While Dr. Diego Coira’s approach to psychiatry may not be typical, he says that it’s “not that complicated.”
As chairman of Hackensack University Medical Center’s psychiatry and behavioral medicine department, Coira is helping lead an effort to broaden the hospital’s approach to behavioral health.
Instead of focusing primarily on medications, Coira and his colleagues use prescriptions as just one potential treatment among many. These include helping patients improve their diet and increase their physical activity.
“Simple things, if you really understand the brain -- like exercise, nutrition, music, art -- can revolutionize the way we practice medicine,” said Coira, who works at the Debra Simon Center for Integrative Medicine, where Hackensack’s outpatient services are located.
The center, which opened last year, builds on research about integrating traditional medicine with alternative approaches. The research is at the center of a Hackensack UMC-hosted conference this week focused on epigenetics -- the study of how genes are expressed -- and neuroplasticity, which is a term describing how the brain reorganizes itself throughout life. Conference organizers, including Coira, see the latest research confirming the need to seek connections among widely disparate symptoms and treat them holistically.
Research in epigenetics has shown that many factors that are under a patient’s control can influence how their genetic code affects their health.
“Epigenetics gives the individual the power to control their own life,” Coira said. “Their lifestyle changes can change the expression of their genes. Even if you’re born with bad genes to develop diabetes and heart disease and alcoholism, you can control that by changing your lifestyle.”
Coira pushes back against any suggestion that this approach to psychiatry is abstract. In fact, he says: “It will actually change the brain … The changes of epigenetics happen in the DNA.”
The Debra Simon Center for Integrative Medicine, located with the HackensackUMC Fitness & Wellness Center in Maywood, reflects this approach. The center’s goal is to reduce the unnecessary use of psychiatric medications and strengthen psychotherapy to better serve patients’ needs.
Dr. Scott Shannon, a Colorado-based psychiatrist, predicted that the use of psychiatric medications has passed its “high water mark.” It was built on measuring whether drugs could correct for chemical imbalances in neurotransmitters -- the chemicals that transmit signals in the brain. But some drugs can cause epigenetic changes that reduce their long-term effectiveness, he said.
“We need an ecological -- that is, broad, system-based -- understanding of health, not one that’s narrow,” Shannon said.
Dan Handley, who studies epigenetics at the Florida-based Clinical & Translational Genome Research Institute, noted that epigenetics research began with a study of babies born to women who were pregnant during a famine in the Netherlands during World War II. Not only were these children much more likely to have heart disease, but their own children’s health appeared to be affected as well.
Not only is childhood trauma “likely to affect the child throughout adult life,” but it could also affect their children and grandchildren, Handley said. He added that this increases the importance of preventing traumatic experiences such as abuse from affecting children. Handley joined the voices at the conference who expressed concern about medications, saying that pharmaceutical companies are unlikely to conduct the decades-long studies that would be required to understand the epigenetic effects of drugs.
Along with discussion of healthy diet and exercise, conference participants suggested that more patients would benefit from the use of neuro-feedback -- a process in which the brain is stimulated with electrodes. They also called for more research into the relationship between infections, the inflammation that they cause, and mental illnesses.
Coira recalled the case of a 14-year-old girl who came to the hospital with paranoid and antisocial behavior. After the girl had a seizure, another doctor told Coira that the girl was experiencing two separate illnesses -- one that caused the seizure and another that caused the mental illness.
“I said, ‘No, it doesn’t work like that,’” Coira said of his response, reflecting his belief that the two symptoms were connected. It later turned out that the child had encephalitis, a brain infection that caused both problems. Coira said this diagnosis led to a change in the attitude of the emergency department nurses and doctors.
“Everything changed, because there was no more stigma,” involved with treating a mental illness, he said. “There was no, ‘This is mental; this is not.’”
Coira said the lesson from the case is that all mental illnesses should be treated as physical illnesses. Seemingly separate problems can be rooted in the same source, such as stress, which can weaken people’s immune response to infections.
Dr. Dan Asimus, a Hawaii-based psychiatrist who focuses on neuroplasticity, supported this point. He said providers could help patients deal with stress in a productive way by helping them make small changes in their routines.
“We have to basically as healthcare providers accept where patients are right now,” Asimus said, adding that this can process can be more challenging for low-income patients who have fewer resources to make changes.
Midge Grady, a Hackensack UMC advanced practice nurse, organized the conference with Coira. She said Hackensack providers use conventional psychiatric approaches when appropriate, but they also learn how to employ a broader range of approaches by asking the patients about their lives.
“It’s our job as providers to engage the patient, educate the patient, and empower the patient,” she said. “And the best we can do that is by having all of these tools in our toolbox… If people walk away (from the conference) and know that there’s more in their toolbox than a prescription pad, we’ve done our job.”
The first day of the conference was yesterday at the Hilton Woodcliff Lake. The conference will conclude today.