Research

Area 4

Biological bases of psychiatric disorders and nuclear psychiatry.

Team leader

Strategic objectives


Our group studies serious psychiatric disorders from the neurobiological and therapeutic perspectives, based on the following 6 research lines: bipolar disorders, schizophrenia and depression-anxiety, pediatric psychiatry and psychology, psychiatric intervention in medical pathology and alcoholism.

Main lines of research


The bipolar disorders program mainly investigates the neurobiological and anatomofunctional mechanisms implicated in the development of the disease (genetics, neuromodulators, hormone factors and neuroimaging) and its relapses, the clinical course and neuropsychological consequences, the efficacy of drug treatments and novel therapies, and psychological interventions for the early detection and prevention of recurrences – increasing treatment compliance and improving the efficacy of the therapeutic strategies applied to bipolar disorder. The strategic objectives are to investigate the causes and mechanisms involved in the etiopathogenesis of bipolar disorder, and to investigate new treatments with a view to improving the prognosis of the disease.

The schizophrenia program focuses research on the first schizophrenic episodes and on resistant and comorbid schizophrenia, through functional neuroimaging (brain perfusion and receptors SPECT, PET and functional magnetic resonance imaging). Sensory and cognitive neuroactivation studies have been made with frontal activation neuropsychological tests and dopaminergic receptor occupation studies, as well as studies of the presynaptic dopaminergic function. Likewise, plasma metabolites of dopamine have been investigated as biological indicators of relapse in a prospective longitudinal follow-up and treatment response study. We have examined the role of schizophrenia in the development of cardiovascular and metabolic diseases, and secondarily also the role of antipsychotic drugs. The pharmacogenetics of antipsychotic drugs has been studied to assess the efficacy and safety of these drugs on the basis of the individual patient genetic characteristics. Specifically, we have analyzed the pharmacogenetics of the extrapyramidal effects caused by antipsychotic drug therapy, the polymorphisms associated with the risk of schizophrenia, and new pharmacogenetic techniques for implantation at healthcare and hospital level. A psychoeducational program has been introduced, adopting new knowledge transmission and exchange formulas, with the application of new technologies and offering rigorous and communicatively adequate contents. The new FòrumClínic web is an interactive program designed to increase patient autonomy in relation to personal health. A program is being developed for characterizing and preventing second psychotic episodes, in order to design preventive strategies allowing us to influence the course of the disease.

The Alcohol Unit is the reference in Catalonia for the treatment of alcohol dependency. We are one of the main research groups in Spain and at present are attempting to consolidate a European leadership position in the setting of short interventions designed to reduce consumption among alcohol consumers at risk. A number of research lines are being conducted in the context of the Alcohol Unit. The main lines are the following: Prospective longitudinal study of alcoholic disease; Follow-up of a cohort of 850 patients starting treatment in 1987 in the Catalan Drug Dependencies Network (Xarxa Catalana de Drogodependències); Screening instruments and techniques for early detection and short counselling in alcohol-consumers at risk in the hospital setting and in primary care; Evaluation and prognosis of alcoholic patients candidates for liver transplantation; treatment of smoking in alcoholic patients; and Evaluation of the European alcohol policies and their public health impact.

The line relating to depression aims to implement new psychopathological and biological endophenotypic methods in application to major depression, with the development of mechanisms for the analysis of the mechanism of action of antidepressant drugs based on the platelet model of depression (developed together with the hemostasis group led by Prof. Ginés-Escolar); the investigation of neurotrophic factors (BDNF) in depressive patients; and the exploration of factors conditioning the residual symptoms of major depression.

