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Welcome to the Clinical
Center Grand Rounds,

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a weekly series of educational
lectures for physicians and

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health care professionals
broadcast from the Clinical

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Center at the National
Institutes of Health in

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Bethesda, MD.

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The NIH Clinical Center is the
world's largest hospital totally

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dedicated to investigational
research and leads the global

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effort in training today's
investigators and discovering

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tomorrow's cures.

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Learn more by visiting us online
at http://clinicalcenter.nih.gov

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TODAY, WE'RE HONORED TO HAVE AS

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OUR SPEAKER DR. CAROLYN

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RODRIGUEZ, ASSOCIATE DEAN FOR

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ACADEMIC AFFAIRS AT STANFORD

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UNIVERSITY SCHOOL OF MEDICINE,

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DIRECTOR OF THE TRANSACTIONAL

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THERAPEUTIC PLAN OR PROFESSOR IN

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THE DEPARTMENT OF PSYCHE FREE

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AND BEHAVIORIAL SCIENCES AT

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STANFORD AND A CONSULTATIONAL

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LIAISON PSYCHIATRIST FOR THE P A

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LO ALTASD O VETERAN'S HEALTHCARE

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SYSTEM.

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DR. RODRIGUEZ EARNED HER

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BACHELORS FROM HARVERDICT

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UNIVERSITY AND THEN AS A STUDENT

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IN THE INTERDISCIPLINARY HARVARD

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MEDICAL SCHOOL, INSTITUTE OF

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TECHNOLOGY OF PROGRAM AND HEALTH

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SCIENCES AND TECHNOLOGY, SHE

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EARNED HEAR Ph.D. IN GENETICS.

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SHE COMPLETED INTERNAL MEDICINE

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RESIDENCY AND THEN PURSUING A

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POST DOCTORAL FELLOWSHIP AT

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COLUMBIA AT NEW YORK STATE'S

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PSYCHIATRIC INSTITUTE.

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AS DIRECTOR OF TRANSLATIONAL

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THERAPEUTICS LAB, OBSESSIVE

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COMSULSIVE RESEARCH PROGRAM, AND

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STANFORD HOARDING RESEARCHERS

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PROGRAM, DR. RODRIGUEZ LEADS

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STUDIES INVESTIGATING SEVERE

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MENTAL DISORDER SAYS.

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HER LANDMARK CLINICAL TRIALS

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PILOT PROJECT OR NEAR ACTIVE

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TREATMENT FOR ILLNESS FOR

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RELATED DISORDERS.

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HER NIH AND DONOR FUND BEING

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MECHANISTIC AND CLINICAL

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EFFICACY STUDIES TARGET DPLIEWT

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MITTERGIC AND [INDISCERNIBLE],

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NONEVASIVE BRAIN STIMULATION,

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PSYCHOTHERAPY AND SUICIDE

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PREVENTION.

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SHE'S ALSO THE AUTHOR OF

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HOARDING DISORDER, PUBLISHED

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THIS LAST AUGUST BY THE AMERICAN

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PSYCHIATRIC ASSOCIATION.

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DR. RODRIGUEZ IS DEPUTY DIRECTOR

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OF THE AMERICAN JOWNAL OF

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PSYCHIATRY, A BOARD MEMBER OF

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THE AMERICAN--RESEARCH COUNCIL

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FOR AMERICAN PSYCHIATRIC

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ASSOCIATION, THE BRAIN AND

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BEHAVIOR RESEARCH FOUNDATION

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SCIENTIFIC COUNCIL AND AMERICAN

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FOUNDATION FOR SUICIDE

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PREVENTION ADVISORY GROUPS AND

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AS A SCIENTIFIC AND CLINICAL

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ADVICERY BOARD MEMBER OF THE

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INTERNATIONAL FOUNDATION.

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DR. RODRIGUEZ HAS RECEIVED

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SEVERAL NATIONAL AWARDS

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INCLUDING PRESIDENTIAL EARLY

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CAREER AWARD FOR SCIENTIST

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ENGINEER WHICH RECOGNIZES

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INVESTIGATORS WHO ARE PURSUING

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BOLD AND INNOVATIVE PROJECTS AND

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CONSIDERED 1 OF THE HIGHEST

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HONORS IN SCIENTIFIC RESEARCH.

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DR. RODRIGUEZ PRESENTED HER

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RESEARCH AT THE 2019 ECONOMIC

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FORUM IN DAVOS, AND AT FORTUNE

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BRAINSTORM HEALTH THIS PAST

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YEAR.

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HER WORK HAS BEEN FEATURED ON

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NPR, PBS, THE NEW YORK TIMES,

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ABC NEWS, NBC NEWS AND NEWS WEEK

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AND TIME.COM.

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IN ADDITION TO HER NEARLY 80

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PEER REVIEWED PUBLICATIONS AND

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BOOK CHAPTERS DR. RODRIGUEZ IS A

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CONTRIBUTOR TO THE HARVARD

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BUSINESS REVIEW AND HUFFING TON

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POST TO SHARE SCIENTIFIC FINDING

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WITH THE GENERAL PUBLIC.

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NOW, PLEASE WELCOME OUR SPEAKER

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DR. CAROLYN RODRIGUEZ WHOSE TALK

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IS ENTITLED:  NOVEL

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INTERVENTIONS FOR OBSESSIVE

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COMPULSIVE DISORDER.

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>>  IT'S A PLEASURE

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TO BE HERE WITH YOU TODAY AND

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SHARE WITH YOU ADVANCES WE'RE

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MAKING NEAR NOVEL INTERVENTIONS

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FOR OCD.

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THIS IS A LIST OF MY FUNDING AND

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DISCLOSURES OVER THE PAST 3

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YEARS AND I WANTED TO START OFF

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BY SHARING WITH YOU THAT IN MY

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TRAINING IT HAS ALWAYS BEEN

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INCREDIBLY MEANINGFUL TO ME

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WANTING TO TRY AND HELP

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INDIVIDUALS SUFFERING FROM

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SEVERE MENTAL ILLNESS, AND EARLY

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IN MY PATH, I MET AN INDIVIDUAL

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NAMED JOHN, HIS NAME IS

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DISGUISED WHO RIGHT WHEN WE

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ENTERED COLLEGE WAS HIT WITH

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THIS WALL OF EXCRUCIATING

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ANXIETY.

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AND HE FELT THAT HE NEEDED TO

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WRITE AND REWRITE HIS

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ASSIGNMENTS UNTIL THEY WERE,

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THEY FELT JUST RIGHT.

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HE SPENT HOURS AT NIGHT, COULD

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BARELY SLEEP IN THE MORNING HE

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WOULD WAKE UP EARLY AND TRY TO

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DIFFERENT CLOTHING UNTIL THEY

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FELT RIGHT AND THIS-THESE

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THOUGHTS AND BEHAVES MADE IT SO

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THAT HE WAS LATE TO CLASS, HE

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WASN'T ABLE TO FUNCTION, HIS

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GIRL BROKE UP WITH HIM AND IT

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WAS INCREDIBLY, INCREDIBLY

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DISTRESSING FOR HIM.

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SO JOHN IS AN INDIVIDUAL WHO HAS

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OBSESSIVE COMPULSIVE DISORDER OR

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OCD.

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ASK THIS IS CHARACTERIZED BY

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INTRUSIVE THOUGHTS, IMAGES,

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URGES THAT INCREASE ANXIETY AND

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COMPULSIONS WHICH ARE BEHAVIORS

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THAT CAN BE MENTAL OR PHYSICAL

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ACTS THAT DECREASE THIS ANXIETY.

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AND THIS DISORDER IS PREVALENT,

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IT'S COMMON.

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IT HAS A HIGH PROPORTION OF

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CASES THAT ARE SEVERE AND 1 OF

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THE--1 OF THE FACTS THAT REALLY

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COMPELLED ME TO STUDY OCD IS

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THAT IT TAKES ON AVERAGE 14

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YEARS FROM AN INDIVIDUAL BEING

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DIAGNOSED, HAVING THE SYMPTOMS

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OF OCD TO THEN BEING DIAGNOSED

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AND HAVING FIRST LINE TREATMENT

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SO IT CAN BE A VERY HIDDEN

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DISORDER AND IT'S IMPORTANT TO

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KNOW THAT EVEN THOUGH SOME OF

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THE MEDIA ABOUT OCD IS SORT OF

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FOCUSED ON CONTAMINATION AND

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HAND WASHING, THERE'S ALSO A LOT

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OF DIFFERENT KINDS OF THEMES IN

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OCD INCLUDING THOSE OF HARM.

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SO PEOPLE CAN HAVE INTRUSIVE

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THOUGHTS THAT THEY'VE RUN

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SOMEBODY OVER WHEN THEY HAVEN'T

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AND THEY WILL FEEL COMPELLED TO

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GO BACK TO THE SITE WHERE THEY

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HAD THIS THOUGHT AND CHECK TO

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SEE IF THEY'VE HEARD ANYONE.

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THEY WILL GO HOME AND CHECK THE

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NEWS TO SEE IF THERE'S ANY

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REPORTS OF ACCIDENTS AND AS YOU

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CAN IMAGINE, THIS REALLY IS

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DISRUPTING FOR PEOPLE'S TIME,

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FOR THEIR SCHEDULE, FOR THEIR

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ENERGY AND ALSO 1 OF THE THEMES

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THAT IS NOT BROUGHT TO LIGHT

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VERY OFTEN IS TABOO THOUGHTS OR

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THEY CAN BE MENTAL RITUALS LIKE

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A PRAYER OR PHRASE OR COUNTING

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OR THEY CAN BE PHYSICAL ACTS TO

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NEUTRALIZE THAT ANXIETY.

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ONE MEMORABLE INDIVIDUAL HAD AN

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ENTRUCIVE THOUGHT OF THE WORD

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JOHN, INCREASED HIS ANXIETY AND

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I HAD THINK IN HIS MIND TO HAVE

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THAT ANXIETY GO AWAY.

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THE STANDARD TREATMENTS FOR OCD

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INCLUDE MEDICATIONS AS SEROTONIN

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INHIBIT UPTAKE, THINGS LIKE

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SSRI, SO THINGS LIKE PROZACH,

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AND ON THE BEHAVIORIAL SIDE,

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BEHAVIORIAL THERAPY WITH

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COGNITIVE RESPONSE.

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AND THIS IS AN EFFECTIVE THERAPY

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WHERE YOU TRY AND DISRUPT THE

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LINK BETWEEN A PERSON FEELING

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LIKE THEY HAVE THIS INTRUSIVE

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THOUGHT THAT CAUSES ANXIETY AND

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THEY THEY HAVE TO DO THE

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COMPULSIONS TO DECREASE THE

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ANXIETY. 

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BUT THE OCD IS STRONG AND WE TRY

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TO DISRUPT THAT THOUGHT AND THE

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ANXIETY GO DOWN AND INDIVIDUALS

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EXPOSE THEMSELVES FROM LEAST TO

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HIGHEST FEAR.

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AND TOGETHER THESE 21st LINE

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TREATMENTS CAN HELP

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APPROXIMATELY HALF OF

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INDIVIDUALS WITH OBSESSIVE

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COMPULSIVE DISORDER BUT HALF OF

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INDIVIDUALS WILL NOT BE HELPED

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AND THAT'S REALLY WHERE MY FOCUS

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OF MY RESEARCH IS AND WHERE

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THE--YOU KNOW WHERE WE GOT TO

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WITH JOHN.

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SO I WOULD LIKE TO REVIEW, JUST

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A LITTLE BIT ABOUT SOME OF THE

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FIRST LINE PHARMAICOLOGICAL

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TREATMENTS FOR THOSE WHO OF YOU

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WHO SEE INDIVIDUALS WITH OCD.

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THIS IS A LIST OF THOSE

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INHIBITORS AND CLOMIPRAMINE IS 1

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OF THE FIRST TREATMENTS.

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PEOPLE USUALLY START WITH THE

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SSRIs, BECAUSE THEY HAVE LESS

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SIDE EFFECTED PROFILE.

