Chairman's Welcome And Overview
Psychiatry is undergoing a tremendous transformation in which underlying mechanisms of mind-brain disorders are being identified, and associated, evidence-based treatments are being enhanced. This reduces the misunderstandings regarding mental illnesses, and increases hope for the large numbers of patients and families who suffer with difficulties in thought, feelings and behavior. It also provides exciting opportunities for fulfilling academic medical careers.
Our Department is helping to define the leading edge of such progress, particularly regarding psychiatric problems associated with medical illness. This tradition of medical psychiatry permeates the Department’s evolution, under Dr. Jonathan Borus, from a hospital-based service within the Department of Medicine to a strong academic clinical department spanning Brigham and Women’s (BWH) and Brigham and Women's Faulkner (BWFH) Hospitals.
Now the Department is deepening and extending its focused mission, with specific emphases and clinical-research-educational integration across sites and services. These developments are coordinated by Dr. Laura Miller, our Vice Chair for Academic Clinical Services, and Dr. Arthur Barsky, our Vice Chair for Research. They are focused in seven key areas:
The Medical Psychiatry (Consultation-Liaison) Division, directed by Dr. David Gitlin, is renowned for its mastery of the diagnosis and management of psychiatric problems that occur in the context of the full range of medical and surgical illnesses. These can include the co-occurrence of psychiatric and medical illness, the psychiatric co-morbidity associated the pathophysiological aspects of medical conditions, and the psychological reactions to medical illness and associated stressors. The Division provides award-winning emergency psychiatry services in the emergency departments of both Brigham and Women’s Hospital and Brigham and Women's Faulkner Hospital. The Medical Psychiatry consultation service has a major fellowship program with five trainees per year, and provides a key site for residency training.
The Ambulatory (Outpatient) Division, directed by Dr. Jay Baer, has recently been re-structured to offer contemporary, evidence-based psychiatric evaluations and treatments for patients with psychiatric difficulties in the context of medical illness and care. A multidisciplinary team including psychiatry, psychology, nursing and social work provides balanced, patient-centered care, with psychopharmacology and psychotherapy (including cognitive-behavioral, skills-based, psychodynamic, and group). A robust teaching environment for our outstanding residents is coordinated by Dr. Charles Surber, the program's education director.
There is robust research concerning medical psychiatry conditions/treatments (Dr. David Gitlin), somatoform disorders (Dr. Arthur Barsky), computer technology/e-behavioral health (Dr. David Ahern), and services and screening/brief intervention research.
The Neuropsychiatry Division has grown substantially with the arrival of my group of dual-trained psychiatrists/neurologists and neuropsychiatrists, and is now integrated with the Cognitive and Behavioral Neurology Division of the Department of Neurology, as well as our Neuropsychology program. This combined, highly expert team is now known as the Brigham and Women’s Center for Brain Mind Medicine (CBBM). The Center, directed by Dr. Kirk Daffner, performs comprehensive evaluations of complex diagnostic conditions at the interface of psychiatry and neurology. The Center also provides multi-disciplinary treatment for psychiatric aspects of neurologic disorders. It has a vibrant educational program for trainees at all levels, including a neuropsychiatry/behavioral neurology fellowship. Associated translational research spans psychiatry, neurology, neurosurgery, neuroradiology and neuropathology, in the context of the BWH Institute for the Neurosciences that I have the privilege of chairing. Such research includes functional neuroimaging, neuroprotection and repair, neurogenesis, and neuromodulation including deep brain stimulation and transcranial magnetic stimulation (please see departmental research descriptions).
Women's Mental Health
The Division of Women’s Mental Health is a broad and encompassing clinical division providing clinical services to women with mental health conditions including management of psychiatric disorders during reproductive life transitions. The Division has affiliated research programs to advance our understanding and treatment of mental health conditions in women. The Division is directed by Dr. Hadine Joffe, a nationally-recognized leader in women’s mental health. Dr. Joffe’s clinical and research focus is on menopause-related conditions, whether age related or cancer/treatment related, as well as reproductive consequences of psychiatric medications. She treats patients with depression and other menopause-related symptoms and is the Director of the Women’s Hormones and Aging Research Program, where she conducts clinical research studies.
