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Teacher of the Year Addresses Psychiatric Education, Schizophrenia Treatment

Teacher of the Year Addresses Psychiatric Education, Schizophrenia Treatment

Increased access to mentors and greater integration of computerization and technology into psychiatric education would better prepare psychiatric residents for academic careers to discover the causes and treatments of psychiatric brain disorders, according to Henry Nasrallah, MD, Psychiatric Times' 2005 Teacher of the Year.

The award, presented to Nasrallah at the 18th annual U.S. Psychiatric & Mental Health Congress in Las Vegas, was designed to honor educators who make outstanding contributions to academic education and career development in psychiatry and/or the behavioral sciences.

Nasrallah, professor of psychiatry, neurology and neuroscience and associate dean at the University of Cincinnati's College of Medicine, has devoted much of his professional career in psychiatry to teaching, mentoring, researching, writing and providing clinical care. Following his psychiatric residency at the University of Rochester and a neuroscience fellowship at the National Institute of Mental Health (NIMH), he held faculty appointments at the University of California and University of Iowa before serving as chair of the department of psychiatry at Ohio State University for 12 years. During his sabbatical, he served as professor of psychiatry, neurology and internal medicine at the University of Mississippi's School of Medicine, before returning to Ohio to join the faculty at the University of Cincinnati's College of Medicine.

Early on, students recognized Nasrallah's teaching excellence. In 1978, he was honored as an outstanding teacher by the psychiatric residents at the University of California at San Diego. Later, he received appreciation awards from psychiatric residents at Ohio State University, a teacher-of-the-year award from the psychiatric residents at the University of Mississippi and the Telly Award (a national media award) for excellence in hosting the Distance Learning Network about serious mental disorders.

In addition to his teaching and administrative duties, Nasrallah has served for many years as senior examiner for the American Board of Psychiatry and Neurology oral examination. He also served three terms on the American Council for Graduate Medical Education (ACGME) Residency Review Committee, which accredits psychiatric training programs in the United States.

Asked what makes a good teacher, Nasrallah told Psychiatric Times, "A good teacher loves the work that he or she does. You have to have a passion for what you are doing in psychiatry and be excited about new research."

When the passion and excitement are present, he added, it becomes more natural to teach the material and to inspire others to enjoy psychiatry and their newly acquired knowledge and to apply it to patient care.

Nasrallah's own passion for psychiatry began when he was in high school.

"Well before I went to college, I used to read a lot of psychology, especially [Sigmund] Freud, and I used to serve as a counselor to my friends," he said. "My mother was a school teacher, and my father was a minister who taught and counseled members of his congregation, which probably means that both nature and nurture played a role in my career choice."

Nasrallah admitted to not only loving teaching, but also mentoring, and he acts as research mentor for various residents and junior faculty.

"Mentoring is beyond teaching," he said, explaining that it involves guiding others through the ongoing process of career development.

"The medical profession is something you can learn in graduate school and the laboratory," he explained, "but you don't really get to achieve excellence unless you get mentored by a senior colleague in clinical matters, in research matters, in methodology, in professional issues, and in leadership skills. Young people in psychiatry will develop much better if they have several mentors and at least one major mentor to guide them along."

Another area that needs to be an integral part of medical education, in general, and psychiatry in particular, he said, is the exploitation of computerization and technological advances to more rapidly access information and synthesize the new knowledge into a digestible form.

"Psychiatry is one of the fastest growing sciences, and neuroscience, in general, is exploding with new knowledge," he said. "Unless you have technology to organize it and present it to you in a coherent fashion, it is very hard to keep up."

Psychiatric research and neuroscience also are extremely dependent on advances in technology and computerization, he pointed out. While the brain is complex and fascinating, Nasrallah said, it is also a very challenging organ to study.

"In medicine, we can do biopsies of the liver, heart, kidney, skin or muscle," he said, "but we cannot do brain biopsies to help diagnose serious mental illness. That's why technology is the key to the advanced noninvasive methodologies, such as magnetic resonance spectroscopy [MRS], being used to study brain biology."

An extension of his teaching is Nasrallah's work in publishing. He has written more than 300 articles and 10 books, and he is editor-in-chief of two journals: Schizophrenia Research and The Journal of Psychotic Disorders. He is also past president of the American Academy of Clinical Psychiatrists and is listed in several editions of the book, Best Doctors in America.

Nasrallah has also maintained his interest in neuroscience research and psychopharmacology, having received more than 50 research grants, with schizophrenia and psychotic disorders his primary areas of research.

Researching Schizophrenia

"After my residency, I decided to pursue research specifically to understand brain mechanisms in the most severe psychiatric disorders, and schizophrenia, in my opinion, is arguably the most severe psychiatric disorder," he told PT.

Specifically, he wanted to discover and explore "some of the neurobiological mechanisms involved in producing this devastating brain disease and its disabling features, including negative symptoms, cognitive deficits and mood symptoms" and to discover new treatments. Although many advances have been made in understanding schizophrenia, much remains to be discovered, Nasrallah said.

"We still have not restored function to the patients who suffer from schizophrenia. We need to get them back into jobs, schools, relationships and into being able to live life and pursue happiness like everyone else. Many of them still cannot," he added.

Developing new treatments for schizophrenia is getting faster with technological advances, but still remains a major challenge, according to Nasrallah. He predicts that within 10 to 15 years, schizophrenia treatment will be heavily driven by genetics data and by the discovery of new neurotransmitters and receptors.

"The next generation of drugs may actually be completely different than the ones that we have right now, and we may pursue neurotransmitter systems like glutamate, N-methyl-D-asparatate [NMDA] receptors and perhaps receptors we still haven't discovered," he said. "We have some 70 or 80 neurotransmitters that we know about, but it is believed that there are several hundred neurotransmitters in the brain and systems that may be involved in mental illness. ... Of course, treatments will be linked with advances in understanding the etiology and pathophysiology of the disease; they go hand-in-hand."

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