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BUT ON AVERAGE 40-60% OF

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INDIVIDUALS WILL HAVE AN AVERAGE

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OF 20-40% SYMPTOM REDUCTION WITH

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1 OF THESE FIRST LINE TREATMENTS

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AND SO IT WILL DECREASE THE

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SYMPTOMS BUT KNOCK IT OUT

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COMPLETELY.

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THE OTHER THING IS THAT THE

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DOSES FOR THESE MEDICATIONS ARE

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MUCH HIGHER FOR OCD THAN MAJOR

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DEPRESSION?

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THEY NEED TO BE GIVEN AT LONGER

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DOSE.

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SO EVIDENCE SHOW THAT HIGHER

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SSRI PRODUCE A GREATER MAGNITUDE

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OF SYMPTOM OF RELIEF AND YOU

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WANT TO CONTINUE THIS FOR 8-12

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WEEKS INCLUDING 4-6 WEEKS AT A

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MAXIMALLY TOLERATED DOSE.

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THIS IS A LOT LONGER THAN

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DEPRESSION WHERE YOU COULD SEE

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AN EFFECT ON SOMETHING LIKE IN

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THE ORDER OF 2 WEEKS.

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LOWER DOSES AND GRADUAL

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TITRATION MAY BE NEEDED FOR

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PATIENTS WITH OCCURRING ANXIETY

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DISORDERS, THE ELDERLY OR IF

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00:10:27,600 --> 00:10:38,520
SIDE EFFECTS ARE A CONCERN.

259
00:10:38,520 --> 00:10:41,240
IF THE FIRST SSRI DOESN'T WORK,

260
00:10:41,240 --> 00:10:46,200
SWITCH TO DIFFERENT, IS SRI OR

261
00:10:46,200 --> 00:10:47,800
SWITCH TO CLOMIPRAMINE, OR

262
00:10:47,800 --> 00:10:52,320
AUGMENT A DOPAMINE BLOCKER OR

263
00:10:52,320 --> 00:10:55,800
TWITCH TO EFEXPECTATIONS OR OR

264
00:10:55,800 --> 00:11:01,760
REMERON, OR TRY CBT.

265
00:11:01,760 --> 00:11:02,360
REGARDING BLOCKERS, RESPIRRA

266
00:11:02,360 --> 00:11:04,560
DONE HAS BEEN TRIED IN STUDIES.

267
00:11:04,560 --> 00:11:09,840
THIS IS WORKED IN PATIENTS WITH

268
00:11:09,840 --> 00:11:13,120
TICK DISORDER, ABILIFY, HAVE HAD

269
00:11:13,120 --> 00:11:19,480
GOOD RESULTS BUT SEROQUELL AND

270
00:11:19,480 --> 00:11:21,720
ZYPREXA'RE MIXED BUT THE OTHERS

271
00:11:21,720 --> 00:11:25,400
THERE'S BEEN NO STUDY IN OCD. 

272
00:11:25,400 --> 00:11:27,680
THIRD LINE TREATMENTS INCLUDE

273
00:11:27,680 --> 00:11:29,200
USING A DIFFERENT DOPAMINE

274
00:11:29,200 --> 00:11:31,960
BLOCKER OR MAYBE A THIRD OR

275
00:11:31,960 --> 00:11:33,480
FOURTH SSRI AND THEY MAY HAVE A

276
00:11:33,480 --> 00:11:34,440
BENEFIT AND THERE'S A PERCENTAGE

277
00:11:34,440 --> 00:11:41,000
OF PEOPLE WHO WILL RESPOND.

278
00:11:41,000 --> 00:11:43,000
ADDING THE MEDICATIONS THAT ARE

279
00:11:43,000 --> 00:11:46,040
DPLIEWT MATE MODULATORS THESE

280
00:11:46,040 --> 00:11:48,720
ARE THINGS LIKE LAMANTIEN OR

281
00:11:48,720 --> 00:11:49,000
OTHERS.

282
00:11:49,000 --> 00:11:53,520
OR SWITCHING TO DUG DRUGS THAT

283
00:11:53,520 --> 00:11:55,000
HAVE AT LEAST 1 RANDOMIZED

284
00:11:55,000 --> 00:12:03,360
CONTROL TRIAL AND SOME EVIDENCE

285
00:12:03,360 --> 00:12:04,960
INCLUDING DEMETHAMPHETAMINE,

286
00:12:04,960 --> 00:12:08,120
MORPHINE, TRAUMA DOLL OR

287
00:12:08,120 --> 00:12:08,400
ONDANSETRON.

288
00:12:08,400 --> 00:12:10,600
SO CAN YOU GO TO AN INTENSIVE

289
00:12:10,600 --> 00:12:14,360
RESIDENTIAL TREATMENT OR HAVE A

290
00:12:14,360 --> 00:12:14,880
PARTIAL HOSPITALIZATION.

291
00:12:14,880 --> 00:12:18,280
ONE THING TO NOTE IS THAT

292
00:12:18,280 --> 00:12:23,280
MONOTHERAPY WITH THINGS LIKE

293
00:12:23,280 --> 00:12:24,600
BENZODIAPINES ARE NOT WELL

294
00:12:24,600 --> 00:12:24,920
SUPPORTED.

295
00:12:24,920 --> 00:12:27,560
THERE'S NO EVIDENCE OF BENEFIT

296
00:12:27,560 --> 00:12:29,560
FROM LITHIUM.

297
00:12:29,560 --> 00:12:31,720
BENZOs MAY BE HELPFUL FOR

298
00:12:31,720 --> 00:12:33,360
ANXIETY AND SLEEP BUT DON'T

299
00:12:33,360 --> 00:12:36,400
ADDRESS THE CORE OF OCD

300
00:12:36,400 --> 00:12:36,640
SYMPTOMS.

301
00:12:36,640 --> 00:12:37,440
IN NEUROLEAPTICS 1 THING TO BE

302
00:12:37,440 --> 00:12:40,760
CAUTIOUS OF IS THAT THESE DRUGS

303
00:12:40,760 --> 00:12:44,120
THIS, DRUG CLASS CLOZAPINE CAN

304
00:12:44,120 --> 00:12:45,800
TRIGGER OR EXACERBATE OCD

305
00:12:45,800 --> 00:12:46,960
SYMPTOMS.

306
00:12:46,960 --> 00:12:48,520
NEXT IS NEURO MODULATIONS,

307
00:12:48,520 --> 00:12:50,600
THERE'S 2 FORMS, NONINVASIVE AND

308
00:12:50,600 --> 00:12:51,960
INVASIVE.

309
00:12:51,960 --> 00:12:55,000
SO FOR NONINVASIVE, FDA HAS

310
00:12:55,000 --> 00:12:59,200
APPROVED A DEEP TMS DEVICE WITH

311
00:12:59,200 --> 00:13:02,800
THE HELMET COIL AND ALSO THE FDA

312
00:13:02,800 --> 00:13:04,160
HAS APPROVED COMPASSIONATE USE

313
00:13:04,160 --> 00:13:12,000
OF DEEP BRAIN STIMULATION FOR

314
00:13:12,000 --> 00:13:12,200
OCD.

315
00:13:12,200 --> 00:13:15,160
AND AS I MENTIONED MY LAB IS

316
00:13:15,160 --> 00:13:16,320
INTERESTED IN THOSE FOLKS WHO

317
00:13:16,320 --> 00:13:17,960
ARE INTERESTED IN HELPING IN

318
00:13:17,960 --> 00:13:19,720
FIRST LINE TREATMENTS AND IN

319
00:13:19,720 --> 00:13:23,000
ADDITION TO TRIALLY TRYING TO

320
00:13:23,000 --> 00:13:25,720
IDENTIFY DRUGS, WE WANT TO TRY

321
00:13:25,720 --> 00:13:27,080
AND UNDERSTAND IF THEY CAN WORK

322
00:13:27,080 --> 00:13:28,920
RAPID LOAMACYY ON SYMPTOMS AS

323
00:13:28,920 --> 00:13:30,400
YOU SAW, 8 TO 12 WEEK SYSTEM A

324
00:13:30,400 --> 00:13:31,800
LONG TIME FOR PATIENTS TO WAIT

325
00:13:31,800 --> 00:13:32,320
TO GET BETTER.

326
00:13:32,320 --> 00:13:35,800
WE REALLY WANT TO BE ABLE TO DO

327
00:13:35,800 --> 00:13:36,720
IT RAPIDLY.

328
00:13:36,720 --> 00:13:38,240
AND THE OTHER IS HOW DO WE USE

329
00:13:38,240 --> 00:13:40,720
THESE DRUGS IF THEY DO HAVE

330
00:13:40,720 --> 00:13:42,000
RAPID EFFECTS, HOW DO WE USE

331
00:13:42,000 --> 00:13:45,760
THEM AS PROBES TO UNDERSTAND THE

332
00:13:45,760 --> 00:13:47,280
UNDERLYING MECHANISMS OF

333
00:13:47,280 --> 00:13:47,560
BEHAVIOR.

334
00:13:47,560 --> 00:13:52,400
SO HOW DOES, YOU KNOW FROM THE

335
00:13:52,400 --> 00:13:55,760
RECEPTOR LEVEL, LOOKING AT

336
00:13:55,760 --> 00:13:56,920
GLUTAMATE RECEPTORS, HOW THOSE

337
00:13:56,920 --> 00:13:59,840
IN NEURONS, HOW THOSE BUILD

338
00:13:59,840 --> 00:14:01,720
CIRCUITS IN OCD, THERE'S A

339
00:14:01,720 --> 00:14:06,840
REPETITIVE, THOUGHT TO BE A

340
00:14:06,840 --> 00:14:08,960
RAPID FIRING--FIRING RAPID HYPER

341
00:14:08,960 --> 00:14:12,000
STIMULATED CIRCUIT INVOLVING THE

342
00:14:12,000 --> 00:14:13,400
CORTEX STRIATUM AND THIS WILL

343
00:14:13,400 --> 00:14:14,480
MUSIN ADDITION TO OTHER CIRCUITS

344
00:14:14,480 --> 00:14:16,960
IN THE BRAIN AND ALSO HOW DO

345
00:14:16,960 --> 00:14:18,440
THOSE CIRCUITS, HYPER ACTIVE

346
00:14:18,440 --> 00:14:21,080
CIRCUITS THEN BUILD INTO SIGNALS

347
00:14:21,080 --> 00:14:24,800
OR NEURAL NETWORKS, SO THAT

348
00:14:24,800 --> 00:14:27,600
YOU--HOW IS THE NETWORK FIRE

349
00:14:27,600 --> 00:14:28,640
NOTHING A SYMPHONY IN ORDER TO

350
00:14:28,640 --> 00:14:30,800
BE ABLE TO ELICIT THESE KINDS OF

351
00:14:30,800 --> 00:14:33,000
BEHAVIORS THAT WE SEE.

352
00:14:33,000 --> 00:14:37,000
AND FINALLY, CAN UNDERSTANDING

353
00:14:37,000 --> 00:14:38,840
MECHANISM IMPROVE PRECISION FOR

354
00:14:38,840 --> 00:14:42,320
OUR DIAGNOSIS AND FOR MONITORING

355
00:14:42,320 --> 00:14:46,120
AND FOLLOWING BENEFITS OF

356
00:14:46,120 --> 00:14:46,400
PATIENTS.

357
00:14:46,400 --> 00:14:47,680
SO I WILL HEIGHT LIGHT FOR YOU

358
00:14:47,680 --> 00:14:52,320
AN APPROACH WE'RE USE NOTHING

359
00:14:52,320 --> 00:14:52,840
TRANSLATIONAL THERAPEUTIC

360
00:14:52,840 --> 00:14:53,120
APPROACH.

361
00:14:53,120 --> 00:14:54,280
I WAS REALLY INSPIRED AND I WILL

362
00:14:54,280 --> 00:14:56,960
TELL YOU ABOUT THIS ABOUT

363
00:14:56,960 --> 00:14:58,800
AN ANIMAL MODEL FOR COMPULSE OF

364
00:14:58,800 --> 00:14:59,240
BEHAVIORS.

