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In FY 1990, the NIMH Intramural Program (IRP) used PET techniques to show that: (1) Patients with panic disorder have increased activity in the right hippocampus. (2) Hyperactive adults with childhood onset of the disorder have reduced activity in the parts of the brain related to motor function. (3) Treatment of obsessivecompulsive patients with clomipramine seems to reduce the higher than normal brain activity observed. (4) Adults with severe developmental dyslexia appear to have lower blood flow in the perisylvian portions of the brain.

SPECT--Single Photon Emission Computed Tomography--is a method for reconstructing cross-sectional images of radiotracer distributions. It is less expensive than PET and provides functional information useful for the diagnosis and management of dementias and organic brain disorders. SPECT can be an accurate diagnostic tool for patients with suspected Alzheimer's disease.

MRI--magnetic resonance imaging--is a new tool in which a computer creates images of body structures from magnetic frequencies. MRI images from autistic children have shown that one small region of the cerebellum, a part of the brain near the base of the skull, is usually smaller than in normal children. The abnormality seems to result from abnormal brain development. The region affected is known to control many of the behaviors affected by autism. These findings suggest further studies that may define the critical point in brain maturation when some agent, such as a toxin, virus, or injury, could disturb growth of the affected region.

In FY 1990, the IRP used MRI to continue examination of identical twins where one twin was diagnosed with schizophrenia. The latest results found measurable differences in the size of the twins' hippocampuses. This size difference discriminated the affected from the unaffected twin in 14 out of 15 pairs.

BEAM--or brain electrical activity mapping--provides an advanced form of the familiar EEG brain wave measurements. Recently, BEAM provided convincing evidence that dyslexia is associated with consistently aberrant electrical activity in two well-defined regions of the cerebral cortex. This finding firmly establishes dyslexia as a physical and not a psychological disorder. In addition, the consistent nature of the electrical abnormality may soon provide a means of identifying dyslexic children at a young age and providing them with programs designed to prevent later school failure.

During the next decade, researchers will use these technologies to find structural and biochemical defects associated with mental illnesses. These efforts are designed to lead to routine diagnostic tests that will aid physicians in treating behavioral disorders in the same way that an orthopaedist uses an x-ray to diagnose and treat fractures. Knowing the biochemical abnormality associated with a disease will point researchers towards the aberrant genes involved and help others design better drug therapies.

NIMH is mounting a major initiative to stimulate the use of advanced brain imaging techniques in the study of mental disorders. The centerpiece of this effort will be the establishment of a series of national brain imaging centers dedicated to the study of mental illness. A program announcement has been released requesting applications for Centers for Functional Brain Imaging in Mental

Disorders with the purpose of establishing core resource centers dedicated to multidisciplinary research using PET in the study of the etiology, assessment, pathophysiology, and/or treatment outcome of mental disorders. To manage these and other activities, the Institute has recently created a Neuroimaging and Applied Neuroscience Research Branch.

DECADE OF THE BRAIN

Question. Dr. Leshner, would you please give us an update on the most recent developments in the implementation of the Decade of the Brain?

Answer. NIMH is continuing to implement the Decade of the Brain strategic plan, Approaching the 21st Century: Opportunities for NIMH Neuroscience Research. Advances in brain science have provided new insights in understanding and treatment of mental disorders. NIMH's expanded research and leadership efforts are encouraging scientists and informing the public of the opportunities for progress.

The

Neuroscience Research Initiatives, Mechanisms, and Programs. National Program in Molecular Genetics of Mental Disorders has several goals. The first is to find the genes responsible for producing vulnerability to major mental disorders such as schizophrenia, manic-depressive disorder, and Alzheimer's disease. Diagnostic Centers for Psychiatric Linkage are gathering clinical and pedigree information and blood samples from families with severe mental disorders. This initiative also includes a National Pedigree Research Service to provide technical assistance and financial support to scientists for the study of large families with many ill members. Coordination of the diagnosis of patients and their family members will allow creation of a National Cell Repository/Gene Bank providing a research resource of cell lines and genetic material.

NIMH has mounted a major initiative, the Brain Imaging Center Program, to expand the use of advanced physical brain imaging techniques in the study of mental disorders. The centerpiece of this effort will be the establishment of a series of national functional brain imaging centers dedicated to the study of mental illness.

