Institute of Geriatric Psychiatry: Research

Weill Cornell Institute of Geriatric Psychiatry: Novel Treatments and Research Studies

Engage: A Novel Neurobiology Based Psychotherapy

Engage is a novel psychotherapy for late life depression supported by a grant of the National Institute of Mental Health. It is based on neurobiological findings showing that abnormal function of the reward system promotes depression. Accordingly, Engage therapists help patients through a variety of behavioral interventions to enrich their daily experiences with meaningful and rewarding activities intended to reactivate their reward system. Participants to Engage are older adults with major depression.

The study is supported by a grant of the National Institute of Mental Health and offers a detailed clinical evaluation, brain MRI, and 9 weekly sessions of either Engage or Problem Solving Therapy, an evidenced based psychotherapy. The principal investigator, G. Alexopoulos, MD and the Engage research team can be contacted at (914) 997 4331.

Psychotherapy for Depressed Stroke Patients

Ecosystem Focused Therapy (EFT) is a novel psychotherapy designed to help depressed stroke patients by reducing their stressful experiences. It is based on findings indicating that the neurobiological responses to stress promote a multitude of processes leading to depression. To interrupt these processes, EFT therapists apply a variety of techniques aiming to enable patients to develop adaptation skills and a perspective useful for adjusting to their disability. EFT therapists also work with the patients’ family and specialized therapist to develop a human and physical environment (ecosystem) that best accommodates the patients’ new disability. Thus, EFT offers an optimal chance for adaptation, by promoting the patients’ adherence to rehabilitation and by increasing their sense of competence and their engagement in activities they value.

The study is supported by a grant of the National Institute of Mental Health and offers detailed clinical evaluation and sessions of either EFT or a psychoeducation therapy. The principal investigator, G. Alexopoulos, MD and the research team can be contacted at (914) 997 4331.

Antidepressant Medication for Patients with Depression

The purpose of this study is to identify how problems with the brain’s ability to ignore distractions and control emotions may lead to or complicate depression in older adults. This research is being done to help develop tests that may better detect older adults at risk for this type of depression and to improve their treatment outcomes. Eligible participants receive an MRI and 12 weeks of the FDA approved antidepressant medication escitalopram under the supervision of a psychiatrist. The principal investigator, Faith Gunning, Ph.D., and the treatment team can be reached at 914-997-4331.

Transcranial Magnetic Stimulation (TMS)

TMS is an FDA-cleared safe and effective treatment for patients with depression who have not benefited from prior antidepressant medication. It is thought to work by stimulating with magnetic pulses brain are underactive in patients with severe depression. The Institute conducts three studies that examine whether TMS increases the efficacy of: a) An antidepressant; b) Problem Solving Therapy, c) Computerized Cognitive Remediation.

Participants to TMS studies receive clinical evaluation and treatment according to study protocols. The principal investigator, G. Alexopoulos, MD and the TMS research team can be contacted at (914) 997 4331.

Neuroplasticity-Based Computerized Cognitive Remediation (nCCR)

nCCR is a novel intervention supported by a grant from the National Institute of Mental Health based on neurobiological findings suggesting that dysfunction in the cognitive control network (CCN) contributes to depression. The cognitive control network modulates aspects of cognition and emotion. nCCR targets the CCN with individually titrated computer exercises designed to induce positive change (i.e. neuroplasticity) in the aging brain and treats both mood and cognitive symptoms of the disorder.

Participants in nCCR are older adults with major depression who still suffer from depressive symptoms despite being treated with an antidepressant. They receive detailed clinical assessment, neuropsychological testing and 4 weeks of computerized cognitive remediation treatment. Dr. Morimoto and the CCR research team can be contacted at (914) 997-4331.