365
00:14:59,240 --> 00:15:03,960
THAT LED TO WANTING TO TEST OUT

366
00:15:03,960 --> 00:15:05,440
NOVEL COMPOUNDS, THAT COULD BE

367
00:15:05,440 --> 00:15:08,480
USED IN HUMAN TRIALS OF OCD, AND

368
00:15:08,480 --> 00:15:10,840
THEN I'LL DESCRIBE A LITTLE BIT

369
00:15:10,840 --> 00:15:11,720
BACK TRANSLATION WE'VE BEEN

370
00:15:11,720 --> 00:15:14,680
DOING TO SEE IF THOSE COMPOUNDS

371
00:15:14,680 --> 00:15:16,440
CAN HAVE EFFECTS IN THE ANIMAL

372
00:15:16,440 --> 00:15:19,800
MODEL TO REFINE THE ANIMAL

373
00:15:19,800 --> 00:15:20,000
MODELS.

374
00:15:20,000 --> 00:15:25,040
SO FIRST EARLY IN MY TRAINING, I

375
00:15:25,040 --> 00:15:26,600
SAW THAT DRUGS IS A FAMILY OF

376
00:15:26,600 --> 00:15:30,760
PROTEINS AND WHEN THEY'RE

377
00:15:30,760 --> 00:15:32,040
DISRUPTED, AT GLUTEMITTERGIC

378
00:15:32,040 --> 00:15:33,400
SYNAPSES, GLUTAMATE AS YOU KNOW

379
00:15:33,400 --> 00:15:36,600
MAY KNOW IS THE EXCITATORY

380
00:15:36,600 --> 00:15:39,600
NEUROTRANSMITTER IN THE BRAIN,

381
00:15:39,600 --> 00:15:40,760
THOSE--THAT DISRUPTION ELICITS

382
00:15:40,760 --> 00:15:44,000
IN THIS ANIMAL MODEL, EXCESSIVE

383
00:15:44,000 --> 00:15:47,520
GROOMING AND ANXIETY LIKE

384
00:15:47,520 --> 00:15:49,240
BELAIEVERS AND CORTICO STRIATUM

385
00:15:49,240 --> 00:15:51,600
DEFINITES AND WHEN YOU

386
00:15:51,600 --> 00:15:53,000
REINTRODUCE THAT PROTEIN

387
00:15:53,000 --> 00:15:55,000
EXPRESSION INTO THE TRIAT UMKC,

388
00:15:55,000 --> 00:15:56,600
YOU SEE A SUSSESSION OF THESE

389
00:15:56,600 --> 00:15:57,600
COMPULSIVE BEHAVIORS AND SO THIS

390
00:15:57,600 --> 00:16:01,800
LINE OF EVIDENCE IN ADDITION TO

391
00:16:01,800 --> 00:16:04,240
STUDIES OF GLUTAMATE MODULATORS

392
00:16:04,240 --> 00:16:07,720
IN OCD, THAT SEEM TO WHEN ADDED

393
00:16:07,720 --> 00:16:11,080
TO AN SSRI HAVE BENEFIT IN

394
00:16:11,080 --> 00:16:12,520
REDUCING OCD SYMPTOMS MAY BE

395
00:16:12,520 --> 00:16:15,480
REALLY INTERESTED IN GLUTAMATE

396
00:16:15,480 --> 00:16:15,720
SYSTEM.

397
00:16:15,720 --> 00:16:17,240
AND AROUND THE TIME THAT I WAS,

398
00:16:17,240 --> 00:16:20,000
YOU KNOW STARTING IN RESEARCH,

399
00:16:20,000 --> 00:16:21,520
KETAMINE HAD JUST BEEN

400
00:16:21,520 --> 00:16:24,480
IDENTIFIED AS A RAPID ACTING

401
00:16:24,480 --> 00:16:31,120
COME POUND THAT DECREASED

402
00:16:31,120 --> 00:16:34,680
DEPRESSION IN STUDY BY BERM AN

403
00:16:34,680 --> 00:16:36,080
ET AL, AND IT SEEMED TO ME TO

404
00:16:36,080 --> 00:16:38,560
MAKE SENSE TO TRY THIS IN OCD.

405
00:16:38,560 --> 00:16:47,160
AND WHAT WE DID IS WE TOOK A

406
00:16:47,160 --> 00:16:50,080
SMALL PILOT STUDY, THOSE

407
00:16:50,080 --> 00:16:53,560
RANDOMIDED TO IV KETA MEAN OR IV

408
00:16:53,560 --> 00:16:54,920
SALIVA--SALIVAINE, WE ASKED THEM

409
00:16:54,920 --> 00:16:57,400
ON A SCALE OF 0-10, WHAT ARE THE

410
00:16:57,400 --> 00:16:59,160
SYMPTOMS LIKE OVER THE COURSE OF

411
00:16:59,160 --> 00:16:59,720
1 WEEK.

412
00:16:59,720 --> 00:17:03,160
AND WHEN WE DELIVERED A 0.5 MIX

413
00:17:03,160 --> 00:17:07,160
PER KG INFUSION OF KETAMINE,

414
00:17:07,160 --> 00:17:11,400
WHICH S&P LOW DOSE AND IT

415
00:17:11,400 --> 00:17:12,080
DOESN'T PRODUCE ANESTHESIA,

416
00:17:12,080 --> 00:17:16,040
AFTER THAT WE SAW THESE REALLY

417
00:17:16,040 --> 00:17:19,480
DRAMATIC AND VAST WITHIN HOURS

418
00:17:19,480 --> 00:17:22,800
DECREASE IN OCD SYMPTOMS.

419
00:17:22,800 --> 00:17:25,240
AND THOSE EFFECTS AMAZING 3

420
00:17:25,240 --> 00:17:29,680
PERSISTED LONG PAST KETAMINE'S

421
00:17:29,680 --> 00:17:31,720
VERY RAPID METABOLISM IN THE

422
00:17:31,720 --> 00:17:32,000
BODY.

423
00:17:32,000 --> 00:17:35,080
AND THEN, FINALLY, WE WERE JUST

424
00:17:35,080 --> 00:17:38,280
BLOWN AWAY THAT THESE EFFECTS

425
00:17:38,280 --> 00:17:40,920
PERSISTED IN THE NEXT COUPLE

426
00:17:40,920 --> 00:17:41,160
DAYS.

427
00:17:41,160 --> 00:17:43,480
THE OTHER THING THAT WAS REALLY

428
00:17:43,480 --> 00:17:45,440
EXCITING WAS THAT NONE OF THESE

429
00:17:45,440 --> 00:17:48,760
INDIVIDUALS WERE ON MEDICATION

430
00:17:48,760 --> 00:17:50,200
AT THE TIME AND THEY DIDN'T HAVE

431
00:17:50,200 --> 00:17:51,640
DEPRESSION AT THE TIME.

432
00:17:51,640 --> 00:17:56,400
SO REALLY FOCUSED ON JUST OCD

433
00:17:56,400 --> 00:17:56,720
SYMPTOMS.

434
00:17:56,720 --> 00:17:59,120
AND THIS IS THE FIRST TIME THAT

435
00:17:59,120 --> 00:18:01,800
THESE RAPID EFFECTS HAD BEEN

436
00:18:01,800 --> 00:18:04,440
DEMONSTRATED IN A NOVEL PATHWAY,

437
00:18:04,440 --> 00:18:08,200
1 THAT DIDN'T INVOLVE SRIs.

438
00:18:08,200 --> 00:18:10,440
WE ALSO ASKED AT 1 WEEK, SO

439
00:18:10,440 --> 00:18:13,880
USING THIS STANDARD MEASUREMENT

440
00:18:13,880 --> 00:18:16,600
FOR RESPONSE, THE YALE BROWN

441
00:18:16,600 --> 00:18:18,240
OBSESSIVE COMPULSIVE SCALE, WAS

442
00:18:18,240 --> 00:18:20,320
THERE AT LEAST A 35% REDUCTION

443
00:18:20,320 --> 00:18:21,240
IN THE SCORE?

444
00:18:21,240 --> 00:18:24,000
AND 1 WEEK OUT HALF OF THE

445
00:18:24,000 --> 00:18:26,600
INDIVIDUALS THAT GOT IV KETAMINE

446
00:18:26,600 --> 00:18:28,080
WERE MET CRITERIA FOR RESPONSE

447
00:18:28,080 --> 00:18:37,200
AND NONE OF THE SALINE DID.

448
00:18:37,200 --> 00:18:39,000
SO JOHN FELT LIKE HE WAS HAVING

449
00:18:39,000 --> 00:18:40,280
A VACATION FROM HIS OCD.

450
00:18:40,280 --> 00:18:42,840
HERE'S QUOTES FROM THE

451
00:18:42,840 --> 00:18:44,360
PARTICIPANTS, BUT WHAT'S REALLY

452
00:18:44,360 --> 00:18:46,640
STRIKING IS THAT THEY CAN'T,

453
00:18:46,640 --> 00:18:48,880
LIKE THE LAST 1, I TRIED TO HAVE

454
00:18:48,880 --> 00:18:50,360
OCD THOUGHTS BUT I COULDN'T.

455
00:18:50,360 --> 00:18:53,800
ONE OF THE DOWN SIDES OF

456
00:18:53,800 --> 00:18:55,400
KETAMINE IS FEELINGS OF

457
00:18:55,400 --> 00:18:57,960
DISASSOCIATION, FEELING OF

458
00:18:57,960 --> 00:18:59,560
FLOATING, UNREALITY AND

459
00:18:59,560 --> 00:19:01,640
INDIVIDUALS CAN FEEL DIZZINESS

460
00:19:01,640 --> 00:19:02,600
AND NAUSEA, CONSISTENT WITH

461
00:19:02,600 --> 00:19:04,600
OTHER STUDIES IN DEPRESSION,

462
00:19:04,600 --> 00:19:08,040
THERE'S MILD INCREASES IN BLOOD

463
00:19:08,040 --> 00:19:11,440
PRESSURE AND HEART RATE AND ALSO

464
00:19:11,440 --> 00:19:12,720
ANOTHER DOWN SIDE IS THAT PEOPLE

465
00:19:12,720 --> 00:19:15,400
CAN'T DRIVE FOR THE NEXT 24

466
00:19:15,400 --> 00:19:15,640
HOURS.

467
00:19:15,640 --> 00:19:18,640
SO IN SUMMARY, THIS IS A FIRST

468
00:19:18,640 --> 00:19:20,080
STUDY SHOWING KETAMINE CAN

469
00:19:20,080 --> 00:19:21,040
DECREASE INTRUSIVE THOUGHTS IN

470
00:19:21,040 --> 00:19:23,200
THE ABSENCE OF SSRIs AND

471
00:19:23,200 --> 00:19:24,400
GLUTAMATE MODULATION MAY BE A

472
00:19:24,400 --> 00:19:27,560
RAPID ACTING TARGET IF ARE OCD.

473
00:19:27,560 --> 00:19:28,600
AND THERE ARE REASONS FOR

474
00:19:28,600 --> 00:19:31,120
CAUTION, SO THE EFFECTS ARE

475
00:19:31,120 --> 00:19:31,400
TRANSIENT.

476
00:19:31,400 --> 00:19:32,600
THERE ARE CLINICS OUT THERE THAT

477
00:19:32,600 --> 00:19:35,120
ARE DELIVERING IT BUT IT CAN BE

478
00:19:35,120 --> 00:19:35,520
COSTLY.

479
00:19:35,520 --> 00:19:38,280
IT'S NOT FDA APPROVED FOR OCD,

480
00:19:38,280 --> 00:19:39,360
THE SIDE EFFECTS I DESCRIBED AND

481
00:19:39,360 --> 00:19:41,400
ALSO A DRUG OF ABUSE, IT'S

482
00:19:41,400 --> 00:19:42,880
CALLED SPECIAL K, WE ARE VERY

483
00:19:42,880 --> 00:19:43,840
CAREFUL TO SCREEN PEOPLE WHO

484
00:19:43,840 --> 00:19:48,320
HAVE A HISTORY OF DRUG ABUSE FOR

485
00:19:48,320 --> 00:19:49,000
OUR STUDIES.

