“Severe mental illnesses are common, they cause a lot of impairment, and available treatments are only partially effective and have many side effects,” said Dost Öngür, MD, PhD, director of McLean’s Laboratory for Early Psychosis (LEAP) Center. “One of the best promises for improving on this picture is early intervention.”
Finding the patterns and trends that lead to early detection and intervention for psychiatric illness is the idea behind the LEAP Center. Established through an NIH grant, the center collaborates with mental health institutions across Massachusetts and across the country to collect data that helps researchers better understand first episode psychosis.
LEAP is one of eight Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults With Mental Illness (ALACRITY) in the U.S. Funded by the National Institute of Mental Health, ALACRITY centers engage in research aimed at improving care for children, adolescents, and adults with severe psychiatric disorders.
To create the LEAP Center, Öngür reached out to internal medicine and health policy expert John Hsu, MD, from Massachusetts General Hospital, and Miguel Hernan, MD, DrPH, an epidemiologist from the Harvard School of Public Health. Both researchers had explored the importance of early intervention in medicine, and Öngür wanted to bring their thinking to the world of psychiatry.
“For conditions like cancer and heart disease, we saw conversations on early screening and early intervention, but we weren’t seeing them in psychiatry,” he reported. In collaboration with Hsu and Hernan, Öngür and his colleagues submitted a proposal to the NIH. Their efforts resulted in the establishment of LEAP in May 2019.
LEAP Center’s researchers have been engaged in several collaborative projects since its founding. For example, LEAP is working with the Massachusetts Department of Mental Health (DMH) to analyze data on early psychosis collected from 13 clinics in the state.
Öngür said that these clinics have pulled together demographic data (age, gender, ethnicity, etc.) as well as information on illnesses, symptoms, hospitalizations, approaches to treatment, and outcomes. Moreover, he reported, clinics have collected information on “whether patients can work, live on their own, need to be in the hospital, or live in a group home. They also have data on suicide attempts, substance use problems, and incarceration.”
Through analysis of this information, Öngür said, “we can capture what’s going on with young people in the early stages of psychotic disorders, and we can also detect patterns.” For example, he explained, the data can reveal if “people with a certain cluster of symptoms respond better to a certain kind of treatment.”
Armed with this data, LEAP investigators are also looking at the effect of antipsychotic medications on young patients as well as what happens when patients stop using these drugs. He said that “a lot of young people when they are diagnosed with a psychiatric disorder go on treatment that includes medication, but many stop the medication—either on their own or in collaboration with their treaters.”
“We don’t have good information from the real world on whether these people have serious problems when they stop using medications, so we are currently collecting this data and analyzing it from various sources,” said Öngür.
The current coronavirus crisis presents another area of inquiry for the LEAP team. In recent weeks, the LEAP Center has been in discussions with the DMH and other clinics to study the impact of the COVID-19 disruption on young people diagnosed with psychotic disorders.
“With the pandemic, many clinics have closed their doors to in-person visits and turned to virtual visits,” said Öngür. “We would like to find out if people are going to struggle more, if they are going to be hospitalized or have more problems, or if we’re going to go back to things as they were.”
Going forward, Öngür sees a continuation of current research efforts and the potential to take on new projects. The center’s support for junior investigators is central to the success of this ongoing work.
“Through the LEAP Center, we are bringing on investigators who are early in their careers,” he said. “Many of them don’t yet have the support to do their work, but we can give them the data and funding for their areas of interest. It’s very helpful.”
LEAP Center team, pictured above:
Back row, left to right: Miguel Hernán, MD, DrPH, director; John Hsu, MD, MBA, director; Peter Thein Durning, research assistant; Emily Carol, PhD, investigator.
Front row, left to right: Jacqueline Dow, research assistant; N. Ada Yilmaz, research assistant; Sandra Melanson, MSW, administrative manager; Nicole Benson, MD, investigator; Alejandro Szmulewicz, MD, MPH, investigator; Dost Öngür MD, PhD, director.
Not pictured: Ann K. Shinn, MD, MPH, investigator; Lauren Moran, MD, investigator.