Rusk Rehabilitation | NYU Langone Health
At NYU Langone’s Rusk Rehabilitation, you receive care that meets your physical, social, emotional, cognitive, and psychological needs.
Our Dance Medicine Team | NYU Langone Health
Experts at NYU Langone’s Harkness Center for Dance Injuries aim to improve the delivery of dance medicine.
Concussion Center Care Team | NYU Langone Health
The medical team at NYU Langone’s Concussion Center specializes in concussion care.
Voice, Swallowing & Airway Conditions We Treat | NYU Langone Health
At NYU Langone’s Voice Center, we are experts in a range of conditions that affect your ability to speak, swallow, and breathe.
Leveraging Biomarkers for Personalized Treatment of Alcohol Use Disorder Comorbid With PTSD
The proposed study is a double-blind, 2-group randomized controlled trial designed to contrast acute and persisting effects of topiramate to those of placebo treatment in a sample of 150 participants with moderate to severe AUD comorbid with PTSD/subthreshold PTSD, and to evaluate the moderating effect of rs2832407 genotype on medication effects. Participants will be randomized in a 2:1 ratio to topiramate vs. placebo. Drug will be titrated to a maximum dose of 200 mg over 8 weeks, continued for 4 more weeks for a total of 12 weeks of treatment, and tapered over a 2-week period. We propose an integrative translational focus on alterations in excitatory and inhibitory signaling, focusing on GABA and glutamate and related circuitry, to model the neurobiology of AUD comorbid with PTSD/subthreshold PTSD and the mitigating effects of topiramate. We will study the behavioral, genetic, and plasma biomarker effects of topiramate vs. placebo in 150 participants with co-occurring AUD and PTSD/subthreshold and ascertain multi-modal imaging markers including structural MRI, task-based fMRI, and TMS evoked potentials in EEG. Imaging markers will be used to characterize excitatory and inhibitory circuits in the clinical trial participants with AUD+PTSD/subthreshold to determine predictors and mechanisms of topiramate vs. placebo treatment outcomes. Clinical interviews will be audio- taped to ensure clinical adherence and conduct interrater reliability. De-identified audio recordings of participants who consent to participate in the voicemarkers analysis will be encrypted and sent via secure sites for analysis. This project will advance our knowledge of personalized medicine for AUD comorbid with PTSD/subthreshold, with particular emphasis on understanding the mechanisms that account for the high variability in treatment outcomes for this comorbidity, how treatments like TPM are effective for certain individuals, and how best to identify those most likely to respond to TPM.
THE PROSPECTIVE NATURAL HISTORY OF FAMILIAL DYSAUTONOMIA
Our ultimate goal is to develop new treatments for patients with familial dysautonomia (FD, OMIM 223900). We also want to learn which specific nerve populations are affected by the disease-causing mutation, whether these features are progressive, and how best to measure them in clinical trials. FD is caused by a founder mutation in the IKBKAP gene that is carried by 1:30 people of European Jewish ancestry. Over 99% of affected patients have two copies of the identical founder mutation. This affects the development of the sensory nervous system, which relays information to the brain. FD is both developmental and progressive. Current drug treatments are supportive and none specifically target the on-going neurological decline. Partnership between academic centers, advocacy groups and federal agencies has allowed the creation of a pipeline for drug development and an infrastructure for translational research. The first aim of this project will be to enroll patients with FD from around the world in a non-interventional natural history study. We will score the severity of their clinical features and follow how they evolve over time. The natural history will focus on establishing disease-specific milestones to use as outcome measures in future clinical trials. We will find ways to measure the progressive neurological aspects of the disease including blindness and gait ataxia, which are intrinsically related and most devastating to the patient’s quality of life overtime. We will also explore other potential biomarkers that quantify renal, cardiovascular, respiratory, orthopedic and cognitive aspects of the disease, which will help us monitor adverse events. The second aim of this project will address one of the most intriguing questions about the disease; why some patients are more severely affected than others. The study will include genomic sequencing from patients with FD, to find specific modifier genes that influence the severity of traits as possible targets for future drug development. Some of these genes may be important in the general population, but discovering them could be easier in FD patients due to >99% being homozygous for the founder mutation.
