Resident Research Track Psychiatry Residency Training Program
Overview
The Resident Research Track is an intensive pathway designed to train and support residents interested in dedicating a significant proportion of their professional life to research. The purpose of the track is to train physician scientists to become leaders in basic, clinical- translational, and/or implementation research.
This track is supported by the Feinstein Institutes for Medical Research, the home of research at Northwell Health, and one of the leading research institutions in the nation, with $62 million in extramural funding in 2019. In particular, the Institute of Behavioral Science at the Feinstein Institutes for Medical Research has a longstanding track record in conducting cutting-edge NIH and industry funded research, and has led some of the breakthrough developments in mental health research over the last decades. The Zucker Hillside Hospital, the main site for the Institute of Behavioral Science, has an extensive clinical research program that focuses on the pathophysiology and treatment of serious mental illnesses, with over 644 participants recruited in over 21 studies in 2019.
The resident research track includes dedicated didactics in research methods and statistics, grantsmanship and research career development. Research track residents are involved in the activities of the Institute of Behavioral Science and are mentored by teams including at least one member of the faculty as primary mentor and another member for career development.
The areas of mentoring include research design, research communication and grant writing. In addition, they may receive departmental support for study coordination, data management, statistical analysis, as it is strongly encouraged that research track residents collect their own experimental data in order to support their research career development. The goal of this track is that graduates of the research track are positioned to secure funding for early career
physician investigator programs (i.e., NIH K23).
The Institute of Behavioral Science has an extensive track record of support for early career physician-investigators. Over the last decade it has received funding for 6 NIH K23 career development award applications.
The main areas of research activity of the Institute of Behavioral Science are the following:
• Genetics
• Neuroimaging
• Neuropsychology
• Neuromodulation (e.g. ECT, TMS)
• Clinical trials
• Health services/implementation research
• Technology and mental health
• Health professions education
This unique combination of expertise in clinical services and research provides an excellent opportunity for mentoring and nurturing a motivated resident’s growth toward a career as a physician-investigator.
Resources for research track residents:
• Protected time:
o 12 weeks to 16 weeks of dedicated time for research during 2nd year of training.
o 50% in PGY3 o Up to 90% in PGY4
• Research didactics (i.e., sessions on grantsmanship, career trajectory etc…)
• Scientific supervision by mentoring team
• Ongoing work in progress sessions for the research track resident group
• Integration of the resident in the activities of the Division of Psychiatry Research at the Zucker Hillside Hospital
• Scientific support from the Feinstein Institute of Medical Research (i.e., statistical support, biorepository...)
• $ 3,000 stipend in PGY3 and PGY4 to support travel to research meetings
• Support for study coordination and experiments (depending on project and departmental budget)
• Focus on the resident’s own data collection What is unique about our Research Track
In addition to providing protected time, didactics, mentorship, and financial support, our research track has two unique characteristics that make it stand out:
• Unique access to research participants: The Zucker Hillside Hospital is the main academic center serving a catchment area of ~ 5 million and has one of the largest clinical programs in behavioral health in New York State, which serve as a source of referrals for clinical research.
• Supportive environment to transition to a junior faculty position after graduation:
Graduates of the research track often stay in attending positions in the department with most of their time protected for research while they transition to faculty positions and are able to secure their own funding.
Eligibility
The research track welcomes psychiatry residents who have already research experience (i.e., prior lead author publications, MD PhD graduates...), as well as those who are interested in developing a career as physician-investigators and have demonstrated potential (i.e., leadership experience, solid research plan...). Applicants rank both our general and research track
programs in the NRLM.
Mentorship and sub-tracks
Mentorship is crucial for the development of a career as a physician-investigator. In addition to a primary mentor, most residents require a network of mentors to enhance their growth. The Faculty Lead guides each resident in developing the best possible mentorship network.
