Take a look at HALLMARK HEALTHCARE CORP. Hospitals Today, more physicians are looking to get away from the stress of a big-city, big-hospitalatmosphere. Theywantmorefortheirhardworkandmorefortheirfamilies. In fact, they wantitall. A first-rate healthcare facility. A profitable practice. A family- oriented community. Access to a large city for dining, shopping, and entertainment. Good schools for their children. A challenging work environment. And most of all, personal fulfillment. Ifyou want it all, Hallmark Healthcare Corp. can help: • Create afinancialpackage to meetyourfamily's needs. • Schedule a tour ofthe community surrounding your new hospitalfor you andyour spouse. • Manageyourrelocationcompletely.HHCarrangesforyourrelocation with a bondednational movingcompanythatwill load,unload,andeven unpack your new home. • Helpyou set uppractice. HHC guarantees a minimum annual income for your first year in practice by subsidizing the difference between your collections and an agreed-upon annual income during that year. HALLMARK HEALTHCARE CORP. Post Office Box 723049 300 Galleria Parkway • Suite 650 David W. Lewellyn Atlanta, Georgia 30339-0049 Director - Physician Recruitment (404)933-5500 • (800)234-1501 MEDICAL COLLEGE TheHealthSciencesUniversity oftheStateofGeorgia Volume 20, Number2 Winter 1992 Introduction Contents ^Schizophrenicshearvoices that 21 Silencingthe Voices f|(u exist in noone'sreality buttheir Medical CollegeofGeorgiaresearchers are uncovering vital information about own. Anorexicsaresoafraidof schizophrenia, adisease markedby delusions andparanoia. gainingweightthat they literally starvethemselvestodeath. Social phobics 61 FightingDepression cloisterthemselves from the worldto An MCG psychiatrist is testing whichdrugs, and in whatdoses, aremost effective for avoidothers' scrutiny. Alzheimer's thosewithdepression. patientsdiea littleeachday, theirminds slipping away into irretrievabledarkness. 7/ BlueprintoftheMind Theonly commondenominatorofall Adiagnostictestguides psychiatriststhrough interviews designedtopickthe brain. these groups is that their—illnesses are classified as psychiatric diseasesofthe 91 AlumNews mind whoseorganicroots are beingbetter understoodeveryday. 221 A MatterofControl MCG Research atthe Medical College of hasestablishedaneating-disordersclinictohelppeople regain control oftheir GeorgiaDepartment ofPsychiatry isdra- eating habits. matically enhancing that understanding. Wanediitnsvictleinyiocaultaopplleiacrantaibonosutinthtehirseesdeiatricohn 261 AMnapMCofGtrheeseBarracihnerisrefining a hi-tech way todiagnose mental illness. ofMedicalCollegeofGeorgia Today. 271 Facingthe World Drs. ManuelCasanovaand Sukdeb Mukherjeeareeach pursuingdifferent New drugs may enablethose with social phobiatoovercome theirfearandfacethe world. meansofshedding light on schizophrenia, adiseasecharacterizedbydelusions and 281 ReclaimingthePast paranoia. Dr. Casanovais tryingtoisolate MCG istestingtwodrugsthat may help victimsofAlzheimer'sdiseasereclaim their agene; Dr. Mukherjee is probingacellu- memories. larbasis. Readabout theirresearchand theconsiderable human toll involved in 291 Plan YourGiving thedisease. Dr. RichardBorison,chiefofthe MCGPresident: FrancisJ.Tedesco,M.D. MCGFoundationOfficers department, is testing memory-enhancing ExecutiveEditor: JamesB.Osborne.Ed.D. President: H.GordonDavis,M.D. drugs in the hope thattheycan salvage DirectorofMarketingandPublicRelations: FirstVicePresident: WilliamC.Collins,M.D the memoriesofAlzheimer's patients. GeorgeH.Foster SecondVicePresident: VirgleMcEverJr.,M.D. Dr. Jeffrey Rausch is tryingtopredict Editor: ChristineHurleyDeriso Secretary-Treasurer: HaroldS.Engler,M.D. how those withdepression will react to ArtDirector: BrentD.Burch ExecutiveDirector: JamesB.Osborne.Ed.D. antidepressantdrugs andat whatdoses Photographers: PhilJones AssistantSecretary-Treasurer: LarryTyler thedrugs will