Drs. Conrad Gilliam, James Knowles, and Nancy Wexler participated in the first day's symposium. How will genomic science impact the genetic study of psychiatric traits and illnesses? An interesting question, indeed. Comparing genes within families and between species (such as in the knock-out genes experiment performed in mice) can provide clues as to the function of certain genes, whose functions were previously unknown. Imagine, for example, that work being done today by researchers like Dr. Gilliam will lead to some day figuring out the pathways to look at in studying schizophrenia.

In his presentation on "Psychiatric Phenotypes and Human Genome Genotypes", Dr. Knowles cited the potential of this type of research in pharmacogenetics, where genetics could be used to predict a favorable drug response or unfavorable side effects. In effect, we could be looking, down the road, at a phenomenon of "personalized drugs" based on one's DNA. In psychiatry, the diagnostic manual of mental disorders may very well be revised to use the underlying molecular basis of diseases as a framework for diagnoses.

Dr. Wexler, couching her presentation in the context of Huntington's Disease, took the human genome discussion one step forward. She spoke of the previously unknown challenges families are confronted with in the face of the raw certainty genetic mapping provides. A test that is positive brings with it repercussions that are both psychological ­ knowing you have a deadly disease for which there is no cure ­ and social ­ knowing you risk losing health insurance as a result. She also touched on the legal ranklings that could be a fallout of genetics research. Does a woman have the right to get her fetus tested in order to determine her husband's genotype?

Workshops that followed proved to be equally provocative. The ethics workshop tackled the issue of when to allow a research participant to assume the risks of study involvement and when do such risks become ethically unacceptable, even if the subject is willing to be exposed to such risks. On the heels of two consultations, Dr. William Tucker and Gerry Segal talked about inaugurating their new consultation program, Psychiatric Telemedicine, with the aid of technological innovation and federal and state grants. Using several brief case studies, Drs. John Oldham and Elizabeth Tillinghast presented on the clinical challenges to treating multidisabled patients.

Mini-retreats, held for the first time last year, presented projects in psychiatric education, substance abuse, and child psychiatry. Initiatives in the child psychiatry program, such as use of the Voice Disc versus in-person interviews proved more effective and accurate in assessing teenagers for symptoms of depression, substance abuse, and suicide. The self-administered Voice Disc allows teens to answer sensitive questions in a "yes/no" format in a private setting through use of a computer and headphones. Approximately 200 students, mostly in the ninth and tenth grades, have been screened. Troubled students, according to Leslie Craft, MSW, tend to drop out after the tenth grade, so screening efforts have been made to reach students prior to this critical point.

Dr. Marian Fischman shared a sobering statistic regarding the number of heroin addicts in treatment: only about 200,000 of the roughly 1 million addicts. Buprenorphine may soon be approved by the FDA for the treatment of heroin dependence. (Physicians trained in the area of substance abuse have to write to the Secretary of Health for permission to prescribe while others have to take an eight-hour course.) With regard to marijuana, the most frequently used illicit drug, the potency has changed over time as the growing of it has become more scientific, thereby, making it more addictive. In a series of studies that looked at marijuana users who smoked over a period of four days, smokers experienced irritability, depression, and trouble sleeping.

The education retreat reviewed the book, Of Two Minds, which explores the current state of American psychiatric education. Faced with the task of training future psychiatrists, presenters asked themselves "What do we know about our trainees' abilities and what do we tell them?" Dr. Jack Gorman proposed more neuroscience and less psychotherapy in training. In order to understand psychiatric disorders, he added, psychiatrists need to know a lot more about the brain.

	Dr. Andrew Dwork, seated, and Dr. John Mann
Dr. Christopher Lucas and Dr. Janet Williams
	Dr. Ramin Parsey, standing, with Dr. David Strauss and Ms. Elizabeth Small