The main research lines of the pediatric psychiatry and psychology research group of the Clinic hospital are the following:

  • Schizophrenia and bipolar disorder: Study and follow-up of the first psychotic episodes, cognitive rehabilitation of adolescent patients with schizophrenia, study of children and adolescents with a high genetic risk of developing schizophrenia and bipolar disorder (offspring of patients with such disorders), study of the prodromic manifestations of psychotic disorders in children and adolescents, and study of the tolerance and safety of antidepressants in children and adolescents.
  • Anorexia and bulimia nervosa, and obsessive-compulsive disorder: Study of the common and differential alterations (genetic, neuropsychological and neuroimaging) of anorexia nervosa and obsessive-compulsive disorder, study of new management approaches (psychological and pharmacological) in bulimia and anorexia nervosa, and study of autoimmune alterations in obsessive behavior and in anorexia.
  • Others: mention should be made of the investigation of addictive behaviors, analyzing the percentages of patients seen in the Department of Pediatric Psychiatry with different disorders and who moreover consume, abuse of or show dependency of toxic substances – exploring the efficacy of new multimodal management modalities for addictive behavior in adolescents. In addition, the study line of the efficacy and safety of psychoactive drugs in children and adolescents focuses on the evaluation and follow-up of the side effects of these drugs in children and adolescents, as well as on the identification of pharmacogenetic predictors of drug response in such patients. The study line in autistic spectrum disorders explores the efficacy of new psychological and pharmacological treatments in these disorders, with examination of the neuropsychological profile of children with high-function autistic spectrum disorders and the correlation to clinical variables. Mention also should be made of the line for the development and validation of scales in application to different pathologies or symptoms. In turn, the line referred to attention deficit hyperactivity disorder (ADHA) involves the neuropsychological, clinical and neuroimaging assessment of predominantly inattentive children versus children with combined-type attention deficit. Lastly, the research line in autoimmune/Tourette syndrome explores the inflammatory and autoimmune processes, and their relation to serious psychiatric pathology, in children and adolescents.

The line ofpsychiatric intervention in clinical pathology has focused research on knowledge of the psychiatric alterations seen in the main neurological diseases: dementia, multiple sclerosis, epilepsy, Parkinson’s disease and Huntington’s disease. The study of psychiatric disease and psychological aspects associated with medical-surgical hospital processes in turn addresses: transplantation, delirium, psychiatric problems in clinical patients admitted to a general hospital, the evaluation of predictive variables and factors associated with suicide in a general hospital. Studies are also made of the biological markers and therapeutic aspects of major depression.

Investigations likewise have been conducted into personality disorders: the structure of the diagnostic systems, their relationship to adjustment to the environment and the validation of new models and instruments.

Websites related to the team:

FòrumClínic
www.forumclinic.org

Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM)
www.cibersam.es

Grups

Bipolar disorders (Associated)

VIETA, EDUARD

(ICN)

The bipolar disorder program has been recognized as a consolidated research group (2009 SGR 1022) by the Agency for the Management of University and Research Aids (Agència de Gestió d’Ajuts Universitaris i de Recerca, AGAUR). The bipolar disorders program fundamentally investigates the neurobiological and anatomofunctional mechanisms involved in the development of the disease and its clinical course, comorbidity with other diseases, the implicated neurocognitive mechanisms, and the search for new pharmacological, biophysical and psychosocial treatments designed to improve the prognosis and quality of life of the patients. The program is characterized by a multidiscipline approach and includes psychiatrists, psychologists, pharmacologists, biologists, nurses, social workers and personnel in training. Our group has pioneered effort in the characterization of associated neurocognitive dysfunction, in the development of new drug treatments, and in the implementation of psychoeducational techniques targeted at both patients and their relatives. As a result of such research and innovation, the main international diagnostic and treatment guides document these contributions and recommend their application in clinical practice. Our program is carried out in active collaboration with other groups of the IDIBAPS, with other groups of the CIBERSAM, and with European and other international research centers, with a view to conducting multicenter studies with a special dedication to translational and innovative investigation.

Schizophrenia (Associated)

BERNARDO, MIQUEL

(ICN)

The Clinical Schizophrenia Group (GEC) has been recognized as a consolidated research group (2005SGR00223; 2009SGR1295) by the Agency for the Management of University and Research Aids (Agència de Gestió d’Ajuts Universitaris i de Recerca, AGAUR) since the year 2005. This is an interdisciplinary group composed of psychiatrists, psychologists, neuropsychologists, nurses, physicians specialized in nuclear medicine, physicists, pharmacologists, toxicologists and biochemists linked to the Clinic Hospital and the University of Barcelona. Ours is a group of investigators forming part of the Clinical Schizophrenia Program (PEC) and working in disorders related to schizophrenia. This is a clinical care, research and teaching program at both hospital and outpatient level that includes different management and research protocols designed to address problems raised by schizophrenia and which integrates the different resources of the Barcelona Clinic Hospital. In the year 2007, the group became a constituting member of the Network of Mental Diseases and Affective and Psychotic Disorders (REMTAP), and in 2008 we likewise became a constituting member of the Center of Biomedical Research in Mental Health Network (CIBERSAM) (www.cibersam.es).