486
00:19:49,000 --> 00:19:54,000
BUT CAUTION IS STILL NEEDED.

487
00:19:54,000 --> 00:19:55,760
SO I'VE TURNED OUT TO 1 OF THE

488
00:19:55,760 --> 00:19:57,480
THINGS WE'RE REALLY INTERESTED

489
00:19:57,480 --> 00:19:59,440
IN AND KETAMINE IS ACTING

490
00:19:59,440 --> 00:20:00,520
THROUGH THE GLUTAMATE SYSTEM,

491
00:20:00,520 --> 00:20:03,240
HOW CAN WE UNDERSTAND THE

492
00:20:03,240 --> 00:20:03,800
MECHANISM.

493
00:20:03,800 --> 00:20:05,440
SO DOES KETAMINE CHANGE LEVELS

494
00:20:05,440 --> 00:20:06,120
OF DPLIEWT MATE?

495
00:20:06,120 --> 00:20:08,400
AND YOU CAN ACTUALLY STUDY THIS

496
00:20:08,400 --> 00:20:10,720
IN THE HUMAN BRAIN USING

497
00:20:10,720 --> 00:20:13,400
SOMETHING CALLED MAGNETIC

498
00:20:13,400 --> 00:20:14,240
RESONANCE SPECTROSCOPY.

499
00:20:14,240 --> 00:20:15,720
SO PARTNERING WITH

500
00:20:15,720 --> 00:20:18,440
[INDISCERNIBLE] AT CORNELL AND

501
00:20:18,440 --> 00:20:20,880
BLAIR SIMPSON ANDULARY

502
00:20:20,880 --> 00:20:21,680
[INDISCERNIBLE] AT COLUMBIA, WE

503
00:20:21,680 --> 00:20:24,600
WERE ABLE TO LOOK AT A SPECIFIC

504
00:20:24,600 --> 00:20:28,800
AREA OF THE BRAIN AND ASK

505
00:20:28,800 --> 00:20:31,000
WHETHER, DPLIEWT MATE AND GLUTEA

506
00:20:31,000 --> 00:20:35,920
MINE TOGETHER CALLED GLX CHANGE

507
00:20:35,920 --> 00:20:37,320
IN KETAMINE.

508
00:20:37,320 --> 00:20:41,000
AND WE CAN ALSO ASK IF GABBA IS

509
00:20:41,000 --> 00:20:43,600
CHANGED, SO GABBA IS AN

510
00:20:43,600 --> 00:20:44,040
INHIBITORY COMPOUND.

511
00:20:44,040 --> 00:20:45,320
AND YOU CAN DO THIS WORK IN THE

512
00:20:45,320 --> 00:20:47,200
SCANNER AND INNED WHEN WE WERE

513
00:20:47,200 --> 00:20:48,040
GIVING THE INFUSIONS TO THE

514
00:20:48,040 --> 00:20:50,640
PATIENTS IN THE SCANNER, WE WERE

515
00:20:50,640 --> 00:20:53,400
ABLE TO COLLECT THIS DATA AND

516
00:20:53,400 --> 00:20:56,000
USE A J-PRESS EDITING APPROACH

517
00:20:56,000 --> 00:20:58,880
TO EXAMINE THESE PEAKS.

518
00:20:58,880 --> 00:21:00,520
AND 1 OF THE FUN THINGS ABOUT

519
00:21:00,520 --> 00:21:02,240
SCIENCE THAT WILL SURPRISE YOU

520
00:21:02,240 --> 00:21:05,120
AND WE DIDN'T SEE ANY CHANGES IN

521
00:21:05,120 --> 00:21:09,520
GLX BUT WE DID SEE ELEVATION AND

522
00:21:09,520 --> 00:21:12,120
THE INHIBITORY COMPOUND GABBA,

523
00:21:12,120 --> 00:21:14,200
WHICH WAS QUITE INTERESTING AND

524
00:21:14,200 --> 00:21:16,000
WE ACTUALLY, THE STUDY WAS

525
00:21:16,000 --> 00:21:17,600
CONDUCT INDEED PARALLEL WITH THE

526
00:21:17,600 --> 00:21:20,400
VERY SIMILAR STUDY DESIGN IN

527
00:21:20,400 --> 00:21:21,200
INDIVIDUALS WITH DEPRESSION.

528
00:21:21,200 --> 00:21:22,920
AND THE IN DEPRESSION

529
00:21:22,920 --> 00:21:25,160
INDIVIDUALS HAD INCREASE IN BOTH

530
00:21:25,160 --> 00:21:32,040
GLX AND GABA, SO THERE MAY BE

531
00:21:32,040 --> 00:21:33,680
KETAMINE EFFECTS IN OCD RELATIVE

532
00:21:33,680 --> 00:21:35,000
TO DEPRESSION BUT AGAIN THIS

533
00:21:35,000 --> 00:21:39,360
NEEDS REPLICATION IN A LARGER

534
00:21:39,360 --> 00:21:39,600
SAMPLE.

535
00:21:39,600 --> 00:21:44,960
SO GOING FROM THE ANIMAL MODEL

536
00:21:44,960 --> 00:21:46,960
SET BACK, 3, TO THINKING IT AS A

537
00:21:46,960 --> 00:21:48,600
CANDIDATE AND TESTING IT IN OCD,

538
00:21:48,600 --> 00:21:51,680
WE WANTED TO GO BACK NOW TO THE

539
00:21:51,680 --> 00:21:53,400
ANIMAL MODEL THAT INSPIRED ME

540
00:21:53,400 --> 00:21:55,560
AND WE PARTNERED WITH LISA

541
00:21:55,560 --> 00:21:56,800
[INDISCERNIBLE] AND GWEN DAVIS

542
00:21:56,800 --> 00:21:59,120
AS A STUDENT IN

543
00:21:59,120 --> 00:22:01,040
DR. [INDISCERNIBLE]'S LAB AT

544
00:22:01,040 --> 00:22:03,280
UCSF TO ACTUALLY DO KIND OF A

545
00:22:03,280 --> 00:22:05,440
CLINICAL TRIAL IN MICE.

546
00:22:05,440 --> 00:22:09,400
WE GAVE THESE ANIMALS HAD BASE

547
00:22:09,400 --> 00:22:10,800
LINE GROOMING DEFICITS AND WE

548
00:22:10,800 --> 00:22:14,200
INJECTED THEM WITH EITHER

549
00:22:14,200 --> 00:22:15,600
KETAMINE OR SALINE ON DAY 0 EXPW

550
00:22:15,600 --> 00:22:20,520
WE CAN ACTUALLY LOOK AT GROOMING

551
00:22:20,520 --> 00:22:22,520
BOUTS 1 HOUR, 1 DAY, 3 DAYS, 7

552
00:22:22,520 --> 00:22:24,000
DAYS AT THE SAME TIME WE DID THE

553
00:22:24,000 --> 00:22:24,880
CLINICAL STUDY.

554
00:22:24,880 --> 00:22:28,600
AND WE WANTED TO ASK

555
00:22:28,600 --> 00:22:31,240
SPECIFICALLY DOES THIS AFFECT

556
00:22:31,240 --> 00:22:32,080
THE FRONTAL TRIAT OLDER PEOPLE

557
00:22:32,080 --> 00:22:33,240
PROJECTION IN THE CIRCUIT WE

558
00:22:33,240 --> 00:22:37,200
THINK IS IMPORTANT FOR OCD.

559
00:22:37,200 --> 00:22:39,200
AND SO THE FIRST THING WE WANTED

560
00:22:39,200 --> 00:22:41,760
TO DO IS YOU SEE HERE IN THE

561
00:22:41,760 --> 00:22:44,280
PURPLE BARS IS THIS IS THE SAPP

562
00:22:44,280 --> 00:22:45,160
A P3 KNOCKOUT MICE.

563
00:22:45,160 --> 00:22:47,000
YOU CAN SEE THE NUMBER OF

564
00:22:47,000 --> 00:22:50,040
GROOMING BOUTS AND ELEVATED

565
00:22:50,040 --> 00:22:51,640
RIGHT HERE.

566
00:22:51,640 --> 00:22:54,360
COMPARED TO WILD-TYPE MICE.

567
00:22:54,360 --> 00:22:59,360
AND THEN, THE INDIVIDUALS WITH

568
00:22:59,360 --> 00:23:01,320
THE DASH BARS ARE THE 1S THAT

569
00:23:01,320 --> 00:23:03,520
GOT THE KETAMINE AND THEN YOU

570
00:23:03,520 --> 00:23:07,400
CAN SEE THE RESPONSE GOING DOWN.

571
00:23:07,400 --> 00:23:09,720
SO THIS IS ANOTHER PICTURE.

572
00:23:09,720 --> 00:23:11,480
SO IN THE KNOCKOUT MICE THIS, IS

573
00:23:11,480 --> 00:23:12,400
THE GROOMING, STAYS UP ABOVE

574
00:23:12,400 --> 00:23:16,120
THIS BAR BUT THEN WHEN YOU GET

575
00:23:16,120 --> 00:23:18,080
KETAMINE, IT COMES DOWN AND THE

576
00:23:18,080 --> 00:23:19,240
WILD-TYPE, THERE ISN'T MUCH

577
00:23:19,240 --> 00:23:23,600
DIFFERENCE BETWEEN THE SALINE

578
00:23:23,600 --> 00:23:26,440
AND KETAMINE AND THEN

579
00:23:26,440 --> 00:23:27,280
DR. [INDISCERNIBLE] IS HER TEAM

580
00:23:27,280 --> 00:23:30,920
WERE ABLE TO USE WOBDERFUL TOOLS

581
00:23:30,920 --> 00:23:32,760
CALLED OPTOGENETICS IN WHICH YOU

582
00:23:32,760 --> 00:23:33,800
INTRODUCE THIS MOLECULE INTO

583
00:23:33,800 --> 00:23:35,080
NEURONS AND BASICALLY WITH LIGHT

584
00:23:35,080 --> 00:23:38,800
TURN ON AND OFF DIFFERENT KINDS

585
00:23:38,800 --> 00:23:39,600
OF CELL POPULATIONS.

586
00:23:39,600 --> 00:23:43,080
AND SO THE FITTER PART OF THE

587
00:23:43,080 --> 00:23:44,000
EXPERIMENT, SHE USED CANETTA

588
00:23:44,000 --> 00:23:46,480
MINE TO SHOW INCREASED ACTIVITY

589
00:23:46,480 --> 00:23:47,800
AND THE PREFRONTAL NEURONS AND

590
00:23:47,800 --> 00:23:49,360
THOSE ARE THE 1S THAT ARE

591
00:23:49,360 --> 00:23:50,600
PROJECTING THE 1S IN THE

592
00:23:50,600 --> 00:23:53,320
KNOCKOUT MICE AND THEN OPTICAL

593
00:23:53,320 --> 00:23:54,840
IMAGES O GENETICALLY, SHE

594
00:23:54,840 --> 00:23:56,320
MIMICKED THIS INCREASE IN THE

595
00:23:56,320 --> 00:23:57,120
FRONTAL TRIAT OLDER PEOPLE

596
00:23:57,120 --> 00:23:59,680
ACTIVITY AND IT SHOWED REDUCED

597
00:23:59,680 --> 00:24:02,480
COMPULSIVE GROOMING BEHAVIOR IN

598
00:24:02,480 --> 00:24:03,600
THE KNOCKOUT MICE.

599
00:24:03,600 --> 00:24:05,520
AND THEN CONVERSELY IF YOU

600
00:24:05,520 --> 00:24:06,960
INHIBIT THE CIRCUIT IN THE

601
00:24:06,960 --> 00:24:10,040
WILD-TYPE MICE, IT INCREASED

602
00:24:10,040 --> 00:24:10,440
GROOMING.

603
00:24:10,440 --> 00:24:13,680
AND THEN, SHE WAS ABLE TO SHOW

604
00:24:13,680 --> 00:24:14,840
THAT KETAMINE BLOCKED

605
00:24:14,840 --> 00:24:16,480
EXACERBATION OF GROOMING IF THE

606
00:24:16,480 --> 00:24:17,840
KNOCKOUT MICE CAUSED BY OPTICAL

607
00:24:17,840 --> 00:24:21,760
IMAGES O GENETICALLY INHIBITING

608
00:24:21,760 --> 00:24:23,880
THE FRONTAL TRIATAL ACTIVITY.