be mosteffective. WillWillner The departmentalsohasestablished TheMedicalCollegeofGeorgiaisthehealthsciencesuniversityoftheUniversitySystemofGeorgia.Focusingon aneating-disordersclinic totreatthose health-careeducation,researchandpatientcare,theAugusta-basedinstitutionconsistsofMCGHospital,morethan HOsupportclinics,statewideoutreachprogramsandtheSchoolsofAlliedHealthSciences,Dentistry,Graduate tormentedby food. And readaboutbrain- Studies.MedicineandNursing. mapping, adazzling technique todiagno- MedicalCollegeofGeorgiaToday(USPS867340)issponsoredbygrantsfromMCGFoundation.Inc.andthe sispsychiatricdisorders. MCGSchoolofMedicineAlumniAssociation.ItisproducedbytheDivisionsofInstitutionalRelationsandHealth Wehopetheseandotherarticles CGroampmhuincicAadtvierotniss;inMge,dPi.cOa.lBCoolxle3g97e.oAfuGgeuosrtgai,a;GeAourgguisata3,09G0e3o.rgPiuabl3i0s9h1e2d.qAudavrteerrtliys,inMgCiGnquTiorideasysihsofuulrdnibsehdeidretoctedto included in thisedition ofthe magazine alumniandfriendsofMCGwithoutcharge.Second-classpostageispaidatAugusta.GA.Theappearanceofadvertise- will intrigueandenlighten you aboutthe mentsinthispublicationdoesnotconstituteanendorsementbytheMedicalCollegeofGeorgiaoftheproductsorser- vicesadvertised.Postmaster:SendaddresschangestoDataUpdateOffice,FI-100AlumniCenter,MedicalCollege workingsofthe mind. ofGeorgia.Augusta.Georgia30912. Silencing the Voices usan Ellis* was people were waitingforher still lying in bed, terrifiedto smothered. She frantically hearing voices outside herdorm room with move. She'dgotten upfor clutchedherchest. Convinced again. guns. Shewastoldto lie in bed foodonlyonce, andthen ate she washavingaheartattack, Thistime, the and stay there; herlife only halfasandwich. she wenttoanemergency room voicestoldherthat dependedon it, they said. She Thevoiceseventually Thathospital tripmarked listened. became socacophonousthat the beginning andtheendfor *Notherreal name. Fourdays later, shewas Susanfeltherheart wasbeing Susan: thebeginningofanew 2 MEDICALCOLLEGEOFGEORGIATODAY MCG life freeofvoices, theendofa wouldn't havegone forhelp." ofVeterans Affairs Medical fessorofpsychiatry at uniquely cruel kindofhell. Shewasdiagnosedalmost Center. and the VA, is pinpointing She learned in the hospital that immediately. "When I was told Andcertaincharacteristics exactly whatdistinguishes the this kindofhell hada name: 'schizophrenia,' I didn'teven ofschizophreniabaffle brainofaschizophrenic. Susan was schizophrenic. know whatthe word meant. I researchers. Thediseaseis While on thefaculty ofJohns She hasn'talwaysheard thoughtschizophrenia meant much lesscommon in rural Hopkins University andthe — voices. Susa—n pretty, outgo- multiple-personality disorder." than urban areas, forinstance. National InstituteofMental ing,artistic enteredcollege But shewashapp—yto learnthat And schizophrenics in Nigeria Health, heparticipated in a afterhigh school topursueher amedica—l reason andatreat- and Indiahave much better study of20setsofidentical loveofart. Butshortlythere- ableone explained hernight- outcomesthan thoseelse- twins. One twin ofeach set after, herfatherdied. Theyear mare. "I was relievedwhen I where. "They don't showthe was schizophrenic. Each was 1989. Shewasdeeply wasdiagnosed." progressivedeterioration," Dr. schizophrenic's brainwas depressedthenextfew months. In the twoyears since her Mukherjee said. He is found to haveunusually large Then she sankdeeperstill. diagnosis, Susan has learned researching such variationsto ventricles, fluid-filledcavities "WhatI wentthrough wasa more about schizophreniathan determinethecauses. within thebrain. seriesofdelusionsthatwent she likelyeverwantedto Researchers have found Since the schizophrenics' through my head," shesaid. "I know. Thedisease, which that schizophrenics have an twins were not likewise thought someonewastryingto affects about 1 percentofthe excess ofdopamine, an amine affected, theresearchersdeter- control