October 19, 2005

Improving drug prescribing for seniors with mental health disorders

New research-clinical program in Toronto brings top investigator home
Pioneering work in understanding role of 'genetics' in drug response

Toronto, ON – Identifying the most effective and safest treatments for seniors with mental health disorders is getting a much-needed shot in the arm!

Baycrest, the Centre for Addiction and Mental Health (CAMH), and the Department of Psychiatry at University of Toronto, have created a joint research-clinical program in geriatric neuropsychiatry. The program will consist of joint research initiatives, the development of a robust academic program, and enhanced clinical services.

The research-education-clinical synergy will ensure new knowledge about treatments, including optimal drug prescribing in the elderly population, is transferred as quickly as possible to the psychiatric care setting.

Traditionally there has been very little research in geriatric mental health despite the fact that seniors suffer from a wide array of mental illnesses and are often prescribed very potent drugs, some of which are inappropriate. These illnesses include mood, anxiety and psychotic disorders as well as the emotional, behavioral and cognitive complications of brain diseases such as Alzheimer’s and Parkinson’s, and the effects of stroke.

Dr. Bruce Pollock, a Canadian researcher and clinician who is internationally recognized for his work in geriatric psychopharmacology (i.e. the study of the effects of drugs on mood and the behavioral disturbances of dementia) – and who is doing pioneering research in understanding how genetic variation may help explain why individuals respond differently to the same drug – is returning from a distinguished position in the United States to oversee the new program as the Sandra A. Rotman Chair in Neuropsychiatry at Baycrest and the University of Toronto, and head of the Division of Geriatric Psychiatry, University of Toronto.

Most recently Dr. Pollock was Chief of the Academic Division of Geriatrics and Neuropsychiatry and Professor of Psychiatry, Pharmacology and Pharmaceutical Sciences at the University of Pittsburgh School of Medicine, as well as Director of the Department of Psychiatry’s Clinical Therapeutics Research program.

“My principal concern has been the very limited evidence base for the drug treatments we provide to the elderly – not only in terms of drug interactions and safety, but the simple efficacy of those treatments,” says Dr. Pollock, who earned his MD from the Faculty of Medicine of the University of Toronto and his PhD in pharmacology from the University of Pittsburgh School of Medicine.

“I felt this initiative would be one of the best platforms in North America to develop and validate psychopharmacological treatments for the elderly. People over 65 now consume approximately 40% of all prescription medications and yet they are the very group we have the least information on, particularly with regards to optimal prescribing strategies for psychotropics.”

Psychotropics are a large class of drugs that include anti-psychotics, tranquillizers and cognitive enhancers. The physiology of aging (particularly decreased kidney function and slower metabolism) -- coupled with the fact that older adults are often on multiple medications to treat coexisting health conditions -- puts this population at high risk for experiencing harmful side effects, including adverse drug interactions.

There is still much to learn about how individual elders handle these medications and how to identify those who are most likely to benefit and those who are at greatest risk for adverse reactions. Currently there is a disturbingly “thin evidence base” to guide doctors’ prescribing decisions and consequently an increased risk of seniors being injured by these treatments, warns Dr. Pollock.

Pharmacogenomics
Dr. Pollock will continue his pioneering work in examining how genetic differences combine with age-associated factors to influence medication response. Known as pharmacogenomics, it combines traditional pharmaceutical sciences such as biochemistry with knowledge of genes, proteins, and single nucleotide polymorphisms. The goal is to one day be able to tailor drugs to individuals, explains Dr. Pollock, so the best available drug is prescribed from the beginning based on the patient’s genetic profile. It would be a vast improvement over the current trial-and-error approach of matching patients with the right drugs.
“We are very fortunate in attracting Dr. Pollock back to Toronto. His joint position will serve as a unifying force for geriatric psychiatry research at the University of Toronto and catalyst for the development of psychopharmacological approaches at Baycrest,” says Dr. Donald Stuss, Director of The Rotman Research Institute at Baycrest.

Dr. Benoit Mulsant
Joining Dr. Pollock on his return to Canada is University of Pittsburgh colleague Dr. Benoit Mulsant, who is internationally recognized for his research in late-life depression and psychotic disorders. His work focuses on the biological underpinnings, psychopharmacological treatments and optimal approaches to treating these disorders. Dr. Mulsant has joined CAMH as Director of the Geriatric Mental Health Program, and Professor, Department of Psychiatry, University of Toronto.

The recruitment of Drs. Pollock and Mulsant is very much in keeping with the university’s vision to attract the best international scientists to build the faculty. “Bruce is one of the world’s leading authorities in an extremely important field and we expect that he will lead an already strong geriatric psychiatry program to new levels of excellence. Benoit is an outstanding individual who brings a great deal of energy and expertise to the academic enterprise,” adds Dr. Donald Wasylenki, Professor and Chair of the Department of Psychiatry, University of Toronto.

Drs. Pollock and Mulsant pointed to the “enormous growth” that has occurred in biomedical research in the Toronto area generally, Baycrest’s reputation as one of the most outstanding geriatric facilities in North America (including its world-renowned strength in cognitive neuroscience research), and CAMH’s brain imaging strengths, as the driving force behind their decision to return to Canada.

"The appointments of Dr. Pollock (to Baycrest) and Dr. Mulsant are very exciting for CAMH. Our organization is committed to integrating the latest in scientific advances into our clinical practice and we're confident that the expertise they bring will improve the circumstances for this underserved older population," says Dr. Trevor Young, Physician in Chief at CAMH.

Drug trials
Most exciting for Baycrest is the anticipated involvement with CAMH in clinical drug trials under the leadership of Dr. Pollock. Historically Baycrest has not been heavily engaged in drug trials. However, with the maturation of its research program and several important clinical initiatives that include the launching of the Brain Health Centre Clinics, and the creation of the Centre for Stroke Recovery, Baycrest is well poised to take this step.

“This new program is an incredible opportunity to expand our knowledge and open up new avenues for more effective and safer treatments,” adds Dr. David Conn, Co-chair of the Canadian Coalition for Seniors’ Mental Health, Head of Baycrest’s Department of Psychiatry, and Director of the Mood and Related Disorders Clinic (which is part of Baycrest’s recently opened Brain Health Centre Clinics).

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The Sandra A. Rotman Chair in Neuropsychiatry was established in 1999 with a generous gift from benefactor Sandra Rotman. The first holder of the chair was Dr. Helen Mayberg, a neurologist who is world-renowned for her studies of depression pathophysiology and treatment.

Baycrest is an internationally-renowned academic health sciences centre with a focus on brain functioning and mental health related to aging. The CAMH is a Pan American Health Organization and World Health Organization Collaborating Centre and a teaching hospital. Both Baycrest and CAMH are fully affiliated with the University of Toronto.

For more information on this release, please contact:
Kelly Connelly
Media Relations
The Rotman Research Institute
Baycrest Centre for Geriatric Care
(416) 785-2432
kconnelly@baycrest.org