Examples of the current areas of study include the following:
1. Clinical research/psychopharmacology
Principal investigator/mentor: John Kane, MD, & Delbert Robinson, MD
This area of research provides the opportunity to gain experience expertise with designing, conducting, and analyzing clinical psychopharmacological studies. Recent or current examples of projects:
a. Effect of Long-Acting Injectable Antipsychotics vs Usual Care on Time to First Hospitalization in Early-Phase Schizophrenia: A Randomized Clinical Trial b. Psychopharmacological Treatment in the RAISE-ETP Study: Outcomes of a
Manual and Computer Decision Support System Based Intervention
c. Early-phase Schizophrenia: Practice-based Research to Improve Treatment Outcomes (ESPRITO)
2. Human genetics
Principal investigator/mentor: Todd Lencz, PhD
For residents who are interested in human genetics, bioinformatics, and its increasing impact on how we understand the biology, diagnosis and treatment of mental illnesses.
Recent or current examples of projects:
a. Association of a Schizophrenia Risk Variant at the DRD2 Locus with Antipsychotic Treatment Response in First-Episode Psychosis
b. Polygenic risk scores (PRS) and treatment response to antipsychotic drugs in first episode schizophrenia
c. Novel ultra-rare exonic variants identified in a founder population implicate cadherins in schizophrenia
3. Neuroimaging
Principal investigators/mentors: Anil Malhotra, MD
This area covers neuroimaging studies of psychiatric population. Many projects in this lab are affiliated with other research areas, such as genetics (imaging genomics), or clinical trials (pharmacologic neuroimaging). Recent or current examples of projects:
a. Social processes initiative in neurobiology of the schizophrenia(s)
b. Striatal functional connectivity as a prognostic biomarker of treatment response in first episode schizophrenia
c. Biomarkers of treatment response to clozapine in individuals with treatment resistant schizophrenia
4. Neuropsychology and subsyndromal psychosis
Principal investigator/mentor: Pamela DeRosse, PhD, & Philip Watson, PhD
This theme covers various aspects of neuropsychological measurement in subsyndromal and psychiatric populations and how they interact with other research domains
a. Neuropsychological features and treatment response to antipsychotics in individuals with schizophrenia
b. Neuropsychological characterization of the prodromal population c. Negative symptoms and reward processing
5. Women’s behavioral health
Principal investigator/mentor: Kristina M. Deligiannidis, MD
This research area provides residents the opportunity to gain experience in
understanding the pathophysiology, clinical presentation and treatment of depressive and anxiety disorders that occur during perinatal period. Residents have the
opportunity to gain expertise in reproductive psychiatric research and develop research projects in this field. Recent or current examples of projects:
a. Neuroendocrine and neuroimaging (EEG, fMRI, MRS, DTI) endophenotypes in perinatal depression
b. Double-blind placebo-controlled studies evaluating efficacy, safety and
pharmacokinetics of SAGE-547 (allopregnanolone) injection and SAGE-217 in the treatment of postpartum depression
c. Perinatal psychiatry genetics consortium (phenotypes and genetics of postpartum depression and psychosis
6. Neuromodulation (BioMend)
Principal investigator/mentor: Miklos Argyelan, MD, & George Petrides, MD This area focuses on novel research aimed at understanding the efficacy and the
mechanism of action of neuromodulatory treatment strategies including ECT, TMS, tDCS and DBS. Participants have the opportunity to gain expertise in the administration of many of these treatment modalities as well as develop research projects in these areas.