methrougha machine. I population, generally strikes in essential tonormal nerve minedthatthecharacteristic thoughtthe machine...orthese youn—g adulthood. The symp- activity in the brain. Susan's resulted not genetically, but people...weretryingtoget me toms delusio—ns, paranoia, schizophreniaiscontrolled from an injury. Noneofthe todosomething. I thought it disorientation maybetrig- with drugs that inhibit the twins sustained abrain injury involveddrugsandthatthey geredby atraumaorforno body's productionof afterbirth, soDr. Casanova wereaftermoneyorsomething. apparentreason. Some dopamine. Thedrugscontrol concluded the brain was I alsosawand felt thingsthat schizophrenics are sometimes hersymptomsandallow herto injuredin utero. "I believethat weren'tthere. I wouldsee catatonic, acquiring and hold- lead afull life. any lesions tothebrain should people'sfacesswell up.... ingoddpostures forhoursata Butas importantasthese haveoccurredduringthe first "Itstruck measvery real. I time. That is becoming drugsare, theyonlytreatthe orsecond trimester,"hesaid. believed itforalongtime." increasingly lesscommon, an symptoms. "Schizophreniaisa Researchersdobelieve, She didn't confideher indication that schizophrenia is progressivedisease, notjust however, thatschizophrenia experiencestoanyone. "I anevolvingdisease. acutesymptoms,"Dr. hasagenetic predisposition. didn'tgotoanybody becauseI These symptoms, unfortu- Mukherjee said. "Wetreat the This tendency may makethe thought these people would nately, provide the only basis acutesymptoms,butthebasic brain lesstolerantofinjury or harmmeormy familyifI fordiagnosis. "Thetrouble disease is still progressing more susceptibletoit. Another did," she said. with thisdisease isthatthere is underneath." Andthedisease study found that schizophren- She hadaprivatedorm noclearbiological measure itselfis maddeninglyenigmatic. icsaremore likely than the room, soshe wasrelatively thatdetermines whetheryou Researchers atMCG are general population tohave had free from scrutiny. But Susan haveit," said Dr. Sukdeb doggedly tryingto shed light compli—cationsduring their couldn't maskhersymptoms Mukherjee, professorofpsy- on it, and with often startling births anotherindication that forlong. Herfearandparanoia chiatry at MCG with ajoint results. made heredgy, withdrawn and appointment atthe Department Dr. Manuel Casanova,pro- Dr. ManuelCasanova moredepressedthanever. "That's—the firstthingmy mom noticed boutsofdepression," she said. Herboyfriend noticed, too; she seemedto constantly pick fights with him. And hergradesdropped dramatically. "Thequarter(before I was hospitalized), I was failing in one ofmy favorite artclasses. My teacherknew something waswrong. Shecalled me in heroffice andaskedifthere wasanythingshe coulddo." But Susandidn't divulge hersecret. Thosevoiceswere asrealtoherasevery other aspectofherlife, andshe fearedforhersafety. "WhenI finally wenttothehospital, it wasbecause I thoughtmy hearthad stoppedbeating. Ifit hadn't been forthat, I VOLUME 20, NUMBER 3/SPRING 1992 brain injury is relatedto, although not theonlyreason for, schizophrenia. MCG has establisheda brain bank sothattissue of schizophrenics andhealthy individualscanbe furtherstud- iedandcompared. Dr. Casanovais seeking50 donors, whocanbeany age and musthavedied from an injury orillness that lefttheir brains intact. Thebrains will be storedat super-cool temper- aturesatwhich icecrystals don't form andtissuecan be safely kept foryears. Dr. Casanovaalso is interestedin the brainsofthose withother typesofneuropsychiatric illnesses such asParkinson's disease, epilepsy, manic depression and mental retarda- tion. (Braindonation coststhe donornothinganddoes not interfere with an open-casket funeral. Those interested in donating may contactthe MCG Organ andTissue Donor Serviceat404-721-341 1.) In the meantime. Dr. Casanovais fashioningother, less literal