Psychotherapies for Suicide Prevention

Suicide rates in middle-aged and older adults are alarmingly high. We have developed psychosocial interventions to reduce suicide risk and at risk middle-aged and older adults. We are recruiting middle-aged and older outpatients with suicidal ideation and treatment resistant major depression and inpatients who have been hospitalized for suicidal ideation or suicide attempt. Our therapies are based on our theory that maladaptive emotion regulation is associated with increased suicide ideation and suicidal behavior. Therefore, therapists teach the patients emotion regulation techniques to help reduce their suicide risk. The principal investigator, Dr. Kiosses and his research team can be contacted at (914) 997 4331. For more information, please look at Dr. Kiosses’ research webpage.

Psychotherapies for Depression and Cognitive Impairment

Problem Adaptation Therapy (PATH) is a new psychotherapy that utilizes emotion regulation techniques based on Dr. James Gross’ process model of emotion regulation. PATH utilizes compensatory strategies and environmental adaptations to bypass cognitive and functional limitations in older adults with depression and cognitive deficits and invites the participation of caregivers when necessary. The principal investigator, Dr. Kiosses, and his research team can be contacted at (914) 997 4381. For more information, please look at Dr. Kiosses’ research webpage.

Sandy Mobilization, Assessment, Referral and Treatment for Mental Health (SMART-MH)

The Sandy Mobilization, Assessment, Referral and Treatment for Mental Health (SMART-MH) program is designed to identify the mental health and social support needs of older adults in areas impacted by Superstorm Sandy. The SMART-MH model integrates community outreach, detection of mental health need and community delivery of psychotherapy for depression and anxiety. SMART-MH is community based and targets people ages 60 and older living in areas impacted by Hurricane Sandy. SMART-MH uses an evidence-based approach to assessment, interventions and psychotherapy to evaluate and to address both specific mental health needs (e.g., depression, anxiety, alcohol abuse) and the impact of the storm. For information on SMART-MH, please contact Dr. Sirey and the SMART-MH team at 212-821-0759.

PROTECT Program for Mental Health Needs of Victims of Mistreatment

Integrating mental health services into aging services offers an opportunity to deliver care to vulnerable older adults as a step toward self-efficacy and self-protection. PROTECT is a program to embed mental health screening, education and mental health treatment for victims of elder abuse. The program is conducted in community agencies that offer elder abuse resolution services. At present the program is being conducted in collaboration with the New York City Department for the Aging’s Elderly Crime Victims Resource Center. The program is described in our recent publication (http://www.ncbi.nlm.nih.gov/pubmed/25611116 ). For more information on the PROTECT program, please call Dr. Sirey and the PROTECT team at 914-997-4333.

Treatment Initiation and Participation Program (TIP)

Antidepressant nonadherence remains a significant challenge to effective depression treatment offered to older adults in primary care settings. The Treatment Initiation and Participation program, TIP is a brief psychosocial intervention to improve adherence to pharmacotherapy. The intervention was designed to address the individual level barriers to care that are associated with medication nonadherence and treatment drop out such as stigma, worries about medication side effects, and difficulty developing an adherence strategy. To learn more about TIP, please call Dr. Sirey at 914-997-4333.

Trio for Successful Aging (Trio for short)

This program extends the SMART-MH model to other aging service sites. It brings together mental health and medical expertise in an integrated program for community older adults delivered in senior centers that can provide social and aging support services. A fundamental tenet of this program is that effective treatment of the mental health needs of older adults also requires us to understand and address their physical and social health needs, which often trigger and perpetuate mental health problems in later life. For more information on the TRIO program, please call Dr. Sirey at 212-821-0759 or 914-997-4333.

Shared Decision-Making in Elderly Depressed Primary Care Patients

Shared decision-making, in contrast to traditional medical decision-making, involves a collaborative process whereby patients articulate personal values and preferences and clinicians provide information to arrive at a mutually-agreed upon treatment decision. Our brief shared decision-making intervention attempts to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that they can successfully implement.

Participants at Lincoln Hospital receive either the shared decision-making intervention or usual care from their physician. Participants receive a detailed clinical assessment and follow up throughout a 6 month period. Dr. Raue and his research team can be conducted at (914) 997 4331.

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