Current or recent projects include:
a. Neural biomarkers of ECT response in schizophrenia
b. Electrical Field and Neuroimaging Based Prediction of ECT Induced Clinical and Cognitive Effects
c. Neuromodulation of Social Cognitive Circuitry in People with Schizophrenia Spectrum Disorders
7. Implementation research
Principal Investigator/mentor: John Kane, MD
This track will facilitate the development of research at the level of systems of care to bridge the gap between best practice and actual practice. Research projects in this area focus on leveraging health systems data, optimizing the interventions of clinical services, or using technology to reduce the morbidity and mortality derived from mental health in the population. Recent or current examples of projects:
a. Recovery After an Initial Schizophrenia Episode (RAISE) -- a NIMH research
project on the trajectory and prognosis of schizophrenia treatment in the earliest stages of illness in order to reduce long term disability.
b. Improve Care and Reduce Cost (ICRC) – a large study interested in improvement of disease management via technology (e.g. cell phones, computerized pills) in schizophrenia to reduce overall morbidity and health care cost.
c. Development and implementation of a digital clinic program – an
implementation project to integrate various technology-based approaches to mental healthcare in “real-world” clinics.
8. Technology and mental health
Principal investigators/mentors: Michael Birnbaum M.D, Michael Kirschenbaum M.D., Sunny Tang M.D
This track provides the opportunity to develop expertise in conducting studies that leverage digital technology to optimize assessment and care delivery in mental health.
Current examples of projects:
a. Using natural language processing and artificial intelligence to characterize speech biomarkers of psychiatric illness and to extract reliable clinically relevant information from EHR
b. Using wearable sensor data and digital care management tools to improve objective data gathering in effort to enhance detection of symptom recurrence and relapse in bipolar disorder and psychosis
c. Using machine learning to identify signals associated with mental illness in the Internet and social media activity, speech and facial movements of adolescents and young adults
9. Human cannabis and psychedelic research
Principal Investigator/mentor: Nehal Vadhan Ph.D
This emerging track will support the development of skills in the area of laboratory neuropsychopharmacology in general, as well as particular skills to study the recreational, cognitive and therapeutic properties of psychedelics and cannabis for mental disorders. Current examples of projects:
a. Study the acute behavioral and physiological effects of inhaled cannabis with varying concentrations of delta-9 THC and CBD in healthy participants and those at-risk for a psychotic disorder
b. Study the acute therapeutic effects of psilocybin on individuals with anxiety disorders
10. Health professions education research
Principal Investigator: John Q. Young, MD, MPP, PhD
This track supports the development of programs of research that advance knowledge in health professions education. Research in this area focuses on improving learning, assessment, professional identity development, and well-being within the framework of
a. Cognitive Load Theory – measurement and application to health professions education, especially handoffs.
b. The development and validation of Entrustable Professional Activities for psychiatry.
c. Competency-based and workplace-based assessment in psychiatry.
d. Patient safety and QI curricula.
e. Direct observation, structured feedback and longitudinal coaching.
f. Trainee and faculty stress, wellness, burnout, and resilience.
These are examples of tracks and provide a broad overview of research activities in the
department. They do not encompass the entirety of the research endeavors of the department or include all the principal investigators.
Overall Program Requirements:
• Application: initial statement of interest that addresses track record, proposal research plan, possible mentors, and proposed training plan.
• Meet regularly with their mentor and as needed with the faculty director of the RRTP.
• Complete relevant methods and biostatistics coursework.
• Develop and implement a program of research in close collaboration with your mentor.
• Participate in works in progress sessions with the faculty director.
• Attend weekly research seminars.
• Update plan with progress report in the spring of the PGY-2 and PGY-3 Year.
• Attend national/international meetings and present your work at least one time at such a meeting.
Research Track Milestones
Intern PGY2 PGY3 PGY4 Goals
Delineate activities to participate in R2 year, define
mentoring team and expectations
Write and have approved IRB protocol. Start data collection.
Continue data collection, data analysis, write a paper or an abstract.
Submit and publish a manuscript.
Develop research niche, collect own dataset, be competitive for career
development award
Additional information on methodological training
The Feinstein Institutes for Medical Research, along with the Research Division at the Zucker Hillside Hospital, assist with the training of investigators in statistical methods, study design, and data management. This is accomplished by short seminars, full courses, and journal clubs, including:
• Ethics and responsible conduct of research
• Biostatistics
• How to pick a research mentor and how to choose a research project
• Introductory course in SPSS and R programming for statistical analysis
• How to write a competitive NIH grant
• How to communicate research findings
• Introductory course in research design and statistical methodology for research-track residents, fellows, and other trainees, led by Dr. Majnu John.