609
00:24:23,880 --> 00:24:26,440
SO WE'RE REALLY EXCITED THIS

610
00:24:26,440 --> 00:24:27,600
EXPERIENCE CEMETERY THAT

611
00:24:27,600 --> 00:24:29,680
KETAMINE INCREASES ACTIVITY IN

612
00:24:29,680 --> 00:24:31,680
THE FRONTAL STRIATAL CIRCUIT

613
00:24:31,680 --> 00:24:32,720
THAT POSITIVELY CONTROLS

614
00:24:32,720 --> 00:24:33,120
GROOMING BEHAVIOR.

615
00:24:33,120 --> 00:24:34,200
THIS IS SOMETHING YOU CAN'T DO

616
00:24:34,200 --> 00:24:37,320
IN HUMANS BUT THIS IS THE

617
00:24:37,320 --> 00:24:39,400
BEAUTIFUL THING ABOUT WORKING IN

618
00:24:39,400 --> 00:24:40,960
ANIMAL MODELS, YOU CAN ACTUALLY

619
00:24:40,960 --> 00:24:41,880
LOOK AT CAUSALITY AND THIS

620
00:24:41,880 --> 00:24:43,640
SUGGESTS THAT THE CIRCUIT MAY BE

621
00:24:43,640 --> 00:24:48,920
IMPORTANT FOR KETAMINE'S

622
00:24:48,920 --> 00:24:49,960
THERAPEUTIC EFFECTS ON OCD.

623
00:24:49,960 --> 00:24:53,200
SO WITH THIS, YOU KNOW FEELING,

624
00:24:53,200 --> 00:24:54,400
YOU KNOW HAPPY ABOUT THESE

625
00:24:54,400 --> 00:24:56,600
RESULTS AND HAVING THIS SORT OF

626
00:24:56,600 --> 00:25:01,720
TRANSLATIONAL MODEL TO WORK

627
00:25:01,720 --> 00:25:03,600
WITH, WE TURN BACK TO SEEING IF

628
00:25:03,600 --> 00:25:04,600
THERE ARE OTHER APPROACHES THAT

629
00:25:04,600 --> 00:25:07,400
DON'T HAVE THE SIDE EFFECTS CAN

630
00:25:07,400 --> 00:25:08,240
KETAMINE.

631
00:25:08,240 --> 00:25:09,600
SO CARLOS [INDISCERNIBLE] AT NIH

632
00:25:09,600 --> 00:25:12,600
AND HIS TEAM DEVELOPED A

633
00:25:12,600 --> 00:25:14,560
METABOLITE OF KETAMINE CALLED

634
00:25:14,560 --> 00:25:16,800
RRHNK AND IT WAS STUDIED IN

635
00:25:16,800 --> 00:25:20,040
ANIMAL MODELS OF DEPRESSION AND

636
00:25:20,040 --> 00:25:22,560
IS NOW UNDERGOING PHASE 2 STUDY

637
00:25:22,560 --> 00:25:25,040
AND IT'S SHOWING VERY PROMISING

638
00:25:25,040 --> 00:25:30,200
EARLY RESULTS THAT IT CAN HAVE

639
00:25:30,200 --> 00:25:30,800
ANTIDEPRESSANT EFFECTS WITHOUT

640
00:25:30,800 --> 00:25:32,600
SOME OF THE SIDE EEIVETS OF

641
00:25:32,600 --> 00:25:32,840
KETAMINE.

642
00:25:32,840 --> 00:25:35,800
AND SO WE'RE VERY FORTUNATE TO

643
00:25:35,800 --> 00:25:39,240
BE ABLE TO DO ALSO A PHASE 2

644
00:25:39,240 --> 00:25:46,880
STUDY IN PARALLEL WITH OCD.

645
00:25:46,880 --> 00:25:48,280
AND THEN FINALLY WITH NIH

646
00:25:48,280 --> 00:25:50,480
FUNDING BE ABLE TO DO A STUDY

647
00:25:50,480 --> 00:25:53,000
LOOKING AT A STRONGER CONTROL

648
00:25:53,000 --> 00:25:55,600
INSTEAD OF SALINE LIKE THE PILOT

649
00:25:55,600 --> 00:25:55,800
STUDY.

650
00:25:55,800 --> 00:26:01,680
WE'RE ABLE TO ELECTRIC AT AN

651
00:26:01,680 --> 00:26:02,720
ACTIVE COMPARITTOR MEDAZALAM,

652
00:26:02,720 --> 00:26:05,600
WHICH MIMIC THE WOOZINESS AND

653
00:26:05,600 --> 00:26:06,600
FLOATY FEELING OF KETAMINE.

654
00:26:06,600 --> 00:26:09,480
AND ALSO LOOK AT BIOMARKERS OF

655
00:26:09,480 --> 00:26:12,000
RESPONSE EXPANDING NOT ONLY

656
00:26:12,000 --> 00:26:12,840
MAGNETIC RESONANCE MICROSOPEN

657
00:26:12,840 --> 00:26:16,200
MEETINGY BUT LOOKING AT FMRI TO

658
00:26:16,200 --> 00:26:17,600
LOOK AT CIRCUITS INVOLVED AND

659
00:26:17,600 --> 00:26:19,680
EEG TO LOOK AT NETWORK AND

660
00:26:19,680 --> 00:26:21,640
SYNCHRONY TO UNDERSTAND WHERE IS

661
00:26:21,640 --> 00:26:23,320
KETAMINE ACTING AND THERE ARE

662
00:26:23,320 --> 00:26:25,080
ANY BIOMARKERS OF WHO RESPONDS

663
00:26:25,080 --> 00:26:25,440
TO THIS.

664
00:26:25,440 --> 00:26:28,600
SO I WILL BE PRESENTING THE TOP

665
00:26:28,600 --> 00:26:30,600
LINE RESULTS AT ECNP THIS COMING

666
00:26:30,600 --> 00:26:32,120
DECEMBER AND SO STAY TUNED THERE

667
00:26:32,120 --> 00:26:34,160
WILL BE A LOT OF WONDERFUL DATA

668
00:26:34,160 --> 00:26:36,880
AND RESULTS THAT COME OUT OF

669
00:26:36,880 --> 00:26:37,720
THIS STUDY.

670
00:26:37,720 --> 00:26:41,480
SO TURNING NEXT TO MECHANISMS OF

671
00:26:41,480 --> 00:26:43,000
KETAMINE, 1 OF THE THINGS WE

672
00:26:43,000 --> 00:26:46,560
FIND IS THAT THERE'S THIS KIND

673
00:26:46,560 --> 00:26:47,560
OF EUPHORIC FEETING FOR KETAMINE

674
00:26:47,560 --> 00:26:51,360
IN THE BEGINNING AND THERE ARE

675
00:26:51,360 --> 00:26:52,880
ALSO LOCKER LASTING EFFECTS, SO

676
00:26:52,880 --> 00:26:55,800
WE WANTED TO TRY AND UNDERSTAND,

677
00:26:55,800 --> 00:26:57,880
IS THIS KIND OF RUSHED THIS

678
00:26:57,880 --> 00:27:00,320
EUPHORIA, IS THAT, YOU KNOW

679
00:27:00,320 --> 00:27:01,400
AFFECTING THE OPIOID SYSTEM.

680
00:27:01,400 --> 00:27:03,200
AS YOU KNOW KETAMINE IS ALSO A

681
00:27:03,200 --> 00:27:03,880
DRUG OF ABUSE.

682
00:27:03,880 --> 00:27:07,480
SO IN ORDER TO TEST THIS OUT, I

683
00:27:07,480 --> 00:27:09,120
PARTNERED WITH ALAN CANNED WHAT,

684
00:27:09,120 --> 00:27:12,520
AND NOLAN WILLIAMS AND

685
00:27:12,520 --> 00:27:14,840
[INDISCERNIBLE] TO LOOK AT

686
00:27:14,840 --> 00:27:17,080
WHETHER WE COULD USE MALTREKS

687
00:27:17,080 --> 00:27:20,080
OWN WHICH IS AN OPIOID RECEPTOR

688
00:27:20,080 --> 00:27:21,160
ANTAGONIST TO BLOCK, TO SEE IF

689
00:27:21,160 --> 00:27:25,240
WE COULD BLOCK THIS EFFECT

690
00:27:25,240 --> 00:27:27,160
ACROSS 2 CONDITIONS.

691
00:27:27,160 --> 00:27:28,920
AND SO INDIVIDUALS WERE

692
00:27:28,920 --> 00:27:31,520
RANDOMIZED TO EITHER GET

693
00:27:31,520 --> 00:27:34,280
KETAMINE PLUS NALTREKS OWN OR

694
00:27:34,280 --> 00:27:38,400
KETAMINE PLUS MA SEEB O AND THEN

695
00:27:38,400 --> 00:27:41,800
THEY WERE ADDRESSED WITH THE

696
00:27:41,800 --> 00:27:43,000
DEPRESSION SCALE AS LISTED HERE,

697
00:27:43,000 --> 00:27:45,520
THE GREATER THE NUMBER, THE

698
00:27:45,520 --> 00:27:46,720
GREATER THE DEPRESSIVE EFFECTS,

699
00:27:46,720 --> 00:27:49,120
OVER THE COURSE OF A WEEK AND

700
00:27:49,120 --> 00:27:51,760
THEN TO ANOTHER ADDITIONAL WEEK

701
00:27:51,760 --> 00:27:54,360
AFTER AND WHAT YOU CAN SEE HERE

702
00:27:54,360 --> 00:27:59,080
IS THAT KETAMINE PLUS NALTREXONE

703
00:27:59,080 --> 00:28:00,800
BLOCKED THE EABT DEPRESS ANT

704
00:28:00,800 --> 00:28:02,600
EFFECTS WHERE JUST KETAMINE

705
00:28:02,600 --> 00:28:04,640
ALONE YOU GET THE NICE ROBUST

706
00:28:04,640 --> 00:28:05,120
EFFECT.

707
00:28:05,120 --> 00:28:09,440
AND THAT THE ANTAGONIST, 10UATE

708
00:28:09,440 --> 00:28:11,400
THE ANTIDEPRESSANT EFFECT BUT

709
00:28:11,400 --> 00:28:14,800
NOT THE DISASSOCIATATIVE

710
00:28:14,800 --> 00:28:15,040
SYMPTOMS.

711
00:28:15,040 --> 00:28:17,160
SO IN SUMMARY, THE OPIOID SYSTEM

712
00:28:17,160 --> 00:28:20,760
ACTIVATION IS CRITICAL FOR

713
00:28:20,760 --> 00:28:21,280
KETAMINE'S ANTIDEPRESSANT

714
00:28:21,280 --> 00:28:22,080
EFFECTS AND 1 OF THE QUESTIONS

715
00:28:22,080 --> 00:28:24,800
IS HOW DO WE

716
00:28:24,800 --> 00:28:26,400
RECOGNIZE--RECONCILE THIS WITH

717
00:28:26,400 --> 00:28:29,200
THE PRIOR RESEARCH IN GLUTAMATE.