The Clinical Schizophrenia Group centers its research on the study of the first schizophrenic episodes, schizophrenia starting in childhood/adolescence, and resistant and comorbid schizophrenia. The main research lines are physical health, neuroimaging, neuropsychology and psychometric assessment, genetics psychological education, neurobiology and neuropsychopharmacology in schizophrenia, with a supervisor for each of them, under the coordination of Dr. Miguel Bernardo. Another research line focuses on childhood- and adolescent-onset schizophrenia – these representing a high risk population for schizophrenia. This line is conducted in close collaboration with the Department of Childhood and Adolescent Psychiatry of the Clinic Hospital, directed by Dr. Castro, together with Drs. Baeza, Lázaro and Sánchez-Gistau (Study of high genetic risk for schizophrenia and early onset schizophrenia).

Clinical depression group (Emergent)

GASTO, CRISTOBAL

(ICN)

Our group is specialized in the investigation of the neurobiological bases and clinical indicators of depression associated with treatment response and the course of this disease. It has been estimated that depression affects 10% of all people at some point in their lives. Depression is currently one of the most important health problems, particularly considering its slow and sometimes incomplete resolution. This disorder significantly interferes with the normal functions of the patients and their relatives, and implies a suicide risk in more than 10% of cases. The project of the World Health Organization (WHO) for the year 2020 considers that depression will be the second cause of disability after cardiovascular disease. In Europe it has been estimated that about 30 million people suffer some form of depression, generating an annual cost of approximately 100 billion euros. Our group is actively involved in the early detection and treatment of this disease, and its comorbidities (medical and psychiatric). The genetic and neuroendocrine markers we are investigating have contributed better understanding of the physiopathological mechanisms of depression. Likewise, a number of investigators in our group are actively working on the design of new individual- and group-based pharmacological and psychotherapeutic management strategies.

Research group in pediatric psychiatry and psychology (Associated)

CASTRO, JOSEFINA

(ICN)

The research group in childhood psychology and psychiatry of the Clinic Hospital forms part of the Department of Childhood and Adolescent Psychiatry, which has developed three fields: healthcare, teaching and research. These fields are all clearly interrelated with a view to affording better healthcare, with standardized protocols and evaluation and teaching at pre- and post-graduate level. Our aim is to facilitate both clinical research and collaboration with groups specialized in genetics, neuroimaging and neurobiology. The group is predominantly composed of members of the Department of Childhood Psychology and Psychiatry, and is integrated within the Biological Bases of Psychiatric Disorders group (coordinated by Dr. M. Bernardo). It also forms part of the CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental) of the Carlos III Healthcare Institute. In addition, it has established important collaboration agreements with the Department of Adult Psychiatry of the Clinic Hospital (especially as refers to schizophrenia, bipolar disorder and addictive behavior), as well as with other centers at international level, such as the Childhood Psychiatry Group of the ECNP (European College of Neuopsychopharmacology), with which relevant aspects of childhood psychopharmacology are investigated in the context of different projects, the University of Pittsburgh Medical Center, Neuroimaging Laboratory, Western Psychiatric Institute and Clinic, Pittsburgh (United States), with which studies are made in relation to bipolar disorder, and the Child and Adolescent Psychiatry Yale Child Study Center, New Haven (United States), with which aspects relating to autoimmunity are studied.
Our research objectives are the study of the manifestations, causes and treatment of the most serious and/or prevalent disorders found in these age groups: schizophrenia and bipolar disorder, anorexia and bulimia nervosa, obsessive-compulsive behavior, autistic disorders, attention deficit disorders, and addictive behaviors. In parallel, other lines have been developed related to the efficacy and safety of psychoactive drugs in children and adolescents, the development and validation of assessment scales, and the investigation of autoimmunity and psychiatric disease such as Tourette syndrome.