August 9, 1996

Meltzer to head Psychopharmacology division

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Dr. Herbert Y. Meltzer

Meltzer to head Psychopharmacology division

Dr. Herbert Y. Meltzer, one of the world's leading authorities on the treatment of schizophrenia, has joined the faculty at Vanderbilt University Medical Center.

Meltzer is professor of Psychiatry and Pharmacology at VUMC, and is also director of the division of Psychopharmacology in the department of Psychiatry.

Prior to coming to Vanderbilt, Meltzer was the Douglas Bond Professor of Psychiatry and Professor of Pharmacology at Case Western Reserve University School of Medicine in Cleveland. He previously served as director of research for the Psychiatry Service at Veterans' Administration Medical Center in Cleveland, and vice-chairman of research in the department of Psychiatry at University Hospitals of Cleveland.

In the past four years, Meltzer has added to his list of awards by winning the Lieber Prize for Schizophrenia Research; the Gold Medal for research from the Society of Biological Psychiatry; and the Stanley R. Dean Award of the American College of Psychiatry.

Meltzer's particular interest is the treatment of patients who have failed to respond to conventional treatments for schizophrenia, depression and mania (bipolar disease).

"Our group will be bringing to Nashville the opportunity for patients to participate in some of the most cutting-edge new treatments that are being developed by the pharmaceutical industry, many of which are based on a theory I put forward about nine years ago," Meltzer said.

At that time, Meltzer was one of the co-developers of clozapine, considered to be the major advance in the treatment of schizophrenia in the past 40 years. He postulated that one of its major sites of action is the serotonin system. All previous anti-psychotic drugs primarily blocked the dopamine system. It has also proved useful in addressing treatment-resistant mania and depression.

"We're now heavily involved in studying a new generation of anti-psychotic drugs which may or may not share in common some of the advantages of clozapine without some of its side effects," he said.

Meltzer said he is also "keenly interested" in the underlying etiology of schizophrenia, mania and depression.

"We will integrate studies on how various drug treatments work with trying to understand the basis for the diseases," he said.

"We're particularly interested in studying the cause of and pattern of development pattern of treatment resistance. We are eager to treat people with schizophrenia for long periods of time, beginning with their first episode, and their long-term responses to treatment, both conventional and newer agents."

In addition to his faculty appointment at Vanderbilt, and his duties at the Psychiatric Hospital at Vanderbilt, Meltzer also plans to conduct research at the Mental Health Cooperative, Village Mental Health Center, Parthenon Pavilion and the Nashville Veteran's Administration Hospital. In these endeavors, he joins other professionals in the community who work with patients diagnosed with schizophrenia, mania and depression.

Meltzer said that although his primary interest is in psychopharmacology, he is also strongly interested in the effect of psychosocial treatments on schizophrenia.

"We'll be setting up various kinds of group therapy programs to work with patients and their families. We're also particularly interested in using partial hospitalization to decrease the length of and avoid inpatient hospital stays for these patients."

Sarah Burnett, a nurse clinician who has worked with Meltzer for the past 28 years, has also come to VUMC. The two are working on incorporating new psychosocial group therapy programs into the existing psychiatric program.

Schizophrenia is a severe mental disorder, or group of disorders, characterized by a disintegration of the thinking process, of contact with reality and of emotional responsiveness. It affects about one percent of the adult population, both males and females between the ages of 16 and 30.

Depression is the more common, with about one in four people having a significant major depressive episode at some time in their life. Mania is less common than depression, but more common than schizophrenia. It affects about 2-3 percent of the population.

Meltzer estimates that within the Nashville area, there are probably 8,000 to 10,000 people who suffer from schizophrenia.

Schizophrenia is a lifelong problem characterized by "positive symptoms" such as delusions and hallucinations, and "negative symptoms" such as withdrawal, lack of pleasure, lack of motivation and energy and flat affect.

It is also characterized by a third group of symptoms called "disorganization," which includes incoherently loose associations, poverty of thought content and inappropriate affect.

A fourth area of schizophrenia is "cognitive dysfunction" and is one of the main areas of Meltzer's interest.

"People with schizophrenia have significant abnormalities in memory, attention and executive function or judgment," he said.

"We have found that clozapine will partially improve this cognitive dysfunction and we are trying to understand why it does that. Cognitive dysfunction leads to much of the social disability of this illness. Our goal is to achieve much more than just the remission of positive and negative symptoms and disorganization. We carefully monitor quality of life, and hope to improve that dramatically for patients with schizophrenia or treatment-resistant forms of mania and depression."

About 30 percent of patients with schizophrenia are treatment-resistant, Meltzer said. But if quality of life issues are considered – such as being able to take part in work and social function – about 70 percent of schizophrenics are considered to be treatment-resistant.

In comparison, about 10 percent of patients with depression, and 20 – 25 percent of patients with mania, are resistant to treatment, Meltzer said.