718
00:28:29,200 --> 00:28:31,400
SO, YOU KNOW 1 POTENTIAL

719
00:28:31,400 --> 00:28:32,200
HYPOTHESIS BUT AGAIN NEEDS LOTS

720
00:28:32,200 --> 00:28:37,440
OF FOLKS IN THE FIELD TO FURTHER

721
00:28:37,440 --> 00:28:41,200
RESEARCH THIS, IS THAT THE

722
00:28:41,200 --> 00:28:43,680
INITIAL EUPHORIC EVENTS AND

723
00:28:43,680 --> 00:28:46,440
EFFECT MAY BE CATALYZED THROUGH

724
00:28:46,440 --> 00:28:47,400
THE OPIOID SYSTEM BUT THEN

725
00:28:47,400 --> 00:28:49,600
THERE'S A PERIOD OF TIME WHERE

726
00:28:49,600 --> 00:28:51,520
THOSE EFFECTS REMAIN AND SO THAT

727
00:28:51,520 --> 00:28:53,240
MAY BE WHERE THE GLUTAMATE

728
00:28:53,240 --> 00:28:56,000
SYSTEM IS IMPORTANT IN DRIVING

729
00:28:56,000 --> 00:28:58,800
THE TRANSIENT MAINTENANCE OF

730
00:28:58,800 --> 00:29:00,160
ANTIDEPRESSANT RESPONSE THROUGH

731
00:29:00,160 --> 00:29:02,440
MODULATION OF BRAIN PLASTICITY

732
00:29:02,440 --> 00:29:04,960
AND CONNOR LISTED AND COLLEAGUES

733
00:29:04,960 --> 00:29:08,080
HAVE INDEED SHOWN THAT DENDRITIC

734
00:29:08,080 --> 00:29:11,120
SPINES ARE IMPACTED BY KETAMINE

735
00:29:11,120 --> 00:29:13,520
AND PLAY A ROLE IN THE

736
00:29:13,520 --> 00:29:14,400
ANTIDEPRESSANT RESPONSE.

737
00:29:14,400 --> 00:29:16,840
WHAT'S REALLY EXCITING TO BE

738
00:29:16,840 --> 00:29:19,080
ABLE TO STUDY AND HAVE OTHER

739
00:29:19,080 --> 00:29:20,200
PEOPLE CONTRIBUTE TO OUR

740
00:29:20,200 --> 00:29:22,640
UNDERSTANDING OF THE KETAMINE'S

741
00:29:22,640 --> 00:29:23,280
MECHANISM OF ACTION.

742
00:29:23,280 --> 00:29:26,920
ONE AREA THAT IS NOT YET

743
00:29:26,920 --> 00:29:30,240
STUDIED, IS WHY THIS REVERSES?

744
00:29:30,240 --> 00:29:32,000
SO KETAMINE'S EFFECTS ARE

745
00:29:32,000 --> 00:29:32,520
TRANSIENT.

746
00:29:32,520 --> 00:29:35,000
AND SO WHAT HAPPENS TO THE

747
00:29:35,000 --> 00:29:39,600
GLUTAMATE SYSTEM THAT ALLOWS IT

748
00:29:39,600 --> 00:29:41,400
TO SUSTAIN BUT THEN WHERE IS IT

749
00:29:41,400 --> 00:29:43,600
HAPPENING THAT HAVE YOU THIS

750
00:29:43,600 --> 00:29:45,920
SORT OF OFF EFFECT.

751
00:29:45,920 --> 00:29:48,840
AND CAN WE DESIGN NEW TREATMENTS

752
00:29:48,840 --> 00:29:56,960
TO TRY AND CONTINUE THE EFFECTS

753
00:29:56,960 --> 00:29:57,720
OF KETAMINE.

754
00:29:57,720 --> 00:30:00,040
NEXT I WILL SPEAK ABOUT WORK

755
00:30:00,040 --> 00:30:01,320
WE'RE DOING WITH

756
00:30:01,320 --> 00:30:02,240
NEUROMODDULATION AND IT'S VERY

757
00:30:02,240 --> 00:30:03,800
EXCITING AND WANT TO SHARE WITH

758
00:30:03,800 --> 00:30:04,000
YOU.

759
00:30:04,000 --> 00:30:05,480
SO AGAIN BEING MINDFUL AS A

760
00:30:05,480 --> 00:30:07,000
CLINICIAN AND WANTING TO DO

761
00:30:07,000 --> 00:30:07,960
THINGS THAT HAVE MAXIMUM

762
00:30:07,960 --> 00:30:11,880
BENEFIT, RAPID AND HAVE LOW SIDE

763
00:30:11,880 --> 00:30:13,400
EFFECT PROFILE, NONINVASIVE

764
00:30:13,400 --> 00:30:14,320
NEUROMODDULATION IS REALLY

765
00:30:14,320 --> 00:30:17,400
EXCITING DIRECTION.

766
00:30:17,400 --> 00:30:21,520
AND SO, WE PARTNERED WITH NOLAN

767
00:30:21,520 --> 00:30:24,720
WILLIAMS, KEEP KEITH

768
00:30:24,720 --> 00:30:27,440
[INDISCERNIBLE] DRS. COLE,

769
00:30:27,440 --> 00:30:28,720
[INDISCERNIBLE] AND LEEAN

770
00:30:28,720 --> 00:30:33,000
WILLIAMS IN ORDER TO DO A

771
00:30:33,000 --> 00:30:35,040
MULTIMODAL COLLABORATION TO TEST

772
00:30:35,040 --> 00:30:36,600
WHETHER ACCELERATED DATA

773
00:30:36,600 --> 00:30:39,080
BIFORTS, SO THIS IS SOMETHING

774
00:30:39,080 --> 00:30:41,040
THAT NOLAN WILLIAMS AND

775
00:30:41,040 --> 00:30:42,360
[INDISCERNIBLE] AN APPROACH

776
00:30:42,360 --> 00:30:44,880
THEY'VE PATENTED COULD THAT BE

777
00:30:44,880 --> 00:30:47,240
APPLIED TO OBSESSIVE COMPULSIVE

778
00:30:47,240 --> 00:30:47,560
DISORDER.

779
00:30:47,560 --> 00:30:50,680
SO THEIR EARLY WORK IN

780
00:30:50,680 --> 00:30:52,000
DEPRESSION WAS REALLY

781
00:30:52,000 --> 00:30:52,320
INSPIRATIONAL.

782
00:30:52,320 --> 00:30:57,920
SO AS I MENTIONED, FDA HAS

783
00:30:57,920 --> 00:31:03,480
APPROVED REPETITIVE TMS USING A

784
00:31:03,480 --> 00:31:05,920
DEEP TMS APPROACH WITH AN H7

785
00:31:05,920 --> 00:31:11,160
COIL, THE TARGET IS THE

786
00:31:11,160 --> 00:31:13,360
PREMEDIAL CORTEX WITH THE

787
00:31:13,360 --> 00:31:14,480
FRONTAL CORTEX BILATERALLY AND

788
00:31:14,480 --> 00:31:17,360
WHAT YOU SEE HERE IS ESSENTIALLY

789
00:31:17,360 --> 00:31:18,880
THE RECIPE FOR HOW THOSE DOSES

790
00:31:18,880 --> 00:31:19,600
ARE DELIVERED.

791
00:31:19,600 --> 00:31:22,000
SO IT'S 5 DAYS A WEEK, 20

792
00:31:22,000 --> 00:31:22,680
MINUTES PER SESSION.

793
00:31:22,680 --> 00:31:26,400
IT TAKES PLACE OVER 6 WEEKS, AND

794
00:31:26,400 --> 00:31:30,160
PATENTS HUNDRED PULSES AND SO,

795
00:31:30,160 --> 00:31:34,320
IN THIS METHODOLOGY, THEY USE

796
00:31:34,320 --> 00:31:34,800
PERSONALIZED TREATMENT

797
00:31:34,800 --> 00:31:35,080
PROVOCATION.

798
00:31:35,080 --> 00:31:36,080
SO THEY WILL DO THE HIERARCHY

799
00:31:36,080 --> 00:31:38,760
THAT I HAD MENTIONED AND TRY AND

800
00:31:38,760 --> 00:31:40,120
HIT A CERTAIN LEVEL OF ANXIOUS

801
00:31:40,120 --> 00:31:44,400
TO KIND OF GET THE CIRCUIT

802
00:31:44,400 --> 00:31:44,600
ONLINE.

803
00:31:44,600 --> 00:31:47,840
AND SO 1 OF THE MOST PROMISING

804
00:31:47,840 --> 00:31:52,000
OPTIMIZATIONS FOR TRANSCRANIAL

805
00:31:52,000 --> 00:31:52,600
MAGNETIC STIMULATION IS TRYING

806
00:31:52,600 --> 00:31:56,240
TO SEE IF WE CAN REDUCE THE

807
00:31:56,240 --> 00:31:57,160
SESSION TIME, THE DURATION,

808
00:31:57,160 --> 00:31:59,760
INCREASING THE DOSE JUST LIKE WE

809
00:31:59,760 --> 00:32:02,760
DO WITH MEDICATIONS, AND SEEING

810
00:32:02,760 --> 00:32:03,440
IF TARGET PERSONALIZATION IS

811
00:32:03,440 --> 00:32:08,920
SOMETHING THAT CAN BE HELPFUL.

812
00:32:08,920 --> 00:32:12,000
SO 1 OF THE THINGS ABOUT BETA

813
00:32:12,000 --> 00:32:15,240
STIMULATION IS NOT ONLY DOES IT

814
00:32:15,240 --> 00:32:18,440
MIMIC NATURAL BRAIN RHYTHMS AND

815
00:32:18,440 --> 00:32:19,400
IT'S AN EFFECTIVE STIMULATION

816
00:32:19,400 --> 00:32:20,760
METHOD FOR THE CORTEX BUT IT

817
00:32:20,760 --> 00:32:22,600
ALSO REDUCES THE TIME OF

818
00:32:22,600 --> 00:32:25,000
TREATMENT WHILE KEEPING A

819
00:32:25,000 --> 00:32:27,120
SIMILAR EFFICACY TO TRADITIONAL

820
00:32:27,120 --> 00:32:28,880
RTMS, SO THAT'S WONDERFUL TO

821
00:32:28,880 --> 00:32:30,000
HEAR, RIGHT?

822
00:32:30,000 --> 00:32:31,000
IT DECREASES PATIENT BURDEN AND

823
00:32:31,000 --> 00:32:36,320
THE RISKS ARE MINIMAL TO

824
00:32:36,320 --> 00:32:36,800
PATIENTS.

825
00:32:36,800 --> 00:32:39,400
AND THIS CARTOON HERE ON THE

826
00:32:39,400 --> 00:32:41,720
RIGHT JUST SHOWS THAT DIFFERENT

827
00:32:41,720 --> 00:32:42,680
KINDS OF STIMULATION THAT YOU DO

828
00:32:42,680 --> 00:32:48,480
IN THE BRAIN CAN BE EXCITATORY

829
00:32:48,480 --> 00:32:51,800
OR INHIBITORY AND WE CHOSE A

830
00:32:51,800 --> 00:32:53,120
MODIFIED CONTINUOUS DATA BIFORT

831
00:32:53,120 --> 00:32:55,600
WITH SPACED APPLICATION THAT IS

832
00:32:55,600 --> 00:32:56,560
INHIBITORY IN NATURE.

833
00:32:56,560 --> 00:32:58,240
AGAIN, THIS ALLOWS US TO

834
00:32:58,240 --> 00:33:01,680
DECREASE THE TIME FROM 20

835
00:33:01,680 --> 00:33:07,040
MINUTES TO AROUND 2 MINUTES.

836
00:33:07,040 --> 00:33:08,760
AND IT ACTUALLY DRAMATICALLY

837
00:33:08,760 --> 00:33:09,840
ALSO SHRINKS THE TREATMENT

838
00:33:09,840 --> 00:33:11,960
DURATION SO INSTEAD OF DOING 6

839
00:33:11,960 --> 00:33:14,960
WEEKS OR 3-4 WEEKS, OUR NEW

840
00:33:14,960 --> 00:33:16,200
PROTOCOL THAT WE'RE DESIGNING

841
00:33:16,200 --> 00:33:23,920
WERE ABLE TO DO IN 5 DAYS. 

842
00:33:23,920 --> 00:33:26,400
AND SIMILARLY, BECAUSE OF THE

843
00:33:26,400 --> 00:33:27,440
DATA BURST STIMULATION, CAN YOU

844
00:33:27,440 --> 00:33:32,800
HAVE EVEN MORE DOSE, SO INSTEAD

845
00:33:32,800 --> 00:33:36,160
OF THE BRAIN SWEEP DEVICE,EE CAN

846
00:33:36,160 --> 00:33:38,200
GET NEARLY 90,000 PULSES IN.

