Statistics Canada figures show more than a quarter of a million violent crimes in Canada reported in 2003, with many more violent crimes unreported. Each violent crime leaves a victim potentially traumatized and physically injured, with resulting high costs to the health system. One target group for whom violence often is studied is people with psychiatric illnesses. Study results have shown an overrepresentation of violence among certain groups of people with psychiatric illnesses, and Canadian law requires that violence risk is assessed among people considered for release from psychiatric, forensic, and correctional agencies. Most of the resulting research, however, has focused on predicting violence among persons with mental illness, rather than on ways to reduce or prevent violent behavior. Dr. Kevin Douglas’ research focuses on treatment-relevant violence risk factors. His research objective is to identify those risk factors most likely to be responsive to treatment, with the goal of informing violence-reduction efforts. Dr. Douglas is following a group of people with mental illnesses released from forensic psychiatric and correctional facilities in British Columbia. They will be administered measures of promising treatment-relevant risk factors (such as poor social support, substance use, and anger) on multiple occasions in the community. From the results of this work, Dr. Douglas will discern which risk factors are most likely both to change and to predict violence. Results from his research may reveal promising treatment targets to reduce violence among this group of people.
Research Pillar: Clinical
The identification of susceptibility genes and phenotypic subgroups for autism spectrum disorders
Autism Spectrum Disorders (ASDs) are characterized by impairments in social interaction and communication, as well as restrictive behaviours and interests. These life-long disabilities affect more than 1 in 250 individuals. It has been shown that early diagnosis is essential for children with ASD: the earlier intervention is initiated, the better the outcome. However, affected children are commonly not definitively diagnosed until they are three years of age or older. Sibling, twin and family studies have shown that ASDs are largely genetic in origin and certain chromosomal regions harbouring possible ASD susceptibility genes have been identified. Recent studies suggest that between 5 and 48% of individuals with autism exhibit chromosomal anomalies. This suggests that small chromosomal anomalies, such as microdeletions and microduplications, may be relatively common and clinically important markers for identifying underlying causes of, and susceptible gene regions for, ASDs. Dr. Suzanne Lewis is researching the genetic susceptibilities of ASD, using a novel method for the analysis of regional changes in DNA called microarray-based comparative genomic hybridization (array-CGH). Using this method she is identifying and characterizing chromosomal abnormalities in 100 subjects with ASD. In parallel, Dr. Lewis is also researching ASD phenotypes – genetic influences in combination with respective behavioural, physical, medical, environmental and family findings. Dr. Lewis aims to build a research pathway that identifies genetically distinct subgroups of ASD that also share unique clinical phenotypes. Through researching this genotype/phenotype correlation Dr. Lewis ultimately hopes her research will contribute to a better understanding of the genetic causes and consequences of autism and help in developing methods for the very early identification of infants and families at risk for autism.
Improving the treatment of posttraumatic stress disorder: A controlled evaluation of a new behavioural treatment
Posttraumatic stress disorder (PTSD) is a common consequence of life-threatening traumatic events (e.g., road traffic collisions, military combat, criminal victimization). PTSD is a severe anxiety disorder that often follows a chronic course and is associated with significant disablement. Existing PTSD treatments are only moderately effective and research is needed to find interventions that can improve treatment outcome. One potential method of improving treatment outcome for PTSD is by reducing anxiety sensitivity, which is described as a person’s fear of experiencing the physical sensations that result from anxiety (e.g. heart palpitations, dizziness) and their belief that these sensations will have harmful consequences. Anxiety sensitivity is elevated in PTSD and is associated with PTSD symptom severity. Interventions that directly target anxiety sensitivity have the potential to enhance PTSD treatment outcome. Dr. Jaye Wald is conducting the first controlled study to examine the effectiveness of interoceptive exposure therapy (IE) on PTSD. While this behavioural intervention has been shown to be effective in treating anxiety disorders, its ability to improve the outcome of existing PTSD treatments has not yet been investigated. Dr. Wald will use IE to repeatedly expose individuals to feared bodily sensations, with the goal of eventually reducing their anxiety sensitivity. Results of this research will have important practical implications for the mental health care field and for individuals with PTSD by enhancing understanding of this disorder and ultimately improving its treatment.
Tissue microarray analysis of Type 1 growth factor receptor family expression by human breast and colorectal Cancer: prognostic significance and treatment implications
Breast cancer and colorectal cancer are leading causes of cancer-related deaths worldwide. The identification of specific tumor characteristics that would allow for an accurate prediction (prognosticators) of disease course and response to treatment would represent an important advancement in the management of these common malignancies. Unfortunately, no currently known disease prognosticators are reliable in predicting clinical course, or identifying the treatment that would be of greatest benefit to an affected individual. Recently the detection in some tumours of HER1 and HER2 proteins – members of the type 1 growth receptor family (T1GFR) – have shown promise for helping predict patient outcomes and in determining which tumors respond best to specific therapies. These proteins have also recently been used as targets for newly developed drugs to treat these cancers. The expression of the entire T1GFR family (HER1, HER2, HER3, and HER4) by breast and colorectal tumors, and their potential usefulness in predicting disease outcome and patient response to specific treatment(s) has not been explored. Dr. Sam Wiseman is evaluating the expression of the entire T1GFR family in a group of 4500 breast cancer and 500 colorectal cancer samples to determine its relationship to patient treatment and outcomes. His study will be carried out utilizing tissue microarrays, a methodology that allows for the rapid evaluation of large numbers of tumors for molecular markers. The results of this study may lead to improved disease prognostication, outcome prediction, and therapy selection for people diagnosed with breast or colorectal cancer.
