcome is assessed in terms of success at medication taper as well as psychological symptom reduction.
Maternal Emotions, Fetal Behavior, and the Etiology of Psychopathology
Dr. Catherine Monk, along with Drs. Michael Myers and William Fifer from Developmental Psychobiology, is engaged in longitudinal studies of fetal and infant development, studying the long term consequences of pregnant women's mood states on child outcomes. They hypothesize that alterations in the intrauterine environment associated with pregnant women's psychiatric symtomatology influence fetal development and thereby contribute to the familial transmission of mental illness. Specifically, they are investigating fetal heart rate patterns in relation to maternal anxiety and depression and the neurobehavioral characteristics of these infants at birth and four months old. Recently, Dr. Monk replicated initial findings that fetuses of highly anxious women increase their heart rate when women undergo mental stress while fetuses of non-anxious women decrease their heart rate under the same conditions. In a related study, they are comparing fetal behavior in depressed pregnant women taking an SSRI and those who are not. These projects have received support from NARSAD, the March of Dimes, the CPMC Office of Clinical Trials, and the Sackler Institute.
Cognitive, Behavioral, and Autonomic Sequelae of Physical Disease
With increased success of treatment, cancer has become a chronic, rather than an acute disease. Correspondingly, the number of cancer survivors has increased substantially. With this success, however, has come concern that treatment may have long-term effects that may increase the risk of second cancers, heart disease, and cognitive impairment. In studies funded by the American Cancer Society and Avon, Dr. Felice Tager is investigating the possibility that treatment for cancer causes subtle but measurable neuropsychological deficits. Anecdotal evidence has suggested that chemotherapy regimens including alkylating agents may be implicated in brain dysfunction. Her studies will obtain controlled neuropsychological data on pediatric cancer survivors and in women receiving chemotherapy treatment for breast cancer.
Similarly, Dr. Sloan and colleagues from the Herbert Irving Comprehensive Cancer Center are studying another aspect of cancer survivorship: the apparent increased risk of heart disease. Using methods they have developed to assess autonomic nervous system control of the cardiovascular system, they are examining the autonomic effects of taxotere treatment in breast cancer patients.
In the area of infectious diseases, Dr. Tager has been working with Dr. Brian Fallon of the Anxiety Disorders Unit to examine the neuropsychiatric symptoms associated with Lyme disease in both adults and children. Although there have been multiple studies examining cognitive functioning in adults with Lyme disease, there is a dearth of research related to pediatric Lyme disease. Their most recent project examines neuropsychological and emotional functioning in children with persistent symptoms of Lyme disease as compared to healthy controls. They have shown that a group of initially healthy children had cognitive deficits related to attention and auditory and visual processing on objective testing.
The "Health Effects" of Religious Activity
Claims about religion, spirituality, and health appear with increasing frequency today, both in the popular media and in professional journals. Corresponding to the rise in these beliefs are increasing calls to incorporate religious and spiritual activities into clinical practice. Nearly 30 US medical schools now include courses on religion and spirituality for medical students.
Drs. Richard Sloan and Emilia Bagiella have extensively reviewed the literature and determined that these claims are greatly exaggerated, providing little support for making religious activities adjunctive medical treatments. In publications in the Lancet and the New England Journal of Medicine, they identify significant methodological failures of papers that purport to demonstrate health benefits of religious activity. They also identify significant ethical problems raised by attempts to bring religious activity into clinical medicine.
In a second, five-year study of treatment strategies for elderly patients who have GAD and have already undergone an initial trial of CBT, responders to initial CBT are randomized to receive either maintenance therapy or no maintenance. Nonresponders are randomized to receive either pharmacotherapy and or continued CBT. Outcome is assessed in terms of quality of life measures and psychological symptom reduction.
Dr. Richard Sloan, center, and staff