Disruption of Sleep May Contribute to Many Symptoms of Mental Illness

cover-02-132x200Karen Gamble joined the Department of Psychiatry and Behavioral Neurobiology at UAB in September 2009, after completing her postdoctoral training at Vanderbilt University.  Dr. Gamble holds a Ph.D. in Behavioral Neuroscience and received a prestigious Pathway to Independence Award from the National Institutes of Health, for a project entitled “Integration of Photic and Nonphotic Signaling in the Circadian Pacemaker.”

The focus of Dr. Gamble’s research is the investigation of sleep timing controlled by the brain’s clock (circadian system). Clock disturbances can greatly disrupt sleep and are characteristic of many mental health disorders including depression and schizophrenia.  Studies have shown that disruption in the timing of sleep can worsen the symptoms of many psychiatric disorders.  Furthermore, the symptoms resulting from disrupted sleep timing, for example, in shift workers or during ‘jetlag’, can be mistaken for psychiatric illness in people who do not have a psychiatric disorder.  On a much broader scale, shift work has been associated with an increased risk of developing cardiovascular disease, metabolic and gastrointestinal disorders, depression, as well as cancer.  In fact, in an animal model of chronic jet lag, circadian researcher Alec Davidson, Ph.D. and colleagues at Morehouse Medical School have shown that geriatric animals had greatly increased mortality rates compared to un-shifted controls.  Dr. Gamble’s research aims to determine how genetic and environmental disruption of the circadian system can lead to mental illness and other medical problems, using animal models of clock-controlled sleep disturbances.

The brain’s master clock is located in a region called the suprachiasmatic nucleus (SCN) of the hypothalamus.  The clock synchronizes with the environment, for example with daylight, due to the activity of “clock” genes called Period1 and Period2. Clock gene activity can be measured in real-time using glowing reporter proteins from fireflies and jelly fish that are artificially linked to the clock genes. These reporters can be used to record electrical signals (the primary language of brain cells) and gene activity at the same time in individual living brain cells. Twenty-four hour gene activity continues for many months after culturing brain slices containing the SCN, and this property allows for examination of the chemical signals that are critical for clock function. Recently, Dr. Gamble and her colleagues demonstrated the importance of a well-known chemical signal in the SCN, gastrin releasing peptide, in the process of resetting the clock and activating clock genes.  In addition to light, other stimuli can also reset the clock, such as arousal and exercise.  In the future, she plans to use similar strategies to investigate how the clock’s cells interpret and respond to conflicting stimuli such as when exercise and light occur together.

In an effort to extend the basic knowledge of circadian rhythms to humans, Dr. Gamble has explored genetic and environmental predictors of adaptation to night-shift work in hospital nurses.  All of us who have benefited from nurse care in hospitals will be interested in how nurses adapt, or do not adapt, to shift work behaviorally and genetically.  In her research, Dr. Gamble and colleagues at Vanderbilt University identified five novel sleep strategies that nightshift nurses used for their days-off.  Nurses who used sleep deprivation in order to switch between day- and night-shifts were the most poorly adapted to night-shift.  In addition, this study showed that some genotypes of circadian clock genes are associated with alcohol and caffeine consumption, sleepiness, sleep duration, and tendency to be a night owl.  Finally, this research demonstrated genes can interact with the environment because some circadian genotypes only contributed to behavior under certain shift conditions.

At UAB, Dr. Gamble is collaborating with Dr. Rachel Fargason, Dr. Xiaohua Li, and Roberta May in a clinical trial exploring new treatments for people with attention deficit hyperactivity disorder (ADHD) with insomnia.  This collaborative group plans to test the idea that some ADHD patients experience insomnia because they have late clocks and are thus, night owls.  Insomnia worsens the symptoms of ADHD.  They expect treatment with a drug that enhances the effects of melatonin will reset the clock in these patients and improve their symptoms.

We are delighted to welcome Dr. Gamble to the Department and look forward to seeing interesting research developments from her laboratory on this important clinical problem.

TASC and Foster Cook: The Man Behind the Program

DSC 0111-275x200Mr. Foster Cook, on the faculty of the Department of Psychiatry since 1978 and the director of the Substance Abuse Programs, has provided the necessary leadership and vision to build a dynamic model of research, direct services, and social justice advocacy through the UAB Treatment Alternatives for Safer Communities (TASC).  His grandparents were missionaries to Korea in the early 1900’s and his family history of public service has imprinted well.

