The NIMH Psychiatric Consultation Liaison Service (PCLS) provides important psychiatric services to the many constituencies of the NIH. While providing such services to the NIH Community, PCLS clinicians conduct research and collaborate with NIH investigators by providing expertise in the areas of psychiatric, neurocognitive, and psychosocial functioning in NIH research subjects who often have complex medical and neuropsychiatric symptoms. Patient-subjects enrolled in research trials in other Institutes/Centers at the NIH offer unparalleled opportunities to explore the roles of specific genes (e.g., monogenic diseases such as methylmalonic acidemia (MMA)) and specific therapies (e.g., anakinra in neonatal onset multisystem inflammatory disease (NOMID)) in psychiatry and neurodevelopment. Psychosomatic medicine trainees on the PCLS are encouraged during their rotations to pursue research projects that result in publications in peer reviewed journals, including literature reviews, case reports and poster presentations at national conferences. Active NIH research collaborators include the CC Bioethics Department, NCI Pediatric Oncology Branch (POB), the NIAID HIV/AIDS Service, and the Smith-Magenis Research Team to name just a few. Initiated in October 2008, the PCLS Neuropsychology Consultation Service performs neuropsychological evaluations for neurocognitive phenotyping of medical disorders resulting in research collaborations with other Institutes such as NIAMS, NHGRI, NIAID, NHLBI, NINDS and others. The PCLS conducts collaborative research with the NCI POB and provides research support to the Pediatric Oncology Psychosocial Research Program which studies palliative care, psychopharmacologic management in pediatric oncology patients, sibling, parent and caregivers concerns, and screening for distress in bone marrow transplantation recipients as compared to other chronic diseases, among other topics. This active research program on psychiatric and psychosocial aspects of pediatric oncology care has led to several shared protocols in data-collection phase including evaluation of a distress thermometer in pediatric medically ill populations, characterization of """"""""lone"""""""" parenting and a protocol to understand the experiences and needs of international families whose children are in research. The PCLS research group provides mental health consultation on a number of educational brochures and booklets and recently reissued and distributed to clinicians, at no cost, a therapeutic workbook, """"""""This is My World"""""""" to help chronically ill youth develop coping skills. The PCLS also offers research design and presentation consultation to the POB for their ongoing research endeavors (e.g., evaluation of the patient and family experience of Medical Isolation Procedures). The PCLS research team has taken a central role in NIMH's collaboration with NIAID and the District of Columbia (DC) in establishing an interdisciplinary, cross-institutional research collaborative effort with local investigators, the DC-NIH Partnership for AIDS Progress (DC PFAP), to enhance knowledge of the biopsychosocial mental health aspects of HIV/AIDS. PCLS staff are working with DC Government leaders, clinical providers and administration, and community groups to identify gaps in services and knowledge to develop related research opportunities. PCLS researchers have also supported IRP HIV/AIDS research collaborations on two projects: 1) prospective evaluation of the relationships between hematologic and radiologic markers of vascular dysfunction and neuropsychological outcomes in HIV+ individuals, and 2) determination of the relationship between neuroinflammation and P-glycoprotein (P-gp) function in minor cognitive motor disorder associated with HIV infection using PET imaging of brain uptake of 11CdLop. The PCLS research group continues to describe the processes involved in developing adequate programs for the protection of healthy volunteers as well as vulnerable subjects while conducting cutting-edge research. They also examined why eligible research participants may decline to enroll in mental health protocols and made recommendations for principle investigators to consider when designing protocols. An informed consent training video produced by the Clinical Research Advocates (CRAs) of the Human Subjects Protections Unit (HSPU), in the Office of the Clinical Director, is now being used for training in all the Graduate Medical Education programs at the NIH as well as throughout the CC. The CRAs continue to provide training courses as well as present at national meetings on their experiences regarding implementing processes to standardize the evaluation and protection of vulnerable subjects in research. They have also been actively involved in the creation and implementation of the Ability to Consent Assessment Team (ACAT) and, in tandem with the CC Bioethics department, are utilized throughout the Clinical Center to provide additional safeguards to vulnerable subjects. The PCLS also provides mental health consultation to the National Institute for Child Human Development (NICHD), and assigns a mental health professional to serve on the NICHD IRB. The PCLS research group is at the forefront of research on suicide screening as an important first step in suicide prevention. In the United States (US), routine screening of pediatric patients in medical settings, such as the emergency department (ED) or primary care clinics, has been suggested as a way to identify youth with undetected mental health needs. As a way to combat this international public health threat, the PCLS has embarked on developing a suicide screening tool for medical settings by spearheading a multisite instrument validation study with Childrens National Medical Center, Children's Hospital Boston and Nationwide Children's Hospital in Columbus, Ohio. 524 ED patients (10-21 years) presenting with medical and psychiatric complaints were recruited for suicide screening. Preliminary results suggest screening nonpsychiatric patients for suicide in the ED is feasible. Data has been analyzed and a four item screening tool has been developed and is being written up for publication and dissemination. Another study found young children under the age of 12 presenting to the ED for psychiatric reasons to be at significant risk for suicide. Given what we have learned, two new protocols are under development: suicide screening tools for youth with developmental delay and for adult medical patients in general hospital settings. The latter will help the Clinical Center and other hospitals meet Joint Commission recommendations for screening all medical patients for suicide. The PCLS research team had a productive year with more than a dozen posters, more than 20 papers and numerous presentations and educational courses in the past year.
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