A new program of research in cognitive and behavioral neurosciences will be significantly expanded in 1991. The systematic study of normal cognitive processes and disturbances are vital for understanding mental disorders characterized by hallucinations, delusion, misperceptions, thought disorders, obsessions and compulsions. Information processing studies, neuropsychology, and brain imaging also contribute to this research. Based upon a favorable report from the NAS/IOM, NIMH is prepared to initiate activities in 1991 to begin establishment of The Human Brain Project, a centrally located computerized set of databases of all knowledge of the brain in an interactive textual and graphic format.

Development of new therapeutic medications has become a realistic goal with the discovery of specific chemical receptors in the brain, and this holds unprecedented promise for relieving misery and disability. NIMH is playing a major role in ADAMHA-wide medication development initiative. Contracts have been initiated to screen the impact of natural and synthetic chemicals. A chemical synthesis

program will provide commercially unavailable compounds to researchers while investigators will also study known products for their efficacy in unusual applications.

The Centers for Basic Neuroscience Research program promotes the integration of basic and clinical neuroscience strategies for studying schizophrenia and other severe mental disorders. This program was announced to the field in 1990. NIMH received a strong response and currently has 10 applications under review.

Renowned

National Leadership and Information Dissemination. NIMH and the NAS/IOM held a 2-day International Neuroscience Symposium to highlight 1990 as the beginning of the Decade of the Brain. brain scientists, other prominent scientists, members of the Administration and Congress, and the public were invited to this commemorative symposium. The presentations will be published as the Decade of the Brain commemorative monograph.

NIMH will co-sponsor with the Fidia Research Foundation a second symposium, "The Centennial of the Neuron," to be held at the National Academy of Sciences Great Hall in Washington, D.C. on June 23-25, 1991. This meeting will feature presentations by an outstanding international roster of neuroscientists who have made seminal contributions to our understanding of the neuron and its functions. Major topical areas include advances in developmental neurobiology; signaling in neuronal function; neurotransmitter biosynthesis and function; and regulation and pharmacology of transmitter receptors.

In collaboration with with the Library of Congress, NIMH is sponsoring the Decade of the Brain Lecture Series for the general public and the Congress on scientific, philosophical, ethical, and policy issues related to brain research. The first of these meetings, to be held on July 24, 1991, will include three presentations that focus, respectively, on brain imaging, on how the brain generates mind, and on current cutting-edge concepts in neurobiology, computer science, and human cognition. The first public lecture in this series is scheduled to be held in the Fall, and in March 1992 a major symposium is planned on ethical implications of neuroscience research.

QUESTIONS SUBMITTTED BY SENATOR WARREN RUDMAN

ADMS BLOCK GRANT APPLICATION

Question. I was recently visited by representatives of New Hampshire's Alcohol and Drug Abuse Prevention program who raised concerns over the amount of time necessary to gather information and prepare a block grant application. The "Notification to Respondent of Estimated Burden" provided by ADAMHA as part of the Block Grant guidelines (copy attached) estimates the information collection requirement to average 400 hours per application. This is a tremendous burden, both in terms of manpower and cost for a small State like New Hampshire; 400 hours means that it will take one individual ten 40-hour weeks to simply apply for federal block grant funding.

What is ADAMHA doing to reduce this paperwork burden and minimize the amount of time necessary to complete a grant application?

Answer. The 400 hour estimate represents an average of all reporting units consisting of awards from $59 thousand to $151 million. Because the reporting requirements are intended to establish how the State spent their award and what their treatment needs are, the actual report preparation time will vary in direct proportion to the size of each State's award. New Hampshire, receiving a smaller award, should expect to spend considerably less time on the report. Costs associated with this paperwork burden are supported by the administrative cost allowance in the ADMS block grant.

We are sensitive to reducing the reporting requirements and have taken or shall be taking the following steps: setting page limits on all narratives and rearranging the voluntary State Plan to offset major requirements of the annual report.

Question. Can information collection requirements imposed by ADAMHA on the States be reduced administratively or are they the result of legislative mandate?

Answer. The information collection requirements could be administratively reduced by ADAMHA; however, prudent Federal management of the ADMS Block Grant dictates that a minimal data set on State's activities and plans be compiled. The voluntary combined State Application and Plan, in the main, focuses on the compliance issues of Section 1916 of the Public Health Service Act, and the responsibilities of the Secretary in Sections 1917 and 1918. In addition, the data are necessary for the DHHS to be in compliance with the Federal Financial Manager Integrity Act.