The Division of Women’s Mental Health has extensive psychiatry services for women during pregnancy and the postpartum period, conducted in close collaboration with BWH’s OB/GYN department, one of the top OB/GYN departments in the country with approximately 8,000 births per year. Perinatal psychiatry services include an integrated consultative service to the Maternal Fetal Medicine program, lead by Dr. Leena Mittal, Director of the Reproductive Psychiatry Consultation Service. The Division includes an integrated women’s mental health service for primary care and subspecialty female patients seen in the Fish Center for Women’s Health at the BWH Ambulatory Care Center in Chestnut Hill, as well as other women’s mental health services for women planning pregnancies, experiencing mental health problems during and after pregnancy, menopause, and in the context of infertility, hormonal contraceptive treatments, breast cancer therapies, and addiction. Outpatient services are provided at BWH, Brigham and Women's Faulkner Hospital, and the Dana Farber Cancer Institute. The Division offers a Women’s Mental Health fellowship, as well as the opportunity to focus on OB/GYN liaison within our Medical Psychiatry (C-L) fellowship, and other educational rotations for fellows, residents and medical students.
The Division is affiliated with the BWH Connors Center for Women’s Health and Gender Biology under the leadership of Dr. Paula Johnson, who is Executive Director of the Connors Center and Chief of the Division of Women's Health at BWH, and the research arm of the Connors Center, which is directed by Dr. Jill Goldstein, who performs leading research on the neurobiology of sex differences in mental and other health conditions.
This important area of psychiatry is led by Dr. Susan Block, Chair of Psychosocial Oncology at the BWH-Dana Farber Cancer Institute. This program is a leader in clinical, educational and research aspects of psycho-oncology and palliative care (a field that Dr. Block has pioneered). Please see the "Psychosocial Oncology" for further information.
Addictions, alone, or in combination with psychiatric and/or medical illness, represent a widespread and difficult problem. Our department has a comprehensive spectrum of addictions services, ranging from an inpatient consultation service at BWH, directed by Dr. Joji Suzuki, within the Medical Psychiatry Division, to inpatient detox, partial (day) hospital, and day and evening outpatient continuity of care at Brigham and Women's Faulkner Hospital, led by Drs. Erica Veguilla (psychiatry) and Carol Garner (medicine). Dr. Joji Suzuki directs addictions and services research, working closely with the clinical teaching services.
In the context of the medical focus, and with the aging population, the department has developed a program in geriatric psychiatry. Drs. Olivia Okereke, Geena Athappily, Catherine Gonzales and Nancy Donovan are all sub-specialty geriatric psychiatrists, and have additional expertise in geriatric depression, (post) menopausal syndromes, late-life psychosis, and dementia, respectively.
Primary Psychiatric Illness
Patients with primary mood, psychotic and anxiety disorders receive care in the outpatient settings of BWH and FH, particularly in the context of concurrent medical illness and treatment. At BWFH, we have an adult inpatient psychiatry clinical/teaching unit, directed by Dr. K.C. Potts, providing exquisite care for acutely and severely ill psychiatric patients. We also have a partial (day) hospital provides associated intensive care for those who are significantly ill and/or in crisis, who don not need hospitalization.
The department’s research is vibrant and rigorous, spanning the clinical content areas noted above, and integrating the following approaches:
- Functional and Structural Neuroimaging
- Basic Neuroscience
- Translational Therapeutics (including neuromodulation/stimulation, neuroprotection, neurogenesis, neurorepair and hormone manipulation)
- Clinical Services Research
- Cohort studies
Please see the departmental research section for a description of laboratories, investigators, and programs.