The effects of proportional assist ventilation on ventricular interaction in patients with heart failure, endurance athletes, and healthy individuals during exercise
About 350,000 Canadians suffer from chronic heart failure (CHF), which can cause premature death. The condition usually progresses slowly as the heart gradually weakens and loses its ability to efficiently pump blood through the body. Patients with CHF develop an enlarged heart and experience “pericardial constraint”: inadequate performance in the ventricles, the heart’s two pumping chambers. The pericardium is a tough, fibrous sac surrounding the heart. Endurance athletes may have an enlarged, more compliant pericardium that allows them to achieve superior levels of cardiac performance during exercise. But with chronic heart failure, the pericardium becomes taut and restricts the heart from fully filling with blood and delivering oxygen to the body. Ben Esch is investigating whether providing oxygen through a mechanical respirator to increase pressure in the chest will decrease pericardial constraint and improve cardiac function in people with CHF. The results could lead to new rehabilitation techniques for patients with chronic heart failure.
Facial processing within the temporal lobes following cerebrovascular infarct: a neuropsychological, anatomical, and functional study
Vision encompasses a very complex sensory system which requires the involvement of multiple brain areas to function properly. Damage to any one of these areas can affect vision in very specific ways. For example damage to a very small and precise region in the brain, found within the posterior temporal lobe, results in a specific perceptual deficit, manifest by an inability to recognize faces. It is common for patients who have suffered from a stroke to experience this or other visuo-perceptual impairments. Based at UBC’s Eye Care Centre, Christopher Fox is examining stroke patients who have temporal lobe damage. Using a variety of tests he is determining visual processing deficits in these patients, then using MRI (Magnetic Resonance Imaging) to examine their brains to see which regions are responsible for these deficits. Christopher’s research will contribute to a greater understanding of the role of the temporal lobes in vision, and of the complex process of visual perception.
Falls risk assessment in elderly, community-dwelling women with age-related macular degeneration
About 30 percent of elderly people fall once or more a year, resulting in injury, disability, loss of independence and enormous cost to the health care system. Age-related macular degeneration (AMD), a degenerative disease of the retina, is the leading cause of legal blindness in Canada and the developed world. The most severe form of AMD affects one in 20 elderly people and is associated with a complete loss of central vision. However, data on fall risk among elderly people with AMD is extremely limited. Shelagh Szabo is conducting the first study to assess whether people with AMD are at higher risk of falling than other elderly individuals because of visual impairment. As people with AMD score poorly on visual measures that predict falls in other individuals, it seems likely that those with AMD may have a higher incidence of falls than those with normal vision. Conversely, as most AMD patients have reduced levels of physical activity due to their poor vision, they may actually fall less than healthy people. If the research confirms that people with AMD are frequent fallers, prevention programs could be targeted for the visually impaired to reduce falls and injury, as well as fall-related costs to the health system.
Mechanisms of attention: implications for brain and behavior
Our attention can be shifted automatically in response to sudden events, such as a hand being raised in a classroom, or can be allocated voluntarily in response to our internal goals and expectations, such as looking left or right before crossing a street. Dysfunction of either type of attentional process may be expressed in a variety of disorders, such as schizophrenia, Parkinson’s disease, autism, and attention deficit disorder. Currently, diagnosis and rehabilitation of attention in patients relies on behavioral procedures that were established more than 20 years ago. Jelena Ristic’s recent research, conducted with both children and adults, suggests that these traditional procedures are based on flawed theoretical assumptions and as such, they do not reflect the main properties of human attention. She is currently working towards developing novel behavioral, as well as imaging, methodologies that will capture accurately the key properties of human attention. Results from her basic research will be used to develop more effective diagnostic techniques and rehabilitation programs for patients with attention dysfunctions.
Competition for control of behavior
Behavioural responses are influenced by information from a person’s immediate environment and an individual’s goals and intentions. Conflict between these sources occurs regularly, and is particularly evident in eye movements, in which split-second decisions about where to look next are made more than 100 times a minute. Many neurological and psychiatric disorders such as schizophrenia, Parkinson’s disease, Alzheimer’s, depression and anxiety are characterized by inefficient or inappropriate eye movements and other behaviours. Amelia Hunt is studying the physiology of eye movements to assess how conflicts between intentions and sensory responses are resolved. She is also investigating whether models of eye movement control can apply to other complex behaviours and disorders. The research could inform and guide intervention strategies to be used when behavioural controls begin to break down from illness or trauma.
Computer-assisted femoral head resurfacing
Every year more than 20,000 Canadians with advanced osteoarthritis receive hip replacements. A new surgical technique resurfaces the head of the femur (the long thigh bone between the hip and knee) with a metal cap, removing far less bone than the traditional method, which involves removing a large portion of the upper femur. Hip replacements for active patients under the age of 55 have significantly increased and many of these patients will likely outlive their first hip implants. This new technique will help ensure they have enough bone to support a second surgery. Surgeons use a cumbersome alignment guide to insert a wire in the top of the femur and position the implant, which leads to variations in alignment that can loosen the implant or cause the femur to fracture. Jill Brimacombe is designing a computer-assisted surgical technique to help surgeons position the implants more accurately. The computer-assisted tool could reduce surgery time, be easier for surgeons to use, and improve accuracy, which would lengthen the life span of patients’ implants.