meansofpeering intothe brain. Magneticreso- nance imaginggives him a startingpoint, providingtwo- dimensional imagesofthe brain. But the brain is multi- layered, sotheimagesprovide limited information. One method he usesto supplement the information isquantitative shape analysis. "Ifyouhaveasphereanda general forceactingonit,you getasmallerspherebutreally nochange in shape,"hesaid. He specifically studiedthe magazinetoanalyze braintex- Dr. SukdebMukherjee "Ifyoutakethe same sphere temporal lobe, theonly areaof ture usingthe same principles andapply afocal forceon it. schizophrenics' brainswith enabling fishermen topredict Mechanicsormagazinesof youhave a—change in shape, abnormally low volume. "I thebest spotsto fishby study- this sort,"he said. notvolume liketakingaslice foundthatthe injuries are ingthe numberoftheocean's Andthe more heunder- outofapie."He wondered focal, as ifaportionofthe waves andthe heightsoftheir standsaboutaschizophrenic's whichtypeofforceoccurredto brain has literally been sliced peaks. "I foundoutthrough brain and its injury, thecloser thebrainofaschizophrenic, out,"he said. textureanalysisthat theante- he thinks heistosinglingouta causingthe injury. "We'retrying torebuildthe riorand medial partsofthe generesponsibleforthedis- Dr. Casanovaappliedthe pictureofwhatthe schizo- temporal lobeare wherethe ease. "We're working back- mathematical principlesof phrenic brain looks like. By shapes are mostabnormal. The ward, fromthe lesiontothe shape analysistomagneticres- plugging numbers intoan tissueisnotaslargeasnormal gene,"he said. "We may be onance imagesofthetwins' equation, you build ashape. and is moredysplastic." verycloseto findingthegene." brains. Usingacomputer, he Now you have morethan num- Dr. Casanova'suseofmath Assuming, ofcourse, that pluggedin mathematical equa- bers; you havea figure, and andcomputerstoobtainclues onegene holds thekey. Dr. tionscorresponding tothepor- youcancompareone figure toschizophreniaisdecidedly Mukherjee isn'tsosure. "All tionofthebrain hecouldsee with another." unconventional. "Curiously disease is the net resultofthe andwasabletoconstructa Healsowas inspiredby an enough, I've gotten mostof interaction between a pictureoftheunseenportion. article inFieldandStream my ideas from Popular pathogenic insultandthe 4 MEDICALCOLLEGEOFGEORGIATODAY —— body'sdefense mechanisms." He is focusingspecifically he said. "Is itapathogenic on catalase, anenzyme which geneorisita varietyofthings appearsto show markedly + FIPPS SURGICAL affecting thedefense mecha- reducedactivity in schizo- nismsofthe body thatcauses phrenic patients. Thisreduced SUPPLY CO., INC. schizophrenia?" activity can deregulatecell Ifthe latteristhecase activity and alterDNA, an that the body'sdefense system individual'sgeneticblueprint. The IndependentDealer isatfault, ashe suspects "Thiscan lead togenetic faults then theentire body is and virtually any kindof affected, notjust the brain. He damage," Dr. Mukherjee said. istestingthe theory by study- "Ourgeneral hypothesis is that ingcell culturesofschizo- the fundamental defect in Fipps has been carefully serving the phrenics, comparingthem to schizophrenics is ageneralized cell culturesofhealthy indi- metabolicdefectofa nature needs of hospitals and physicians for viduals. "Acell culturepro- that may not affect anypartof more than 20 years. vides amodel ofapatient ina the body but thebrain." If you're looking for quality health littledish."he said. "But Thisyear, he will begin unlikeblood, thisisagrowing, studyingcell culturesofchil- care products and personalized service, dynamic system. To my under- dren ofschizophrenics to see if call us today: standing, wehavethe world's theircells show the samedis- biggestcell bankofschizo- organized pattern. Ifso,the 241-3296 phrenic patients." diseasemaybediagnosable (800) or He andhiscolleagues have before symptomsdevelop. foundthat