Week 5: Calarge Lab

February 18th, 2014

Allan Knight ’14, Chaffin Fellow in Psychology

It’s been a little over a month, and I feel like I have established something of a routine here at the lab. I mostly enter data now for the bone loss prevention study. This study is a kind of sister project to the SSRI bone mass density study, which seeks to monitor and uncover correlations between bone mass density, mental illness status, SSRI treatment status, gut bacteria, genetic factors, physical activity, handedness, family traits, and countless other factors. The goal for both is to better understand how mental illness and its treatment contribute (or do not contribute) to bone health later in life. In medicine there is a phenomenon called the “osteoporosis line”, a point where bone mass density is so low that people are extremely susceptible to fractures. At the age where one typically crosses this threshold, the stress of recovery from a major fracture could shorten one’s life, or at least seriously lower the quality of that life. Most of our bone development occurs in childhood and adolescence; the age group of interest to Dr. Calarge. The anti-psychotic Risperidone is widely prescribed to children and adolescents struggling with surging emotions, and has been already shown to lower bone mass. Dr. Calarge thinks that by taking a supplement of Calcium and Vitamin D, these kids who today take Risperidone may be able to live with healthier bones when they might otherwise start breaking in their 70s and 80s. To assess this, Dr. Calarge has set up a double-blind placebo study on the effects of a vitamin D supplement. Each participant’s entire health history is obtained (at great cost to the NIH) and their vitals, bone mass densities, and mental states (along with other factors such as ongoing treatments) are then closely monitored for up to two years. I will not see the outcome of this study for a long time, but it’s satisfying to know my efforts are helping people live better lives.

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Week 4: Calarge Lab

February 11th, 2014

Allan Knight ’14, Chaffin Fellow in Psychology

This week I not only got on the schedule to shadow a visit, but the participant showed up too! I’ve been waiting for the opportunity to observe a  visit for some time, as two participants beforehand had blown off their scheduled meetings. This is pretty common. When I asked Nichole (a more senior research assistant working on her Ph.D in Psychology) just how often participants followed through on their scheduled meetings, she estimated only about 30%-50% make it to the hospital at the agreed time. When it comes to ease of administration, participants seem to fall into two main camps: the reliable and the unreliable. Nichole, often frustrated with trying to get people to stick to the schedule, is currently working on her own research project trying to identify what personality factors make for reliable study participants. According to her research, the mental illness status of a participant is actually not the strongest predictor of their reliability. People suffering from mental illness in general have a tough time getting tasks done, but she feels that a particular subset of people who employ avoidance strategies have an especially difficult time making it in when depressed. Even if these people recover from their major depression and regain a sense of direction and control in life, they usually blow off the meeting to do something else.

Ethical considerations regarding patient confidentiality prevent me from over-sharing details of the more personal aspects of the visit, but most of what I really learned came from paying attention to the technique employed by the interviewers. Dr. Calarge spoke with me beforehand about the challenge of balancing his own need to actively pursue the answers to questions necessary for concluding a diagnosis, while simultaneously listening passively enough to guide your hunches and not just unilaterally leading a patient on. Whether you’re a lawyer, psychiatrist, or detective, it’s an incredibly difficult skill to master, and no two people strike quite the same balance between the two objectives. Since he was short on time and already had established the patient’s history he was forced to lean almost entirely to the active questioning side of the equation. However next week I have the chance to shadow a first-time visit, where with more time and fewer givens I expect the process to look quite different.

Week 3: Calarge Lab

February 4th, 2014

Allan Knight ’14, Chaffin Fellow of Psychology

This week the lab hasn’t been able to run any bone-scans, so there have not been any participant visits in a little while. Mostly this has been a week of data entry, but I am on the board for shadowing this Thursday’s patient visit! I also got to shadow Sean as he prepared blood samples for human DNA extraction.

Dr. Calarge has taken it upon himself to help me better understand the methods he uses to ‘strategically converse’ with a patient -how important it is for investigators to pursue specific yes/no facts while also respectfully listening to what the patient considers important.

I’ve been listening to books on tape while I do data entry, and one quote from The Death of Ivan Ilyich (about a judge) resonated with me as I thought about this kind of investigative mental health,

In his work itself, especially in his examinations, he very soon acquired a method of eliminating all considerations irrelevant to the legal aspect of the case, and reducing even the most complicated case to a form in which it would be presented on paper only in its externals, completely excluding his personal opinion of the matter, while above all observing every prescribed formality.

This week I attended another weekly ‘L.I.F.E.’ meeting where Dr. Calarge gives his input to judgements of a different kind of case. To prepare for these meetings I have been studying the DSM’s (Diagnostic and Statistical manual- the truth of human experience as agreed on by the high priests of psychiatry) entries on mood and personality disorders. During the meeting, Dr. Calarge quizzed me on the book’s criteria for a major depressive disorder (MDD) diagnosis, and I named 4 of the 5 minimum symptoms! It was intimidating, but I felt pretty good considering that my study time was split up amongst hundreds of symptom permutations. Clearly I still have a lot to learn, but I can think of few better environments than the Calarge lab to for that to happen.