Mr. Cook’s attributes include a remarkable understanding of: salient political forces, the power of judges and law enforcement, the burden of not treating those with addiction caught up in the judicial system, and cost-effective evidence based treatment combined with a passionate commitment to advocacy for a disenfranchised population.  Starting in the mid to late 80’s, his aggressive solicitation of federal dollars brought resources into the local systems that have helped drive policy-topractice reforms.  Over the years, Mr. Cook has been awarded over 16 million dollars to fund such entities as: drug prevalence research, implementation of drug courts, and mental health courts, and expanded access to substance abuse treatment.  His vision, diligence, and leadership have created, preserved and sustained a system of care that saves money, but more importantly, saves lives.  He and TASC have never stopped working to help those who so desperately need assistance in the State of Alabama.

The UAB Treatment Alternatives for Safer Communities (TASC) originated through a federal grant proposal in The White House Special Action Office for Drug Abuse Prevention.  TASC was established as a case management program for felony offenders with serious substance abuse and addiction disorders.  In 1973, the Law Enforcement Assistance Administration (LEAA) and the National Institute in Drug Abuse funded 13 TASC sites, which included the UABTASC Program.  TASC was the first effort to bring together, through a formal partnership, the criminal justice system and the substance abuse treatment system.  It remains the oldest operational TASC Program in the country.

Mr. Foster Cook, the current director, helped implement the program, then housed in the Birmingham City jail, in 1973.  Mr. Bill Cox, a local parole official, was director until 1977.  At that time, federal funding had dissipated and local city and county funding was obtained for continuation of the program.  UAB Department of Psychiatry, then headed by Dr. Patrick Linton, provided the administrative infrastructure and support.  The partnership between UAB Psychiatry and TASC expanded in mission and scope under Mr. Cook’s leadership.  The UAB Methadone Clinic merged with TASC and the outpatient UAB Drug Abuse Program at Smolian Clinic in 1980.

In the early 90’s, the Jefferson County jail became dangerously overcrowded.  To alleviate these conditions, the county utilized UAB-TASC as a jail diversion/pre-trial program.  UAB-TASC also implemented one of the states earliest drug court programs; now the largest drug court in Alabama.  Presently, Jefferson County incorporates two Judicial Circuits-Birmingham and Bessemer.  Parallel programs, including pre-trial release and a drug court, were created in Bessemer to match services with the Birmingham Judicial Circuit.

In 1992, The National Institute of Drug Abuse selected 5 TASC programs for evaluation by the RAND Corporation and the UCLA Department of Neuropsychiatry.  UAB-TASC was one of the sites and the research team compared TASC program outcomes with criminal justice clients who did not receive TASC services.  UAB-TASC clients received significantly more services in every domain than the control group (jobs, drug treatment, HIV screening, mental health, urine screening) and responded with lowered re-arrest rates for high-risk felony offenders.

In 1996, UAB-TASC was one of three sites in the nation to be selected as a demonstration model for the Break-The-Cycle Project.  The White House office of National Drug Control Policy funded this unique effort to expand TASC core operational elements (early intervention, assessment, referral to appropriate community services and assertive case management) into a system wide continuum from arrest through final sentencing and adjudication.  The Urban Institute provided the outcome evaluation, which concluded that TASC supervision lowered recidivism dramatically (30%) compared to a control group.

Upon completion of this project, the local justice system retained the improvements that were implemented under Break-The-Cycle.  In 2001, TASC targeted those with severe mental illness who were incarcerated for longer periods of time and could not access the critical services necessary for management of their mental illness.  UAB-TASC collaborated with the National Alliance for the Mentally Ill (NAMI), county government and the courts to complement two mental health courts in Birmingham and Bessemer.  These courts are administered similar to the drug court model of intermediated sanction and incentives.  UAB-TASC has also served the juvenile offender population since the mid 1980’s.  The Adolescent Substance Abuse Program (ASAP) is contracted with the juvenile court system and provides urine screening and substance abuse treatment, prevention and monitoring for the court.

As can be readily observed, since 1973 UAB-TASC has evolved considerably, managing to combine the collective efforts of treatment providers, law enforcement, and the judiciary, to offer populations challenged by substance and drug dependence a breadth of services that have proven, overtime, to be profoundly effective.  Supported by federal funding, Mr. Cook implemented the core program elements and networks the have proven effective for over 35 years.