Training in psychopharmacological clinical trials
Every year the research department organizes a course on psychopharmacological clinical trials, modeled after the one co-sponsored by the American Society of Clinical Psychopharmacology, Inc., the National Institute of Mental Health and The Zucker Hillside Hospital, and also led by Dr John Kane.
The program focuses on the general problems and challenges of designing and implementing clinical trials with an emphasis on methodology. Topics include trial design, diagnosis, clinical assessments, patient ascertainment, and recruitment. It also reviews recent developments in psychotropic drug research and ethical issues in the conduct of clinical trials. The organization of the course includes didactic sessions, discussion and interactive workshops.
External mentorship and collaboration
Networking with leaders in the field as a young investigator is crucial for successful career development. The research track residents are encouraged to participate in career
development and mentorship opportunities at the national level to interact with leaders in the field and develop a network of researchers that help the resident develop as a leader him or herself. This includes participation in national and international conferences, application to early career research awards and travel grants, or participating in research projects in collaboration with other institutions.
Examples of RRTP resident led Projects
Prospective assessment of mood, suicidality and menstrual cycle Principal Investigator: Sara Carlini, MD (PGY-4)
Funding: Feinstein Institute for Medical Research
This prospective cohort study to collect ecological momentary assessment on mood, anxiety and suicidality in menstruating women, to identify correlation of symptoms with the phase of the menstrual cycle.
Inflammatory biomarkers associated with ECT response in major depression:
Principal Investigator: Paul Masi, MD (PGY-4) Funding: Feinstein Institute for Medical Research
This clinical trial examines specific markers of inflammatory response in patients with major depressive episodes before, during, and after an acute course of electroconvulsive therapy (ECT). Results will help identify biomarkers for major depression and ECT response.
Examples Research Projects led by graduates of the RRTP
Biomarkers of Relapse in Schizophrenia During Antipsychotic Maintenance: A Proof-of- Concept Study
Principal Investigator: Jose M Rubio, MD Funding: Alkermes Pathways Research Award 2020-2022
This project will use neuroimaging techniques to identify neural circuits whose activity differs between individuals with psychosis who maintain clinical efficacy on antipsychotic drugs, and those who relapse despite continued “guaranteed” medication. Ultimately, the identification of those circuits will have clinical value to facilitate the identification of individuals at risk of relapse, for whom preventive and therapeutic interventions could be developed.
Neural Biomarkers of Clozapine Response Principal Investigator: Deepak Sarpal, MD Funding: NIH/NIMH K23
2016-2021
Psychotic symptoms that do not respond to first-line antipsychotic drugs result in a significant amount of morbidity and mortality worldwide. Clozapine has consistently shown to be a superior drug for psychosis in patients who do not respond to other treatments, but its
mechanism of action remains unknown. The overall goal of this K23 proposal is to examine the functional neural circuitry that underlies successful treatment with clozapine, which may lead to the identification of biomarkers that will allow for more efficient use of clozapine, as well as additional treatment targets for patients with refractory illness. Simultaneously, this proposal will launch the career of the Principal Investigator, Deepak K. Sarpal, M.D., as an independent translational researcher.
Neural Biomarkers of ECT Response in Schizophrenia Principal Investigator: Miklos Argyelan, MD
Funding: NIH/NIMH K23 2020-2024
Electroconvulsive therapy (ECT) has been consistently shown to be an effective augmentation strategy in the treatment of schizophrenia, however its mechanism of action remains unknown, and there are no clinical or biological predictors to predict response. The overall goal of this K23 proposal is to examine the functional neural circuitry that underlies successful treatment with ECT, which may lead to the identification of biomarkers that will allow for more efficient use of ECT, as well as additional treatment targets for patients with refractory illness. Simultaneously, this proposal will develop the career of the Principal Investigator, Miklos Argyelan, M.D., as an independent physician scientist.