At this Fellowship’s halfway point, I have learned much about the reality of standardized psychology, and its big book. Not just memorizing entries on individual disorders, but what it really means means to be ‘mentally ill’, and how we as a society deal with it. In the DSM handbook’s introduction it notes that the use of its standard criteria “enhances agreement among clinicians and investigators”. The National Institute of Mental Health strongly disagrees, and based on the medical forms I have entered as well as the L.I.F.E meetings I’ve attended thus far -so do I. Rarely are patients or the people responsible for interviewing them of the exact same mind from check-in to check-in. An interview that was conducted a week ago usually sounds much different during a later review (like how this blog post probably will). At an interview’s first listen there is little “agreement among clinicians and investigators”, but -and this is the real strength of the DSM- they are able to argue their positions until a group consensus is reached. I am starting to see the DSM almost like the U.S constitution (or Imperial Russian law, as in the case of Ivan Ilyich). Both legal and clinical standards work not so much to answer specific questions with definite answers, but rather they create a common environment for their discussion!

“‘So that’s what it is!’ he suddenly exclaimed aloud. ‘What joy!’”

Week 2: Calarge Lab

January 30th, 2014

 Allan Knight ’14, Chaffin Fellow in Psychology

Real world lesson for the week: the research of emotional anguish is itself stressful, complicated, and often disheartening.  On Tuesday I was suppossed to shadow a visit with Sean, another student research assistant. Unfortunately his participant experiences extreme anxiety and social phobia, and Sean thought the presence of two researchers might overwhelm her. The second visit was supposed to be with Nichole’s patient, a symptom-free ‘control’ participant, but he was a no-show. I’m really looking forward to attending a patient visit that will (hopefully) take place next week. For now, the team is having me listen to past initial-visit interviews so I can gain a sense of how people are diagnosed before any assumptions are drawn.

The purpose of these interviews is to diagnose patients using standarized techniques like the Beck Depression/Anxiety inventories. In the past I viewed these forms as reductive; without sufficient respect to the intricacies of depression or paranoia. Now, after participating in this enormous study I see their value. In order to compare large groups of people in research you need to cast big, and often simple nets of categorization. I still feel uncomfortable with the idea of insurance company mandated standard inventories in a clinical setting, but I suppose they too are just trying to cut definite paths through a jungle of human complications.

In the absence of patient visits this week I have also further integrated into the data collection side of things. I’ve finally gotten the hang of relaying samples and testing equipment between the lab and the clinical research unit. Soon I am supposed to help with the lab analysis of both human and bacterial (gut fauna) DNA samples. Throughout all of this I am becoming deeply interested in the medical side of psychology, and am even considering gaining the credits neccessary to apply to medical school after I finish my bachelor’s.

Week 1: University of Iowa- Calarge Lab

January 22nd, 2014

Allan Knight ’14, Chaffin Fellow in Psychology

The Calarge lab is quite an operation! I am one of the sixteen who assist Dr. Chadi Calarge in his studies of the psychiatric medication of adolescents. His lab is a part of the massive University of Iowa hospital system. I had no idea it was so big! My hope as a psychology major is to one day become a neuropsychologist -a psychological specialist who deals with difficult cases of mental illness which require  interweaving biological and learned-behavioral factors to be teased apart so each can be properly treated. I signed up for this research fellowship hoping that I could get the inside perspective on real treatment of mental illness in the field.

For the first week, I needed a lot of helping finding my way through its maze of tunnels and elevators. In fact, I needed a lot of help in general, but in the culture of this lab asking for help is never chastized. Dr. Calarge has a reputation around the hospital for being extremely detail-oriented, and also having a very low tolerance for mistakes made out of ignorance. In his letter to new hires he writes, “If I ask you to do something you do not understand, please say so. If you are too scared of me, please find someone else to work for”.  In most jobs this position may be extreme, but here it pays to be honest and fastidious when researching a topic as slippery as people and their moods (especially troubled people and their troubled moods). An ethical psychiatrist cannot afford to act on unchecked assumptions when their patient’s minds are on the line.

It was intimidating asking for so much assistance (and so often too), but everybody here has been very helpful and patient in getting me up to speed with the basic day-to-day operations of the lab. Right now, I’m on the data entry squad for Dr. Calarge’s SSRI study. Basically, this involves copying handwritten forms like the Beck Depression/Anxiety Inventories into an electronic database; where at some point in the future they will be statistically analyzed. Occasionally I also will answer phones or run samples from the hospital’s Clinical Research Unit (CRU) to the freeze room here in the Calarge Lab. The aim of the study I’ve been involved with is to understand/uncover a causal relationship between the use of antidepressant SSRI-type medications (such as Paxil, Zoloft, Prozac, or Lexapro) in 15-20 year old patients, and resultant changes in bone mass density. Stool and blood are also taken and stored in deep-freeze for later analysis. The Dr. hopes to become one of the first researchers to identify links between metal illness, its pharmacological treatment, and their effects on gut bacteria as influenced by genetic factors. There are close to 1,000 patient files on this topic. Each 4-inch binder represents a young adult who, upon starting an SSRI treatment, submitted themselves to a two year program of testing and questioning  by Dr. Calarge and his assistants for a payment of $800 (assuming they remain in the program for the duration; payments are given upon completion of each visit). It can be sobering reading out a person’s struggle with mental illness as rendered on sheets of zeroes, ones, twos; and occasionally threes, fours, and fives. Often the patient whose data I am sorting is just another undergrad student like any of my friends at Cornell. The lab follows extremely strict confidentiality protocol. Every patient is assigned a code-number, and any identifying information like names or SSNs are whited out. All I have seen of any of these patients so far are ghostly CT-scans of their bodies. If I am honest, eight hours of data entry each day is tedious work, but there’s still a life in every binder, and countless more like them who stand to benefit from the Dr.’s research. Friday’s lab meeting is supposed to assign me to some real-life patient visits, and I can’t wait to start!

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