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Elucidating Neural Mechanisms and Sex Differences in Response to Mindfulness Based Stress Reduction in Generalized Anxiety Disorder
Mindfulness-Based Stress Reduction (MBSR) has demonstrated efficacy for Generalized Anxiety Disorder (GAD), yet there remains a major knowledge gap about its neural mechanisms. Neuroimaging studies thus far have mostly focused on the impact of MBSR on structural and resting-state brain changes, and these studies have been predominantly conducted in healthy participants. Core features of GAD, such as ruminative worry, represent dysfunctional emotion regulation strategies that increase bias towards future threat. MBSR success is associated with improved emotion regulation, enhanced attention to the present moment, and non-judgmental acceptance of internal and external cues. Our primary aim is to elucidate neural mechanisms that drive response to MBSR in patients with generalized anxiety disorder (GAD), and to examine the degree to which sex differences in MBSR response are explained by sex differences in these mechanisms. Our overarching hypothesis is that MBSR enhances ‘top-down’ learning and memory capacities that are broad and impact ‘top-down’ as well as ‘instinctual’ abilities (bottom-up) to regulate fear and emotions. We will first study the functional activation of brain regions associated with the fear extinction network (ventromedial prefrontal cortex (vmPFC), hippocampus, and amygdala) as a specific probe of the ‘instinctual’ type of emotion regulation. Second, we will use a novel analytic approach to examine large-scale functional connectivity as a marker of neural plasticity changes (pre- and post-MBSR) trial-by-trial during fear extinction learning across the entire brain, focusing analyses on the default mode network (DMN), frontoparietal network (FPN), and ventral attention network (VAN). Next, we will examine sex differences in MBSR-induced neural changes and their relationship to sex differences in clinical GAD response. Finally, we will use a novel statistical approach to explore whether baseline neural measures can predict MBSR-induced neural changes and clinical symptom reduction to identify likely MBSR responders. Participants will undergo a standardized 2-day fear conditioning and extinction paradigm in the fMRI scanner before and after MBSR or stress education (SE) with primary clinical outcomes at endpoint and 3 month follow-up. This study will deploy rigorous scientific methods with a time and attention control intervention to enable isolation of MBSR’s mechanistic impact on brain regions involved in emotion regulation and clinical response. The unique combination of a focus on a classic anxiety condition with established emotion regulation difficulties implicating target neural circuits, previously demonstrated MBSR efficacy, and sex differences with rigorous fMRI behavioral probes with novel analytic approaches ought to provide major new insights about MBSR mechanisms and sex considerations, moving towards precision medicine that could guide future treatment development research.
OurChild: A Health IT Solution to Reduce Minority Health Disparities
Chinese American immigrant families are a fast-growing immigrant group with unmet early childhood mental health needs. We propose to design, build, and implement OurChild, an integrated mHealth/EHR solution to increase access to early childhood mental health knowledge and mental health services and resources for Chinese American children ages 2-6 years old and their parents in the Sunset Park Brooklyn. Our proposal unites our longstanding partnership with the Chinese American community in Sunset Park and the safety-net clinics serving it with our team’s 1) clinical and scientific expertise in health disparities, participatory research and early childhood mental health and 2) the digital health/health IT expertise of the WonderLab, a digital incubator in the NYU Langone Department of Child and Adolescent Psychiatry. Our goal is to reduce health disparities by explicitly designing a digital solution that facilitates connection and bidirectional exchange of information across the cultural, contextual, language, and setting differences that are key barriers to early childhood mental health knowledge and access to care for this immigrant population. Our first aim is to iteratively design, build, and test OurChild. To do this we will 1) collaborate with our family, clinical, and community stakeholders to conduct an early childhood mental health context/needs analysis and participatory design and discovery activities; 2) use these insights to adapt and user-test iterative prototypes; 3) evaluate the usability and acceptability of a beta version of OurChild in a mixed-methods pilot with 20 Chinese American parents and their 2- to 6-year-old children who receive care at the Sunset Park 7th Avenue Family Health Center; and 5) optimize the design, features, and performance to create OurChild 1.0. Our second aim it to evaluate the Reach, Effectiveness, Adoption, and Implementation of OurChild 1.0 with a 6-month longitudinal implementation cohort study with 200 parent/child dyads. We will use a mixed-methods approach using metadata collected with the OurChild app, parent-reported data from the app, EHR data, and post-implementation focus groups with providers to determine whether use of Our Child increases referrals of young children for a mental health consultation or evaluation (Primary Aim). Our secondary aims will examine whether use of OurChild 1) increases parent self-efficacy; 2) parent–provider engagement; and 3) linkage with community early childhood resources. Both OurChild and our digital methodology will be designed to be scaled to other Chinese populations and efficiently adapted for other health disparity populations.