2010 Brings a Successful Match to our Residency Training Programs

newseal-214x200This year has been another successful year for the Department of Psychiatry Residency Training Program.  After interviewing more than 60 well qualified applicants the 8 available training positions were finally filled.  The new residents are Michael Anderson from the Medical College of Georgia, School of Medicine; Irena Bukelis from Kauno Medicinos Universiteto; Zhendong Ma from Shanghai Second University, China; Bryant Mahaffey, a local from the University of Alabama School of Medicine; Stephan Meadors from the Medical University of South, Carolina College of Medicine; Laurence McMillan from Meharry Medical College; Samuel Polek from Ross University; and Michelle Reeves from the University of Alabama School of Medicine.

Also, the Child & Adolescent Residency Training program had a successful match with the addition of two new residents.  They are Richard Stephen Pannel from Kansas City University of Medicine and Biosciences and Miriam Sevilla Saez-Benito from the University of Granada Faculty of Medicine.

The addition of these strong fellows is a testament to the quality of training and education received at UAB.  It is clear the word is spreading as applications were received from across the U.S. from as far away as California and South Dakota.  UAB continues to attract a number of international medical graduates as well.  UAB Psychiatry Residency Training Director and Vice Chair for Education and Clinical Services, Dr. Daniel Dahl, states that, “We have seen an increase in the competitiveness of the applicants every year over the past 9 years.  This year was no exception.  We had over 700 applicants for 8 positions and many of these applicants have additional degrees including MD / PhD’s from prestigious research institutions.  Psychiatry is on the verge of becoming a popular specialty for graduating medical students.  The future of psychiatry in Alabama is determined by the quality of applicants we attract.  From my viewpoint, the future looks extraordinarily bright.”

Please join the Department of Psychiatry in welcoming these new additions.

New Child & Adolescent Chief Resident for 2010-2011

Theodore-M.-Morgan-II-232x200The UAB Department of Psychiatry is pleased to announce the appointment of Theodore Morgan II, M.D. as Chief Resident for the Child and Adolescent Psychiatry Residency Program for 2010-2011.  Dr. Morgan is from Montgomery, Alabama.  He received his BS in Molecular Biology from Florida A&M University and his MD from Meharry Medical College.  He completed his Residency in Psychiatry at UAB and is now completing his training in Child and Adolescent Psychiatry.  In addition to his appointment as our Child and Adolescent Chief Resident, Dr. Morgan will be featured in our next issue of UAB Psychiatry for his work with Birmingham youth.  He, along with local physician Dr. Hernando Carter, established The Kappa League Leadership and Development Program.  This mentoring and training program is designed to inspire young men in high school to accomplish what they set out for in life through hard work and dedication.  Please join us in congratulating Dr. Morgan on his new appointment.

Jacinda C. Hammel, Ph.D.

Jacinda-Hammel-2-177x200The Department of Psychiatry welcomes Jacinda C. Hammel, Ph.D., as an assistant professor.  Dr. Hammel’s research focuses on mental health services and her clinical foci include outpatient therapy with adults.  She is a member of the UAB Psychology and Internship Training Consortium and will be providing psychotherapy supervision for psychiatry residents.  Dr. Hammel received her first undergraduate degree in Business and Accounting in 1994.  In 2001 she received her second Bachelor of Science degree (cum Laude) in psychology from Indiana University in Bloomington, Indiana.  Her graduate work was completed at Auburn University in 2004 (MS) and 2006 (PhD), where she worked with Dr. F. Dudley McGlynn studying anxiety disorders.  Her specific interests were that of “autonomic activity in generalized anxiety disorder: Sympathetic and parasympathetic activity during worry exposure and decatastrophizing.”  Thereafter, she completed her dissertation entitled “Meta-worry and Generalized Anxiety Disorder.”  As a clinical psychology intern at the Durham Veterans Affairs Medical Center in North Carolina, Dr. Hammel provided therapeutic, assessment and consultation services in a medical setting.  Some of those services included mental health, infectious disease, inpatient psychiatry, rehabilitation, and medical consultation. She also has extensive teaching and training experience in Dialectical Behavior Therapy, suicide and self-injury prevention, social psychology, behavior therapy, abnormal psychology, and lifespan development.  Dr. Hammel’s clinical experience includes private practice and working with the Youth Services Institute of the University of Alabama and the State of Alabama Department of Youth Services.  Her duties included working with incarcerated adolescent females, program/policy development, design and oversight of research, and supervision of clinical staff.  Dr. Hammel is currently a co-investigator with the program.  She is a member of professional organizations including the American Psychological Association and the Association for Behavioral and Cognitive Therapies.