Behavior and mental health issues are an important part of Prader-Willi syndrome (PWS). In particular, one of the most challenging aspects for families to face is the onset of psychosis (i.e., mental illness characterized by symptoms, such as delusions or hallucinations, that indicate an impaired contact with reality). Recognizing the early — or “prodromal” — signs of psychosis can be a very effective path to intervention and treatment.
While relatively new to the PWS community, Dr. Carrie Bearden has extensive experience studying the causes of psychosis in neurodevelopmental disorders, and has recently been funded by FPWR to identify these early signs of mental illness in PWS. I recently talked with her about her background, research, and perspective on PWS.
Early Studies in Conflict, Communication, Psychiatric Disorders
Though beginning her college career as an English major and feeling torn between the studies of science and literature, Dr. Bearden was drawn to the field of psychology after taking an introductory psychology class. A class on developmental psychopathology — i.e., the study of brain development and psychological disorders — convinced Dr. Bearden that she wanted to go to graduate school in psychology. As an undergraduate, she conducted research in a few different labs, most notably one in which she studied the emotional and physiological reactions of couple during conflict (one of her responsibilities was to talk to the couples in such a way as to provoke conflict).
After college graduation, Dr. Bearden received a Mellon Fellowship to study at the Western Psychiatric Institute and Clinic in Pittsburgh, and did an internship studying dolphin communication at the Kewalo Basin Marine Mammal Laboratory at the University of Hawaii. She then started graduate school at the University of Pennsylvania, studying the biological basis of schizophrenia, building on her interest in using psychiatric disorders to understand the brain, and the biological basis of behavior.
Dr. Bearden's Lab at UCLA
Following graduate school, Dr. Bearden did a clinical internship at the San Diego VA Medical Center and Child Psychiatry Inpatient Unit, and postdoctoral fellowships at both the University of Pennsylvania and UCLA before joining the faculty of the Departments of Psychiatry and Biobehavioral Sciences in the Semel Institute for Neuroscience and Human Behavior, and the Department of Psychology at UCLA. At UCLA, she also directs the Center for the Assessment and Prevention of Prodromal States (CAPPS) program and the Adolescent Brain-Behavior Research Clinic.
Dr. Bearden’s lab studies the causes and underlying physiological mechanisms of psychosis, using a variety of approaches. These include neurobiological techniques such as brain imaging and the measurement of hormone levels, molecular biological methods such as finding the links between specific genes and their expression in mental illness, and clinical approaches based on the analysis of responses to surveys that identify risk factors for mental illness. Genetic disorders with an increased instance of psychosis provide great test cases for understanding the factors leading to mental illness.
Focus on Psychosis Related to Genetic Disorders
While still in graduate school, Dr. Bearden was first introduced to 22q11.2-deletion syndrome, a genetic disorder that results in some common behavioral problems, and an increased risk of psychosis. She performed psychological assessments of children with 22q-deletion syndrome as part of a large project on the syndrome being performed at Childrens Hospital of Philadelphia. Studying the onset of psychosis in 22q-deletion syndrome remains a focus in Dr. Bearden’s lab today. Another genetic disorder that the Bearden lab investigates is Neurofibromatosis I, which is commonly associated with cognitive problems and learning disability.
Dr. Bearden was invited to attend the FPWR Mental Health Research Strategy workshop in March, 2015, as an expert on psychosis related to genetic disorders. At this meeting, Dr. Bearden participated in many stimulating discussions about how to develop the optimal tools for characterizing psychosis in PWS in a systematic fashion, and fully utilize the information collected in the Global PWS Registry. For example, anecdotally, psychosis in PWS often seems to manifest in brief intense episodes, and be associated with extreme mood swings; but how can we predict the onset of such episodes?
Current Study on Predictors of Psychosis in PWS
Following the FPWR workshop, Dr. Bearden identified the need to conduct a systematic survey project to characterize the early (or “prodromal”) signs of psychosis in individuals with PWS. In this pilot project, recently funded by FPWR, Dr. Bearden and her group will study 50 individuals with PWS over an age range of 12 to 50.
The project is titled Predictors of Psychosis in PWS. These individuals (or their caretakers) will complete carefully designed surveys geared to find the early signs of psychosis (example survey items to agree/disagree with include, “I see things other people don’t see”, and “I see visions”), and those that probe memory, verbal and non-verbal reasoning, emotion recognition, and processing speed. Participants will also provide saliva samples that will be used to measure the levels of hormones such as cortisol, for which an elevated baseline level appears to be associated with a higher instance of psychosis. DNA will also be extracted from saliva samples, for future analysis and association with signs of mental illness. The data collected for this project will be used to understand the multi-dimensional factors leading to psychosis in PWS, and to provide a baseline cognitive description of individuals with PWS who have not yet experienced psychosis.
Identifying the prodromal signs of psychosis in PWS will enable early intervention and treatment, which has been shown to result in better mental health outcomes. In addition to anti-psychotic medication, Dr. Bearden has hope for multiple forms of non-pharmacologic treatment, which include family therapy focused on stress reduction, vagus nerve stimulation, and cognitive behavioral therapy. The results from Dr. Bearden’s pilot study will pave the way for a larger prospective study, and transform our understanding of mental illness in PWS.
Outside the lab, Dr. Bearden loves spending time with her family, including her husband, who is also a psychologist, and her son (13) and daughter (10). Dr. Bearden’s family loves to travel together, and to sample the wide variety of cuisines that can be found in Los Angeles.