two-thirdsofthe Such findingsalsowould lead (404) 874-5734 cellsofschizophrenics are toamuchclearerunderstand- grossly disorganizedand mis- ingofthedisease. "I would shaped. "Atthispoint, we're liketointervene beforethe FIPPS SURGICAL SUPPLY CO., INC. tryingtotrackdown thebasis psychosisdevelops," Dr. NE 733 Lambert Drive, ofitandsee what itmeans," Muk—herjee said. he said. CHRISTINE HURLEYDERISO Atlanta, Georgia 30324 HealthCare Consultants, Inc. Augusta's Hometown Bank If your practice needs a "check up,"HealthCareConsultants,Inc. can help. Let us put our proven GEORGIA experience in assisting physicians, medical BANK societies and hospitals to work for you. We offer: CONSULTING SERVICES: & • New practice set-up • On-site medical practice assessments•CPT/ICD-9coding•Incomeenhancement TRUST •Claimsreview• Feeanalysisandstructuring• Preand post audit assistance • Evaluation of computer needs. COMPANY Plus: medicalpracticeandorganizationalmanagement, educational programs, seminarsand training. MEDICAL PUBLICATIONS: •1992PhysicianFeeGuide • RBRVS:AComprehensive MemberFDIC GuidetoMedicarePaymentReform • BusinessAspects ofMedicalPractice • MakeMedicare Workfor You Main Office: Southside Office: 3530WheelerRoad 3111 Peach Orchard Road Help foryourmedical practice is only a phone call Augusta, Georgia 30909 Augusta, Georgia 30906 awa-y.8Fo0rm0or-e i2nfo5rma3tio-n,4pl9eas4e c5all 404-738-6990 404-790-3111 1 HealthCare Consultants, Inc. Atlanta • Augusta • Jacksonville VOLUME20, NUMBER 3/SPRING 1992 5 Making psychia- try a more exactsci- ence is thegoal ofDr. Jeffrey Rausch, professor andvice chairman ofthe DepartmentofPsychiatry andHealth Behaviorat the Medical College of Georgia. Dr. Rausch isobserv- ingthecomplex molecular reactionstoantidepressant drugstobetterpredict whichdrugswill be most effective inagiven patient andinwhatdoses. "Sofar, we haveonly testedone drug and were abletopredict with 70 percentaccuracy how patients wouldreact," Dr. Rausch said. The study hascen- teredaround serotonin, a chemical in thecentral nervous system thatacts asamessengerbetween brain cells. Even though theexactcorrelation between serotonin and the antidepressants is not known, areaction between thetwohas been observed. "In the studies we havedonetodate, we have usedthedrug Nortriptyline," Dr. Rausch said. "It is avery common antidepressant." Nortriptyline attaches itselftothe same recognition site on thebraincells as serotonin. Therefore, thedrug inhibits the amountofserotonintransported bythe Fighting cells which are involvedin theantide- pressanteffect. "Fortunately, forthe purposes ofour research, the platelets in theblood havea similartransport site as the braincells," Depression Dr. Rausch said. "This allows ustocon- ductourtrials usingtheplatelets, which wecanobtain forstudy, when wecannot directly examine the brain cells." In the laboratory, the platelets areiso- latedandthe serotonin is added. itmaybeone indication ofthe effective- variables also figure intotheequation. Researchersthen measuretheamountof ness aspecific medication will haveona Even thoughthis research is promis- serotonintaken upby theplatelets. given patient." ing, itis still in its infancy. Dr. Rausch is "When the amountproducingthe Limiting the amount ofserotonin now studyinganotherserotonin receptor maximum absorbancy level isdetermined absorbedby the braincells is anecessary site on thecells which he hopes willoffer inthepatient, wecutitinhalf,"Dr. partoftheaction ofan antidepressant, but even more insight intotheeffectsof Rausch said. "This numberis knownas this action alone will notproduce the antidepressantson individ—ual cells. the affinity constant, andwebelievethat antidepressanteffect. Otherunknown DAVIDWALLER 6 MEDICALCOLLEGEOFGEORGIATODAY Blueprint Mind of the Georgia. "A structured format such as thinkingorconcentrating?" and "Didyou thisis more accurate, and it has been everfeel thatyou