The data being collected from the States describe how the money was spent and how many people are in need of services supported by the Block Grant. Our failure to have had this most basic information the past has led to wide criticism from Congress, GAO, and the DHHS Inspector General.

Question. Last year, New Hampshire Alcohol and Drug Abuse completed nine different needs assessment surveys on training which were generated by the Office of Substance Abuse and Prevention. Many of these surveys requested the same basic information but they were prepared by the different contractors and used somewhat different formats.

States are being urged to collaborate and cooperate; yet it appears this message is not being followed at the federal level. What can ADAMHA do to reduce overlap and the collection of duplicative information being requested of our State programs?

Because

Answer. In developing and implementing a fully comprehensive training program, OSAP has undertaken a large, global needs assessment survey intended to assess the training needs for a variety of interrelated though diverse populations such as health professionals, allied health professionals, preventionists, social workers, community coalition members, parents, and others. of the distinctness of each of these populations, it has been necessary for OSAP contractors to query States for information specific to the populations each OSAP initiative is intended to address. While this may appear as multiple requests to the States, all inquiries are, in fact, part of a larger needs assessment survey. Effort is made within OSAP to share information among the program initiatives in order to limit the burden placed on the States for information.

NIMH NATIONAL PLANS

Question. The National Advisory Mental Health Council will shortly release a report on a National Plan of Research to Improve Care for Severe Mental Disorders. Can you provide a preview of the recommendations contained in this plan?

Answer. We are very excited about the promise of the new research field developed in this plan. With the help of three panels of experts, and many consultants throughout the Nation, this Council Report has formulated recommendations that lay the basis for a new effort to bring the full power of scientific research to the quest for improved services for the millions of people with severe, persistent, disabling mental disorders. Specific focuses of the plan

are:

Improving quality of care. Research is needed on methods to: (a) improve diagnosis and assessment of rehabilitation potential for mentally ill individuals; (b) apply treatment and rehabilitation in the most effective ways in daily clinical settings; and (c) assure that state-of-the-art diagnosis and treatment is available to everyone who needs mental health services. Special emphasis is placed on how best to combine medication, psychosocial treatments, and rehabilitation methods into effective treatment plans for each individual, that are consistent with consumer and family goals while accounting for variations in culture and personal characteristics. Investigators must develop measures of outcome that do justice to the full range of desired effects, from clinical and rehabilitation goals to the fundamental question of improving the quality of life for people with these disorders.

Improving organization and financing of services. Public mental health and other necessary services may be delivered through a confusing maze of bureaucracies. Finding ways to deliver comprehensive, community-based services in an efficient, equitable way, to guarantee access to all who need them with proper concern for dignity and personal needs and desires, is a challenge. Finding ways to provide the needed services economically, assuring that money invested is well spent, and providing adequate financing, is another. The proper role of the judicial and correctional system in providing care to mentally ill offenders and the best uses of coercive treatments, such as outpatient services, are specific areas of interest in the law and mental health. Strategies for overcoming the terrible stigma accompanying these disorders also need to be tested and applied.

Identifying research strategies and issues. The Report has identified a number of ways that research capacity can be developed, including efforts to increase research training. One important need is to enhance the use of research demonstrations, especially controlled, multi-site demonstration projects such as are used in other fields of health care. Another area of the highest priority is to find better ways to apply the results of research, and we are establishing a Task Force on Knowledge Exchange to conduct this effort.

Question. Please provide an update on your implementation of the National Plan for Research on Child and Adolescent Mental Disorders.

Answer. Specific action steps are being taken for the implementation of the National Plan. In order to more accurately determine the incidence, prevalence, and range of child and adolescent mental disorders, a multisite methodologic study is in progress that is providing information on how best to implement a nation-wide epidemiologic survey. Information from this current study will form the basis of a much larger, developmental epidemiologic survey of child and adolescent mental disorders, envisioned to begin in 1994. NIMH has also begun steps to initiate a multicenter collaborative treatment study of disruptive behavior disorders and attention deficit hyperactivity disorder, one of the most common and disabling childhood mental disorders. The determination of effective treatments and service systems for these children and adolescents will have important longer-term effects for a substantial portion of children who are under-, ineffectively, or untreated and who may go on to develop significant problems with substance abuse, delinquency, or adult vocational disability.

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