Our education programs are a particular source of pride and joy. They include:
Clinical Fellowships in Psychosomatic Medicine, Neuropsychiatry/Behavioral Neurology, Women’s Mental Health, Neuropsychology, and Psychotherapy. We also offer geriatric and addiction fellowships, that we participate in together with McLean and Mass General, under the Partners umbrella.
The Harvard Longwood Psychiatry Residency Training Program, co-sponsored with the Beth Israel Deaconess Medical Center Department of Psychiatry and the Massachusetts Mental Health Center. This outstanding residency program is now expanding its opportunities in neuropsychiatry as well as research and scholarship, adding to its widely-recognized strengths in all aspects of hospital and community psychiatry training. The program, also known for its warm community and individualized environment, is directed by Dr. William Greenberg, who works closely with our BWH-FH director of education and training, Dr. Charles Surber. Read more about the Harvard Longwood Global Psychiatry Interest Group here.
Harvard Medical School students doing their Principal Clinical Experience at BWH receive carefully-crafted psychiatry clerkship training in our department. A new part of the curriculum provides integration with neurology and (neuro) radiology clerkships at BWH. Electives in our specialty areas are offered as well. Our faculty work with those of our sister departments in other HMS-affiliated hospitals to develop and teach the first and second year courses.
Our department is integrally involved in the BWH Institute for the Neurosciences, spanning the departments of psychiatry, neurology, neurosurgery, (neuro)radiology, and (neuro)pathology; and integrating clinical, research and educational activities at the interface of these fields. The Institute, which I chair, has a particular focus on the scientific development of translational, mechanistic diagnostic biomarkers and targeted therapeutics, leading to personalized brain-mind medicine. Patients and families benefit from the one-stop-shopping access to leading experts and new treatments at the interface of these fields, while the next generation of clinical neuroscientific leaders is trained in a stimulating, collegial academic medical environment that transcends traditional boundaries.
The department is also a charter member of the National Network of Depression Centers (NNDC), a new organization of 16 leading academic medical institutions joined in a nation-wide effort to advance the understanding and treatment of mood disorders. I am privileged to serve as Vice Chairman of the Governing Board of the NNDC. Dr. Jane Erb directs our Depression Center and Emily Benedetto, LCSW is our Progam Manager. In this context, our BWH Center for Depression in Medical Illness includes faculty from our department as well as many other BWH departments with whom we work closely. The Center focuses upon the enhanced recognition and treatment of mood disturbances in the medically specialized areas outlined above, and hosted this year’s annual NNDC meeting.
We are part of Partners Psychiatry and Mental Health, chaired by Dr. Scott Rauch, together with our sister psychiatry departments at Mass General Hospital and McLean Hospital.
Commitment to the Community
The prevalence of psychiatric disorders and substance abuse is great, the suffering is poignant, and the socio-economic consequences are enormous. For this reason, as the department advances the field, it reaches out to the local, national and international community. Activities includes faculty members working on a Native American Mental Health and Addiction Center; volunteers doing post-earthquake and tsunami mental health work in Japan; Harvard Longwood residents working with chronically mentally ill and homeless individuals through the Mass Mental Health Center; the Women's Mental Health Program working with Massachusetts, Illinois, and other states to develop women's mental health services, and contributing to the BWH Birth Equity Initiative to reduce disparities in pre-term labor and its sequelae; the BWH Depression Center working as part of the National Network of Depression Centers on national policy and program development regarding depression and bipolar disorder; neuropsychiatrists leading public policy and affairs development in the context of the American Neuropsychiatric Association; staff at the Dana Farber Cancer Institute developing new programming for adolescent cancer survivors; individuals working with patient/disorder advocacy groups; mental health teams providing care in community mental health centers in disadvantaged communities; physicians and trainees working with Partners in Health to develop mental health educational initiatives for health care providers in developing countries; and a team working with other programs at Harvard to develop a program providing neuropsychiatric approaches to international conflict resolution.
David Silbersweig, M.D.
This page was last modified on 4/22/2014