wereespecially impor- shown togreatly improve the inter-rater tant in some way, orthat you had powers reliability ofadiagnosis, meaningthat todothingsthatotherpeoplecouldn't twopsychiatrists are more likely to do?" Questions areaccompanied by crite- concuronthecorrectdiagnosis." riatohelpthe psychiatristrate how SCIDis most useful in research stud- normal these responses are andthe sever- ies,toassurethatpatientsare identified ityofthe difficulty, as well asa variety of anddiagnosedconsistently, totrainresi- follow-upquestions. dents howtoconductathorough interview "It'sespecially helpful incomplex andforclinicalqualitycontrol, according cases, where several thingsaregoingon toDr. Rausch. It is notcommonly used in atonce, tohelpyoudecidethe impor- general psychiatricpractice. tance and meaningofeach," Dr. Rausch "A problem with alotofpsychiatric said. "Italsotends tobe really useful in literature in the past wasthat you were makingadiagnosis in apatient whotends neversure ifthe studies werediagnosing togiveadisorderedhistory. the patients inthe same way," he said. "This is particularly helpful in training "Thisreducesthe variability, and means residents how toconductathoroughpsy- thatyou can morereadily comparediffer- chiatric interview. Whilethere's not entstudies." really anythingcompletely new inthe Forexample, MCGisconductinga SCID interview, it'sagreat stepforward study onpredictingtheeffect ofthe indiagnosisby making sure that all the antidepressantdrugNortriptylineon questionsare asked in a logical sequence people with depression. (See Fighting and in a standardizedway. Ithelps train a Depression, opposite) Inordertostan- psychiatristtoaskthe rightquestions, go dardize the research, patients involved in through the interviewin astructured way the study arediagnosed using SCID. andcategorizetheproblem clearly." — A SCID interview isconducted much INGRID HEGGOY likeanyotherpsychiatricinter- /t's oneofthe mostdifficult aspects view: thephysician asksthe ofpsychiatry: determiningexactly patientanumberofquestions, whatone's mental illness is. takesnotesanddeterminesthe Anexample ofatried, reliable probablenature ofthedisorder method isthe StructuredClinical basedonthepatient's InterviewsforDSM-III-R. SCIDisan responses. The psychiatrist first organized, structured interview designed asksgeneral background infor- tocoverawide variety oftopics in athor- mation, suchasage, marital ough, organized manner. status,educational level and There arethree variationsofthe inter- employment history. Hegoeson view: ageneral psychiatric screening,one toaskabout why they came for forpersonality disorders andathird for treatment,current symptoms, psychoses. possibledrug useand feelings "Oneofthe problemstraditionally in andreactionsto situations. psychiatry has been thatthere is apoten- Questionscoverawide tial foragreaterdegreeofsubjectivity in variety oftopics, such as. "In makingthecorrectdiagnosis thanyou the last month, hastherebeen a may find in many otherfields of periodoftime when you were medicine," said Dr. Jeffrey Rausch, pro- feelingdepressedordown most fessorand vicechairmanofthe oftheday nearly everyday? Department ofPsychiatry and Health During this time, how wereyou Behavioratthe Medical Collegeof sleeping?Did you have trouble VOLUME20, NUMBER3/SPRING 1992 7 Some Atlanta landmarks capture the veryheart ofthe city. Marriott's Marquis is one of them. The Marquis is the onlyAtlanta hotel to win the Gold KeyAward, the Pinnacle Award and the Award ofMerit and Distinction forthe last three years. It features a A forty-seven story atrium. staffwhose abilities and hospitality have become a South- ern tradition. And an ideai downtown location. It's also Atlanta's newest and largest convention hotel. So ifyou're planninga meeting, large ATLANT or small, call our Director ofSales at (404)52 -0000. ^Vi(3rriOTl 1 * And give your meeting a solid foundation. marquis