Examples of Faculty Research Projects
Early-phase Schizophrenia: Practice-based Research to Improve Treatment Outcomes (ESPRITO)
Principal Investigators: Delbert Robinson, MD Funding: NIH/NIMH R01
2019-2024
This project links 11 clinics in four states that now provide the NAVIGATE model of coordinated specialty care with a scientific hub. Implementation of standard measures and integrated data sets will facilitate rapid learning to improve the fidelity and quality of early phase psychosis.
Research will address obstacles to care, reducing hospitalizations and preventing premature treatment discontinuation.
Striatal Connectivity and Clinical Outcome in Psychosis Principal Investigator: Anil Malhotra, MD
Funding: NIH / NIMH R01 2016-2021
Psychotic symptoms are present in multiple psychiatric disorders, but there is little information regarding the critical brain circuitry associated with psychosis. We will conduct a longitudinal brain imaging study of individuals with psychosis to investigate the relationship between brain circuitry and psychosis in relationship to treatment. Data derived from this project could lead to a biomarker for psychosis and be used as a target in the development of more effective
treatments.
A Randomized Controlled Trial of Electroconvulsive Therapy plus Usual Care versus
Simulated-ECT plus Usual Care for the Acute Management of Severe Agitation in Alzheimer's Dementia (ECT-AD)
Principal Investigator: Georgios Petrides, MD Funding: NIH / NIA R01
2019-2023
Alzheimer's dementia (AD), the most prevalent neurodegenerative disease of aging, already affects an estimated 5.4 million individuals in the United States. By 2050, AD is predicted to affect 13.8 million in this country. The neuropsychiatric symptoms (NPS) of AD, such as
agitation, depression and apathy, are nearly universal over the course of AD, add greatly to the public health burden of AD and significantly impact caregiver stress. This proposal aims to study the efficacy and safety of Electroconvulsive therapy (ECT), already demonstrated to be an effective and safe treatment for severe depression and psychosis in older adults, to treat severe agitation in moderate to severe stage AD. This proposed study represents an entirely new treatment approach for severe agitation in moderate to severe stage AD and uses a single- blind, Simulated-ECT controlled, randomized design. Establishing safety and efficacy of ECT for severe agitation in AD provides an opportunity to decrease long-term care placement, decrease the risk of mortality, decrease caregiver burden, and most importantly, enhance quality of life for patients with AD and their caregivers.
Relationships between Neuroactive Steroids, GABA and Glutamate MRS and Connectivity of the Default Mode Network in Postpartum Depression
Principal Investigator: Kristina Deligiannidis, MD Funding: NIH / NIMH R01
2020-2024
Postpartum depression is one of the most common complications of childbirth and is associated with poor maternal/child outcomes. The underlying pathophysiology of postpartum depression is largely unknown, creating an obstacle to developing improved treatments. This study will determine the relationships between sex steroids, brain chemistry and brain circuitry in women with postpartum depression, healthy postpartum women and healthy women during the follicular phase of the menstrual cycle to better understand what causes postpartum depression so that novel treatments may be developed and tested.
Cognitive Genomics as a Window on Neurodevelopment and Psychopathology Principal Investigator: Todd Lencz, PhD
Funding: NIH / NIMH R01 2018-2023
Neurocognitive deficits represent a core component of several major neuropsychiatric disorders, most notably schizophrenia, affective disorders, autism spectrum disorders, and attention-deficit/hyperactivity disorder (ADHD). The proposed study is designed to exploit the Cognitive Genomics (COGENT) consortium dataset, in which we have performed large-scale genome-wide association studies of cognitive performance, as well as other publicly available genetic and neuroimaging datasets, to enhance our understanding of the causes of psychiatric illness and its treatment.