847
00:33:38,200 --> 00:33:40,600
IS SO WE WERE ABLE TO USE A

848
00:33:40,600 --> 00:33:45,400
PERSONALIZED TARGET APPROACH, SO

849
00:33:45,400 --> 00:33:45,920
HIERARCHICAL CLUSTERING

850
00:33:45,920 --> 00:33:48,000
ALGORITHM CAN BE APPLIED TO EACH

851
00:33:48,000 --> 00:33:49,200
PARTICIPANTS RESTING STATE SCAN

852
00:33:49,200 --> 00:33:51,800
TO IDENTIFY THOSE PERSONALIZED

853
00:33:51,800 --> 00:33:52,160
SUBREGIONS.

854
00:33:52,160 --> 00:33:56,000
SO IN PHASE 1, WE BRING THE

855
00:33:56,000 --> 00:33:57,960
INDIVIDUAL INTO THE INNER

856
00:33:57,960 --> 00:33:58,800
IMAGING FACILITY.

857
00:33:58,800 --> 00:34:01,840
AND WE APPLY AN 8 MINUTE RESTING

858
00:34:01,840 --> 00:34:04,080
STATE SEQUENCE, AND THEN YOU CAN

859
00:34:04,080 --> 00:34:07,600
DO AN ANALYSIS, SO WE SELECT THE

860
00:34:07,600 --> 00:34:09,040
RIGHT FRONTAL POLE SUBUNIT

861
00:34:09,040 --> 00:34:09,880
SHOWING THE GREATEST

862
00:34:09,880 --> 00:34:12,480
CONNECTIVITY ACROSS ALL THE

863
00:34:12,480 --> 00:34:14,760
VENTRAL STRIATUM SUBUNITS AND

864
00:34:14,760 --> 00:34:16,520
THEN PHASE 2, IS REGISTRATION

865
00:34:16,520 --> 00:34:20,400
AND STIMULATION, SO THIS

866
00:34:20,400 --> 00:34:22,000
IS--THIS IS IN THE SCANNER SO

867
00:34:22,000 --> 00:34:26,640
THIS IS MY ACTUAL BRAIN HERE AND

868
00:34:26,640 --> 00:34:28,680
LOOKING AT THE LOCALITE

869
00:34:28,680 --> 00:34:29,280
NEURONAVIGATION SYSTEM TO

870
00:34:29,280 --> 00:34:31,080
POSITION THE COIL AND THIS

871
00:34:31,080 --> 00:34:32,760
SYSTEM ALLOWS YOU TO KIND OF

872
00:34:32,760 --> 00:34:33,600
POSITION TO REGISTER WHERE IS

873
00:34:33,600 --> 00:34:35,880
THE SITE YOU WANT TO STIMULATE

874
00:34:35,880 --> 00:34:38,080
AND ACTUALLY POSITION THE COIL

875
00:34:38,080 --> 00:34:43,520
OVER THAT PERSONALIZED TARGET.

876
00:34:43,520 --> 00:34:46,600
SO THIS WAS AGAIN OUR FIRST

877
00:34:46,600 --> 00:34:47,480
FORAY OPEN LABEL, MEAN ITS

878
00:34:47,480 --> 00:34:49,120
DOESN'T HAVE A RANDOMIZED

879
00:34:49,120 --> 00:34:52,280
CONTROL ARM OF 7 INDIVIDUALS

880
00:34:52,280 --> 00:34:56,080
JUST SO SEE, COULD WE DO 5

881
00:34:56,080 --> 00:34:57,840
CONSECUTIVE DAYS OF AN

882
00:34:57,840 --> 00:35:00,360
ACCELERATED COURSE OF THE THETA

883
00:35:00,360 --> 00:35:01,600
BUST STIMULATION TO THE RIGHT

884
00:35:01,600 --> 00:35:04,400
FRONTAL POLE AND HIT UP TO

885
00:35:04,400 --> 00:35:05,400
90,000 TOTAL PULSES AND JUST

886
00:35:05,400 --> 00:35:07,280
SEE, IS THIS SOMETHING THAT CAN

887
00:35:07,280 --> 00:35:12,520
BE OF BENEFIT TO INDIVIDUALS.

888
00:35:12,520 --> 00:35:14,360
AND I WAS REALLY HEARTENED AND

889
00:35:14,360 --> 00:35:16,800
THE TEAM WAS HEARTENED TO SEE IF

890
00:35:16,800 --> 00:35:19,720
YOU LOOK AT THE OBSESSIVE

891
00:35:19,720 --> 00:35:21,200
COMPULSIVE RATINGS SCALE WHICH I

892
00:35:21,200 --> 00:35:23,080
USED BEFORE, THE HIGHER THE

893
00:35:23,080 --> 00:35:26,000
NUMBER, THE MORE THE SYMPTOMS AT

894
00:35:26,000 --> 00:35:29,480
DAY 0 AND AT DAY 7, SO AFTER THE

895
00:35:29,480 --> 00:35:31,920
5 SESSIONS WE WERE ABLE TO SEE

896
00:35:31,920 --> 00:35:36,280
75% REDUCTION IN SYMPTOMS, 63,

897
00:35:36,280 --> 00:35:38,000
IT WAS VERY DRAMATIC AND WHAT'S

898
00:35:38,000 --> 00:35:39,560
INTERESTING THEN IF WE SEE,

899
00:35:39,560 --> 00:35:40,520
WHAT'S THE DURABILITY OF THE

900
00:35:40,520 --> 00:35:43,280
EFFECT, SO WE LOOK AT, YOU KNOW

901
00:35:43,280 --> 00:35:46,880
2 WEEKS OUT, 3 WEEKS OUT, 4

902
00:35:46,880 --> 00:35:47,920
WEEKS OUT, THE FIRST INDIVIDUAL

903
00:35:47,920 --> 00:35:52,280
HERE HAD A REMARKABLE DURABILITY

904
00:35:52,280 --> 00:35:57,280
OF THE EFFECT, AND NO LONGER

905
00:35:57,280 --> 00:36:01,520
MEETS CRITERIA FOR SYMPTOMATIC

906
00:36:01,520 --> 00:36:02,200
OCD SYMPTOMS.

907
00:36:02,200 --> 00:36:03,480
SOME INDIVIDUALS THOUGH,

908
00:36:03,480 --> 00:36:05,160
DIDN'T--DIDN'T HAVE ANY EFFECTS

909
00:36:05,160 --> 00:36:08,000
AND SOME HAD EFFECTS THAT TOOK A

910
00:36:08,000 --> 00:36:10,000
WHILE AND SOME HAD EFFECTS THAT

911
00:36:10,000 --> 00:36:16,080
STARTED IMMEDIATELY BUT THEN

912
00:36:16,080 --> 00:36:16,880
WENT AWAY.

913
00:36:16,880 --> 00:36:18,560
LOOKING AT THE SIDE EEIVETS IT

914
00:36:18,560 --> 00:36:19,720
WAS REALLY WONDERFUL TO SEE

915
00:36:19,720 --> 00:36:21,240
THERE WERE VERY FEW.

916
00:36:21,240 --> 00:36:23,560
SO IT WAS REMARKABLY WELL

917
00:36:23,560 --> 00:36:24,760
TOLERATED HEADACHE RESOLVE

918
00:36:24,760 --> 00:36:27,280
INDEED 1-3 DAYS POST SIMULATION

919
00:36:27,280 --> 00:36:28,200
START.

920
00:36:28,200 --> 00:36:30,520
AND FATIGUE RESOLVED IN 1-3

921
00:36:30,520 --> 00:36:30,760
DAYS.

922
00:36:30,760 --> 00:36:34,280
AND AS A CLINICIAN THIS IS WHAT

923
00:36:34,280 --> 00:36:36,000
WE WANT TO SEE.

924
00:36:36,000 --> 00:36:42,000
THERE WERE NO SERIOUS ADVERSE

925
00:36:42,000 --> 00:36:42,400
EVENTS.

926
00:36:42,400 --> 00:36:44,440
SO AGAIN THE CAVEAT IS A VERY

927
00:36:44,440 --> 00:36:46,920
SMALL OPEN LABEL PILOT BUT WE

928
00:36:46,920 --> 00:36:48,440
WANTED TO SEE IF WE COULD JUST

929
00:36:48,440 --> 00:36:50,800
EXPLORE AND GET A SIGNAL OR

930
00:36:50,800 --> 00:36:51,600
BIOMARKERS OF COGNITIVE CONTROL.

931
00:36:51,600 --> 00:36:53,960
SO I MENTIONED THAT IN OCD,

932
00:36:53,960 --> 00:36:55,640
THERE'S THIS KIND OF HYPER

933
00:36:55,640 --> 00:36:57,600
ACTIVE CIRCUIT, AND 1 OF THE

934
00:36:57,600 --> 00:36:59,120
HYPOTHESIS IS THAT WITHOUT A

935
00:36:59,120 --> 00:37:03,000
STOP SIGNAL, SO WITHOUT HAVING

936
00:37:03,000 --> 00:37:04,000
THE COGNITIVE CONTROL MACHINERY

937
00:37:04,000 --> 00:37:06,480
TO STOP THOSE THOUGHTS, THAT'S

938
00:37:06,480 --> 00:37:07,920
WHAT'S SORT OF BOMBARDING

939
00:37:07,920 --> 00:37:12,520
PATIENTS LIKE JOHN WITH THESE

940
00:37:12,520 --> 00:37:12,800
THOUGHTS.

941
00:37:12,800 --> 00:37:15,760
AND SO, WHAT WE LOOKED AT IS A

942
00:37:15,760 --> 00:37:19,520
TASK THAT ACTUALLY ALLOWS YOU TO

943
00:37:19,520 --> 00:37:23,720
LOOK AT COGNITIVE CONTROL AND WE

944
00:37:23,720 --> 00:37:26,000
SHOWED THAT RESPONDERS SHOWED

945
00:37:26,000 --> 00:37:28,400
GREATER DECREASE IN DORSAL

946
00:37:28,400 --> 00:37:30,000
LATERAL PREFRONTAL CORTEX DURING

947
00:37:30,000 --> 00:37:34,720
THE COGNITIVE CONTROL TASK

948
00:37:34,720 --> 00:37:36,360
FOLLOWING THE PROTOCOL.

949
00:37:36,360 --> 00:37:40,280
AND SO IN SUMMARY, WE SAW ROBUST

950
00:37:40,280 --> 00:37:42,920
AND RAPID, SO 5 OUT OF 7 OF

951
00:37:42,920 --> 00:37:46,120
THOSE INDIVIDUALS, 71% AT LEAST

952
00:37:46,120 --> 00:37:50,440
50% REDUCTION WITHIN 7-14 DAYS.

953
00:37:50,440 --> 00:37:51,720
IT WAS--SUSTAINED IN THE SUBSET,

954
00:37:51,720 --> 00:37:54,600
SO 3 OUT OF 5 HAD THESE EFFECTS

955
00:37:54,600 --> 00:37:57,720
THAT LASTED UP TO 4 WEEKS.

956
00:37:57,720 --> 00:38:00,040
AGAIN, SORT OF THINKING ABOUT

957
00:38:00,040 --> 00:38:02,240
THINGS IN TRANSLATION AND

958
00:38:02,240 --> 00:38:04,680
CLINICAL APPLICATION, IT WAS

959
00:38:04,680 --> 00:38:06,880
WONDERFUL IT WAS NONINVASIVE, IT

960
00:38:06,880 --> 00:38:10,840
HAD MINIMAL AND TRANSIENT SIDE

961
00:38:10,840 --> 00:38:11,080
EFFECTS.

962
00:38:11,080 --> 00:38:12,640
AND AGAIN, BIG CAVEAT THIS NEEDS

963
00:38:12,640 --> 00:38:16,520
TO BE REPLICATED AND SNEEDS A

964
00:38:16,520 --> 00:38:17,760
SHAM CONTROL BUT HEARTENING TO

965
00:38:17,760 --> 00:38:19,240
SEE AND THERE ARE MORE QUESTIONS

966
00:38:19,240 --> 00:38:19,800
TO EXPLORE.

967
00:38:19,800 --> 00:38:22,760
SO WHY DO SOME BUT NOT ALL

968
00:38:22,760 --> 00:38:23,160
PATIENTS RESPOND?

