Teaching, Administrative and Research Role

Research

Our trainees and faculty members engage in cutting-edge, translational research to develop novel and improved strategies to prevent or treat psychiatric conditions among the medico-surgical patients. The three primary research goals of the Yale PM Service are:

1. To elucidate etiopathogenesis and discover innovative treatment strategy of common psychiatric syndromes among medico-surgical patients.

2. To examine the impact of presence, incidence, detection, and treatment of psychiatric co-morbidities in the quality of life, morbidity and mortality of the medico-surgical patients.

3. To develop innovative ways to efficiently deliver medico-surgical services for mentally ill patients both in the inpatient and outpatient setting and bridge the disparity gap in health service between those with severe mental illness and without.

Health Services

Three Strategies for Implementing Motivational Interviewing on Medical Inpatient Units: See One, Do One, Order One

PI: K. Yonkers, MD/S. Martino, PhD; Funding Source: NIDA R01.

The goal of this project is to compare the success of three strategies geared to implementation of motivational interviewing. Interviewing techniques would be provided by physician assistants in the general medical units of Yale New Haven Hospital.

Behavioral Intervention Team: A Model of Proactive, Multidisciplinary CL Psychiatry Service

PI: W. Sledge, MD; Funding Source: The George D and Esther S Gross Professorship Endowment.

The goal of this on-going study is to assess the quality and cost-effectiveness of an innovative, proactive model of screening for psychiatric issues among and delivering mental health services to medical inpatients with psychiatric co-morbidity

Study of Very High Cost Primary Care Patients in a University Clinic

PI: W. Sledge, MD; Funding Source: The George D and Esther S Gross Professorship Endowment.

This is a descriptive account of what is associated with the top 5% cost patients in terms of psychopathology, living conditions, demographics and medical conditions.

Transplant Psychiatry

Pre-Transplant Behavioral Weight Loss Treatment Trial for Patients with End-Stage Liver Disease

PI: D. Fehon, PsyD; Funding Source: Yale Transplant Psychiatry Development Fund.

This is a Stage 1A treatment development study which examines the feasibility and preliminary effectiveness of a group behavioral weight loss intervention for liver transplant candidates.

Eating disorders and body image beliefs in liver transplant recipients

PI: P. Zimbrean, MD; Funding Source: Yale Transplant Psychiatry Development Fund.

This cross-sectional study examines the prevalence of eating disorder symptoms and body-image issues among post-liver transplant patients.

Kidney Transplantation for Lithium induced nephropathy - Medical and Psychiatric Outcomes

PI: Paula Zimbrean, MD.

This retrospective study assesses the course of patients with psychiatric illness receiving kidney transplantation for lithium induced kidney disease.

PMS, Perinatal, and Postpartum Psychiatry

Project START: Screening to Augment Referral to Treatment.

PI: K. Yonkers, MD; Funding Source: NIDA R01

This proposal conducts a randomized clinical trial conducted in a reproductive health center which compares two SBIRTS for substance misusing women, delivered either by a trained nurse or by computer, to usual care (a control condition). As part of this trial, we will include outcomes that allow us to assess the cost effectiveness of these three conditions.

Progesterone Augmentation for Smoking Cessation in Women

P.I. Kimberly Yonkers, MD and Mehmet Sofuoglu, MD, PhD; Funding source: National Cancer Institute, R21 198187

This study will manipulate the hormonal milieu by adding progesterone to the follicular phase of the menstrual cycle in order to enhance women’s response to nicotine replacement therapy.

Prenatal Substance Use Screening Measures

P.I. Kimberly Yonkers, MD; Funding source: Centers for Disease Control, R21 DP006082-01

This study would test the validity and reliability of 6 screening measures for substance use and misuse in pregnancy.

Economic Evaluation of Drug Abuse Treatment and HIV Prevention Services for Pregnant Women

PI: Ruger; Site-PI: K Yonkers; Funding Source: NIDA R01

This evaluation proposes to conduct an economic evaluation of a behavioral approach with pregnant women to decrease substance abuse, reduce HIV risk behavior, and improve postnatal outcomes.

Progesterone for Smoking Relapse Postpartum: Feasibility, Breastfeeding and Infant Safety

PI: A. Forray, MD; Funding Source: NIDA R21

The purpose of this study is to examine the utility of oral micronized progesterone as an intervention to prevent smoking relapse in postpartum women.

