Kaiser Permanente clinicians and investigators collaborate on solutions
Mental Illness Awareness Week is October 6 to 12
By Jan Greene
People with serious mental illness are already dealing with distressing and life-altering symptoms, so it’s a real problem when their psychiatric medications cause them to gain weight. That’s counterproductive for psychiatrists hoping to ease their patients’ conditions, not throw new obstacles in their paths.
When Kaiser Permanente psychiatrists in Oakland heard there might be a supplemental medication that could counter weight gain in these patients, they were eager to give it a try, and reached out to their colleagues in the Kaiser Permanente Division of Research (DOR) for answers.
Esti Iturralde, PhD, a new mental health research scientist at DOR, took on the request to explore the use of metformin, a diabetes drug, to reduce the metabolic havoc caused by psychiatric drugs such as quetiapine and risperidone. This use of metformin has appeared in the scientific literature for several years but is not yet common practice. “There is strong evidence psychiatrists should try it, as the risks appear low and the potential benefits significant,” Iturralde said.
Iturralde and colleagues pursued research questions that could lay the groundwork for a potential change in practice. They documented whether metformin was being used for psychiatric patients at risk of metabolic disease and interviewed Kaiser Permanente psychiatrists about their familiarity with combining metformin with antipsychotic medications.
Behavioral health researcher Stacy Sterling, DrPH, MSW, MPH, said the division’s investigators welcome the chance to address problems their clinical colleagues wrestle with. “We have a great working relationship that benefits both clinicians and researchers, as well as Kaiser Permanente members, and we are expanding our portfolio of mental health-focused research significantly,” Sterling said.
DOR’s behavioral health section, led by Constance Weisner, DrPH, MSW, includes 10 investigators and recently expanded with the addition of Iturralde and new adjunct investigator Matt Hirschtritt, MD, and Kathryn Ridout, MD, a new member of The Permanente Medical Group’s Physician Researcher Program.
The DOR investigators provided key support when Kaiser Permanente Northern California (KPNC) established a new psychiatric residency program in Oakland, assisting with accreditation and offering training to residents. This includes teaching skills in evaluating scientific literature, obtaining small grants, and developing community benefit grant work to answer questions important to the residents.
Elsewhere in KPNC, DOR’s researchers work closely with primary care clinicians to support the integration of behavioral health practitioners into primary care settings throughout the region. Behavioral health teams are also embedded in emergency care.
Kaiser Permanente’s commitment to embedding behavioral health care in medical settings in turn gives researchers fodder for investigation of this new direction in health care delivery. “You want to look at the whole person,” notes Sterling. “How to do that brings up a lot of good research questions.”
Some of the other behavioral health research being undertaken at DOR, much of it focused on vulnerable populations:
—Adjunct investigator Derek Satre, PhD, and Michael Silverberg, PhD, completed a large clinical trial of motivational interviewing to help people with HIV reduce problematic alcohol use.
—Sterling is studying the use of screening and brief interventions to reach adolescents at risk of depression, anxiety and substance use.
—Hirschtritt published a study in the Journal of the American Board of Family Medicine highlighting the importance of depression screening for vulnerable people, such as those with alcohol use problems.
—Several section investigators collaborated on a paper in AIDS Care that showed how adverse childhood experiences are common among people with HIV and are associated with increased depression and anxiety.
—Cynthia Campbell, PhD, examined how a patient activation intervention in primary care for patients using prescription opioids long term could support their overall health and pain management.
—The research division has also recently completed new alcohol and opioid registries of de-identified patient information.
The section also manages long-term research projects, often collaborating with other Kaiser Permanente regions and other health systems:
—Weisner and Campbell are leaders, along with Kaiser Permanente Washington Health Research Institute, of a $21 million, 5-year NIH grant for the Addiction Research Network to integrate substance use disorder treatment in health systems.
—Sterling is KPNC’s principal investigator for the Mental Health Research Network, a collaboration of several different health systems.
—Kelly Young-Wolff, PhD, MPH, and Lyndsay Avalos, PhD, MPH recently received a large NIH grant to explore cannabis use by pregnant women, with plans to delve into what types of cannabis products they use and how that affects neonatal and maternal outcomes.
“Our section continues to grow with the addition of talented new researchers who extend our reach into important areas of behavioral health investigation,” said Weisner, who is a professor emeritus in the Department of Psychiatry at the University of California, San Francisco. UCSF and the Kaiser Permanente Division of Research share investigators who have trained and practiced at both institutions. “And with essential contributions from clinicians in the field, we’ll continue to tackle questions important to people’s lives.”