News and Commentary Archive

Explore recent scientific discoveries and news as well as CLBB events, commentary, and press.

Mission

The speed of technology in neuroscience as it impacts ethical and just decisions in the legal system needs to be understood by lawyers, judges, public policy makers, and the general public. The Massachusetts General Hospital Center for Law, Brain, and Behavior is an academic and professional resource for the education, research, and understanding of neuroscience and the law. Read more

McLean OnTrack: A Transdiagnostic Program for Early Intervention in First-Episode Psychosis

By Ann K. Shinn, Kirsten W. Bolton, Rakesh Karmacharya, Kathryn E. Lewandowski, Cagri Yuksel, Justin T. Baker, Virginie-Anne Chouinard, Samira M. Pingali, Hilary Bye, Katherine Cederbaum, and Dost Öngür | Early Intervention in Psychiatry | November 29, 2015

Abstract:

Aims

Most programs specializing in the treatment of first-episode psychosis in the United States focus on schizophrenia. However, many early psychosis patients do not fit into this diagnostic category. Here we describe McLean OnTrack, an intensive outpatient treatment program that accepts all comers with first-episode psychosis.

Methods

We assessed baseline characteristics of patients in the 2.5 years since program initiation. We examined how initial referral diagnoses compare with current diagnoses, calculating the proportion of diagnostic changes.

Results

At 2.5 years, patients in McLean OnTrack consist of 30 (33.0%) individuals with primary psychotic disorder, 40 (44.0%) with affective psychosis, 19 (20.9%) with psychotic disorder not otherwise specified (NOS) who do not meet full criteria for either category and two (2.2%) individuals with no psychosis. Although patients with affective psychosis had higher pre-morbid functioning, all three categories of psychosis had similar rates of prior hospitalizations and substance use. The retention rate in the psychotic disorder NOS group was lower than that in affective and primary psychotic disorders. Finally, diagnoses changed over the course of treatment in 50.5% of patients.

Conclusions

Diagnostic heterogeneity appears to be the norm among patients with first-episode psychosis, and diagnoses commonly evolve over the illness course. Baseline indices of illness severity were similar across categories and suggest the need for early intervention, irrespective of specific diagnosis. We discuss the benefits and challenges of a transdiagnostic approach to early intervention in first-episode psychosis, treating patients who share many but not all characteristics.

Read the entire paper here.

Parcellating Cortical Functional Networks in Individuals

By Danhong WangRandy L BucknerMichael D FoxDaphne J HoltAvram J HolmesSophia StoeckleinGeorg LangsRuiqi PanTianyi QianKuncheng LiJustin T BakerSteven M StufflebeamKai Wang  Xiaomin WangBo Hong, and Hesheng Liu | Nature Neuroscience | November 9, 2015

Abstract:

The capacity to identify the unique functional architecture of an individual’s brain is a crucial step toward personalized medicine and understanding the neural basis of variation in human cognition and behavior. Here we developed a cortical parcellation approach to accurately map functional organization at the individual level using resting-state functional magnetic resonance imaging (fMRI). A population-based functional atlas and a map of inter-individual variability were employed to guide the iterative search for functional networks in individual subjects. Functional networks mapped by this approach were highly reproducible within subjects and effectively captured the variability across subjects, including individual differences in brain lateralization. The algorithm performed well across different subject populations and data types, including task fMRI data. The approach was then validated by invasive cortical stimulation mapping in surgical patients, suggesting potential for use in clinical applications.

Read the full journal article here. 

CLBB leads in special issue on “Neuropsychiatry”

CLBB faculty and staff are significant contributors to an in-press special issue of Current Opinion in Neurobiology on Neuropsychiatry. CLBB faculty and psychiatric genetics pioneer Steven Hyman, along with Raquel Gur, is co-editor of this special issue. The also issue includes a paper co-authored by Justin Baker, CLBB associate director, on the use of fMRI in understanding the neurodevelopment of psychosis.

View the issue in-press, and stay tuned for its publication in February 2015.

CLBB Director of Law & Ethics to lead HMS Master’s Program in Bioethics

As of fall 2014, CLBB Director of Law & Ethics Rebecca W. Brendel, JD, MD, will join the Harvard Medical School Center for Bioethics to lead the development of a new Master’s Program in Bioethics. Originally established as the Division of Medical Ethics, The Center was rebranded in spring 2014 to serve as a convener for faculty who will collaborate with the ethics services at the HMS affiliates and with ethics programs at schools throughout Harvard University. Dr. Brendel will develop and then lead the new Master’s Program in Bioethics at HMS.

The Master of Bioethics Degree, beginning fall 2015, will combine resources from the Center for Bioethics, Harvard teaching hospitals, and departments across the University in a one-year full time course of study and is open to working professionals holding a terminal degree in any discipline. A core group of applicants is expected from medicine, law, nursing, public health, social work, public policy, scientific and biotechnology research, journalism, and business.

Rebecca W. Brendel

Dr. Brendel is Assistant Professor of Psychiatry at Harvard Medical School and Director of Law & Ethics at CLBB. An expert consult-liaison psychiatrist and ethicist, Dr. Brendel has published widely on issues including voluntary psychiatric hospitalization (2014), evaluation of capacity to appoint a healthcare proxy (2013), and legal issues including mandatory reporting and informed consent (2010).

Dr. Brendel will be stepping down as Clinical Director of the Home Base Program — a collaboration of the Red Sox Foundation and MGH — in order to step into the new role at the Center for Bioethics.  Continue reading »