Ecological Momentary Assessment and Postpartum Smoking Relapse: A Pilot Study

PI: A. Forray, MD; Funding Source: NIDA K12

This is a pilot study using ecological momentary assessments (EMA) to evaluate the impact of situational and affective stimuli on relapse to smoking in the postpartum period. Abstinent smokers, recruited during pregnancy, are asked to carry a small handheld computer (PDA) which will prompt the women to complete an assessment about cravings, affect and environmental cues at four random times per day. The results from this study will provide an assessment of the process of relapse in relation to a number of covariates.

Flumazenil treatment of Hepatic Encephalopathy and Changes in cortical GABA levels

PI: H.B. Lee, MD; Funding Source: NIDDK/Yale Liver Center

The purpose of this study is to develop an experimental paradigm for discovery of a biochemical mechanism and treatment development for hepatic encephalopathy based on the GABA hypothesis of hepatic encephalopathy.

Involuntary Hospitalization Papers in CT: Do they have predictive value?

PI: M. Prabhu, MD; Funding Source: American Academy of Psychiatry and Law

The purpose of this study is to evaluate the risk factors associated with emergency psychiatric commitment and involvement with the criminal justice system.

Functional and structural brain magnetic resonance imaging comparison between early-onset and late-onset RLS subjects

PI: H.B. Lee; Funding Source: RLS/WED Foundation

The purpose of this study is to identify the etiopathophysiology of late-onset RLS based on functional MRI (fMRI) and structural MRI by comparing elderly patients with early-onset RLS versus those with late-onset RLS in the following areas: (a) cerebral blood flow as measured by Arterial Spin Labeling (ASL), BOLD and FLAIR analyses; and (b) fMRI default mode resting state connectivity; and (c) white matter hyperintensities (WMH) measured by number, volume and locations of WMHs and measurable "silent" cerebral infarctions.

Qualitative Considerations of the Experience of High Cost Sickle Cell Patients

PI: W. Sledge, MD; Funding Source: The George D and Esther S Gross Professorship Endowment

This qualitative study compares health service utilization, attitudes and experience of eight Sickle Cell Disease (SCD) patients who had averaged over a hundred hospitalization days over three years (“high cost utilizers”) and eight matched (by gender, age, and genotype for disease expression) SCD patients (“low cost utilizers”) before and after a SCD-specific “medical home” intervention.

Cancer/Tobacco Treatment

New Approaches to Smoking Cessation in Heavy Drinkers

PI: L. Fucito, Ph.D.; Funding Source: NIAAA K23

This pilot study will test an integrated behavioral intervention to concurrently treat smoking and heavy alcohol use.

Novel Treatment to Enhance Smoking Cessation before Cancer Surgery

PI: B. Toll, Ph.D., MUSC; Site PI: L. Fucito, Ph.D.; Funding Source NCI R21

This project is a preliminary study of the effect of adding contingency management to standard smoking cessation treatment to enhance rates of smoking cessation for cancer patients before their cancer surgery.

Yale SPORE in Lung Cancer: Core Project: “Personalized prevention: smoking cessation in lung nodule patients

PI: Roy Herbst, MD; Co-Investigator: Lisa Fucito, PhD. Funding Source: NCI P50

The purpose of this study is to develop and test the efficacy of a new personalized approach to gain-framed messaging to improve smoking cessation in Americans with asymptomatic lung nodules who continue to smoke.

Sickle Cell

Psychiatric Screening of Adults Living with Sickle Cell

PI: A. Forray, MD; Funding Source: Adult Sickle Cell Fund

The purpose of this study is to screen adults living with sickle cell disease for psychiatric disorders and symptoms and determine the impact of psychiatric conditions on patient outcomes such as inpatient hospitalizations, emergency room visits, adherence to treatment and opiate medication utilization.

Perioperative Psychiatry

Intracranial Atherosclerosis and Predictors of Post-CABG Depression

PI: H. Lee, MD; Funding Source: NIMH R01

The purpose of this grant is to examine the intracranial atherosclerosis measured by Transcranial Doppler as a risk factor for post-CABG depression based on the vascular depression hypothesis. This study also aims to determine pre-surgical predictors of post-CABG cognitive decline and delirium.

Perioperative Cognitive Protection – Dexmedetomidine and Cognitive Reserve

PI: J Silverstein, Mount Sinai; Site-PI: H. Lee, MD; Funding Source: NIA R01

The purpose of this six-site double-blind, randomized, placebo-controlled study is to evaluate the effect of dexmedetomidine in the prevention of delirium in non-cardiac surgical patients.