969
00:38:23,160 --> 00:38:25,040
AND WHY DO SOME HAVE PEAK

970
00:38:25,040 --> 00:38:26,240
RESPONSES AT DIFFERENT TIMES AND

971
00:38:26,240 --> 00:38:31,880
OTHERS HAVE MORE DURABLE

972
00:38:31,880 --> 00:38:32,160
RESPONSE.

973
00:38:32,160 --> 00:38:36,040
SO I JUST WANT TO SAY THAT THIS

974
00:38:36,040 --> 00:38:37,120
IS WHAT REALLY--THAT REALLY

975
00:38:37,120 --> 00:38:40,120
DRIVES AND MOTIVATES ME, SO

976
00:38:40,120 --> 00:38:41,880
JOHN, WAS ABLE YOU KNOW AFTER

977
00:38:41,880 --> 00:38:46,080
DOING THE KETAMINE STUDY,

978
00:38:46,080 --> 00:38:48,240
REDUCES SYMPTOMS, HE WAS ABLE TO

979
00:38:48,240 --> 00:38:49,920
DO COGNITIVE BEHAVIORIAL THERAPY

980
00:38:49,920 --> 00:38:51,120
WITH EXPOSURE AND RESPONSE

981
00:38:51,120 --> 00:38:52,240
PREVENTION AND CONTINUE WITH

982
00:38:52,240 --> 00:38:53,880
MAINTENANCE TO DO WELL, WAS ABLE

983
00:38:53,880 --> 00:38:57,440
TO GO BACK TO COLLEGE, ABLE TO

984
00:38:57,440 --> 00:38:58,400
GRADUATE, AND THAT'S REALLY WHY

985
00:38:58,400 --> 00:39:01,240
I DO THIS WORK.

986
00:39:01,240 --> 00:39:05,480
ALSO IT TAKES A VILLAGE TO DO

987
00:39:05,480 --> 00:39:07,440
CLINICAL RESEARCH STUDIES AND BE

988
00:39:07,440 --> 00:39:10,320
IN TRANSLATIONAL TEAMS SO I'M

989
00:39:10,320 --> 00:39:12,160
INCREDIBLY GRATEFUL FOR OUR

990
00:39:12,160 --> 00:39:13,800
RESEARCH TEAM AND ALL OF OUR

991
00:39:13,800 --> 00:39:15,720
COLLABORATORS THAT HAVE

992
00:39:15,720 --> 00:39:20,480
MENTIONED AS WE'VE GONE ALONG IN

993
00:39:20,480 --> 00:39:20,880
THE PRESENTATION.

994
00:39:20,880 --> 00:39:23,960
CONTACT US IF YOU KNOW, WE'RE AT

995
00:39:23,960 --> 00:39:25,360
STANFORD AND THE BAY AREA.

996
00:39:25,360 --> 00:39:26,800
IF YOU KNOW OF SOMEBODY WHO MAY

997
00:39:26,800 --> 00:39:28,400
BE INTERESTED IN PARTICIPATING

998
00:39:28,400 --> 00:39:32,400
RESEARCH STUDY FOR OCD, PLEASE

999
00:39:32,400 --> 00:39:36,200
E-MAIL US AT OCDRESEARCH

1000
00:39:36,200 --> 00:39:37,400
@STANFORD PASSPORT EDU.

1001
00:39:37,400 --> 00:39:39,760
I ALSO MENTIONED THE RESEARCH

1002
00:39:39,760 --> 00:39:46,760
AND HERING DISORDER SO E-MAIL US

1003
00:39:46,760 --> 00:39:49,040
AT CLUTTERHELP @STANFORD.EDU.

1004
00:39:49,040 --> 00:39:50,440
AND WE TRY TO HELP PEOPLE WITH

1005
00:39:50,440 --> 00:39:52,320
CARE, EVEN IF YOU'RE NOT

1006
00:39:52,320 --> 00:39:53,880
ELIGIBLE FOR RESEARCH STUDIES WE

1007
00:39:53,880 --> 00:39:55,480
ARE WELL CONNECTED WITH OCD

1008
00:39:55,480 --> 00:39:56,040
FOLKS THROUGHOUT THE UNITED

1009
00:39:56,040 --> 00:39:57,960
STATES SO FEEL FREE TO USE US AS

1010
00:39:57,960 --> 00:39:59,400
A RESOURCE IN THAT WAY.

1011
00:39:59,400 --> 00:40:00,400
AND FINALLY WE'RE REALLY

1012
00:40:00,400 --> 00:40:01,480
INTERESTED IN RESEARCH

1013
00:40:01,480 --> 00:40:01,960
COLLABORATIONS.

1014
00:40:01,960 --> 00:40:04,600
WE WOULD LOVE TO TRANSLATE

1015
00:40:04,600 --> 00:40:05,400
DISCOVERIES INTO NEW TREATMENTS

1016
00:40:05,400 --> 00:40:06,600
AND SO IF YOU'RE INTERESTED IN

1017
00:40:06,600 --> 00:40:08,280
BEING PART OF THIS RESEARCH WORK

1018
00:40:08,280 --> 00:40:12,760
OR PARTNERING WITH US, WE

1019
00:40:12,760 --> 00:40:13,600
DEFINITELY WELCOME THAT.

1020
00:40:13,600 --> 00:40:14,120
SO THAT'S IT.

1021
00:40:14,120 --> 00:40:15,200
THANK YOU SO MUCH.

1022
00:40:15,200 --> 00:40:16,720
I WILL TAKE QUESTIONS NOW AND I

1023
00:40:16,720 --> 00:40:22,880
WILL STOP SHARING MY SCREEN.

1024
00:40:22,880 --> 00:40:27,200
>> THANK YOU DR. RODRIGUEZ FOR

1025
00:40:27,200 --> 00:40:28,480
YOUR PASSION AND SHARING YOUR

1026
00:40:28,480 --> 00:40:30,800
WORK IN WHAT IS OBVIOUSLY A VERY

1027
00:40:30,800 --> 00:40:32,360
DIFFICULT DISEASE OR SPECTRUM OF

1028
00:40:32,360 --> 00:40:32,920
DISEASES.

1029
00:40:32,920 --> 00:40:35,000
A COUPLE QUESTIONS HAVE COME IN.

1030
00:40:35,000 --> 00:40:36,280
FIRST OF ALL CAN YOU TELL US

1031
00:40:36,280 --> 00:40:40,480
MORE ABOUT THE ROLE OF THE

1032
00:40:40,480 --> 00:40:42,080
PREFRONTAL CORTEX IN THE EMILY

1033
00:40:42,080 --> 00:40:45,960
CIBOL SYSTEM IN OCD?

1034
00:40:45,960 --> 00:40:46,160
YEAH.

1035
00:40:46,160 --> 00:40:48,080
>> YEAH, HAPPY TO DO THAT.

1036
00:40:48,080 --> 00:40:49,040
SO THERE'S CONVERGING MINDS OF

1037
00:40:49,040 --> 00:40:52,800
EVIDENCE THAT THERE IS A HYPER

1038
00:40:52,800 --> 00:40:55,080
ACTIVE LOOP CONSISTING OF THE

1039
00:40:55,080 --> 00:40:56,280
ORBITAL FRONTAL CORTEX WHICH IS

1040
00:40:56,280 --> 00:40:57,560
IMPORTANT FOR GENERATING

1041
00:40:57,560 --> 00:40:59,320
THOUGHTS, THE STRIATUM WHICH IS

1042
00:40:59,320 --> 00:41:00,240
IMPORTANT FOR GENERATING ABOUT

1043
00:41:00,240 --> 00:41:01,800
HAIEVERS AND LOOPING DOWN TO THE

1044
00:41:01,800 --> 00:41:04,040
THALAMUS WHICH IS A RELAY

1045
00:41:04,040 --> 00:41:06,040
STATION BACK TO THE ORBITAL

1046
00:41:06,040 --> 00:41:07,600
FRONTAL CORTEX AND IF YOU LOOK

1047
00:41:07,600 --> 00:41:09,480
AT NEURAL IMAGING STUDIES, THIS

1048
00:41:09,480 --> 00:41:14,520
REGION TENDS TO BE HYPER ACTIVE.

1049
00:41:14,520 --> 00:41:17,880
AND SO, THAT IS 1 OF THE MAIN

1050
00:41:17,880 --> 00:41:20,280
SORT OF TOPICS OF INVESTIGATION.

1051
00:41:20,280 --> 00:41:22,400
HOWEVER, IN THE OCD FIELD, SO

1052
00:41:22,400 --> 00:41:24,840
THIS WAS KIND OF LIKE THE FIRST

1053
00:41:24,840 --> 00:41:26,120
CIRCUIT THAT WAS HIGHLIGHTED BUT

1054
00:41:26,120 --> 00:41:28,080
THERE ARE A LOT OF REALLY

1055
00:41:28,080 --> 00:41:29,400
INTERESTING LINES AND THREADS OF

1056
00:41:29,400 --> 00:41:33,720
RESEARCH LOOKING AT OTHER LOOPS

1057
00:41:33,720 --> 00:41:38,160
AND OTHER AREAS, SO LOOKING AT

1058
00:41:38,160 --> 00:41:41,120
THINGS LIKE HABIT AND GOAL

1059
00:41:41,120 --> 00:41:43,880
DIRECTED ACTIVITY AND MANY MORE,

1060
00:41:43,880 --> 00:41:48,080
SO, REALLY I'VE KIND OF

1061
00:41:48,080 --> 00:41:50,360
SIMPLIFIED AND WE CAN FOCUS ON

1062
00:41:50,360 --> 00:41:53,800
THIS 1 BUT OCD IS COMPLICATED,

1063
00:41:53,800 --> 00:41:55,000
IT'S HETEROGEANIOUS AS WELL SO

1064
00:41:55,000 --> 00:41:56,080
THAT'S WHY IT'S IMPORTANT TO

1065
00:41:56,080 --> 00:41:58,400
HAVE RESEARCH AND SORT OF

1066
00:41:58,400 --> 00:42:00,400
PRECISION AND BIOMARKERS TO

1067
00:42:00,400 --> 00:42:02,760
FIGURE OUT WHO HAS THESE SORT OF

1068
00:42:02,760 --> 00:42:04,000
UNDERLYING CIRCUIT CHANGES AND

1069
00:42:04,000 --> 00:42:05,440
WHO MIGHT NOT.

1070
00:42:05,440 --> 00:42:07,440
SO WHO MAY BENEFIT FROM WHAT

1071
00:42:07,440 --> 00:42:08,720
TYPE OF THERAPY OR NOT.

1072
00:42:08,720 --> 00:42:12,000
RIGHT NOW WE KNOW 1 SIZE DOESN'T

1073
00:42:12,000 --> 00:42:13,120
FIT ALL.

1074
00:42:13,120 --> 00:42:14,200
>> ALONG THOSE LINES, ACTUALLY,

1075
00:42:14,200 --> 00:42:16,480
DO YOU HAVE ANY THOUGHTS ON WHY

1076
00:42:16,480 --> 00:42:19,240
DRUGS WORK IN SOME PATES AND WHY

1077
00:42:19,240 --> 00:42:22,440
CBT WILL WORK IN OTHERS?

1078
00:42:22,440 --> 00:42:23,040
>> THERE'S ONGOING RESEARCH.

1079
00:42:23,040 --> 00:42:25,560
I KNOW IF YOU LOOK AT CLINICAL

1080
00:42:25,560 --> 00:42:26,760
TRIALS .GOV, THERE'S A LOT OF

1081
00:42:26,760 --> 00:42:30,040
STUDIES LOOKINGA THE THIS, SO

1082
00:42:30,040 --> 00:42:32,120
WHY, YOU KNOW WE DON'T KNOW, 1

1083
00:42:32,120 --> 00:42:33,560
OF THE GREAT MYSTERIES, I DON'T

1084
00:42:33,560 --> 00:42:36,240
KNOW IF YOU'VE SEEN THE RECENT

1085
00:42:36,240 --> 00:42:38,200
PRESSES THAT SEROTONIN AND ITS

1086
00:42:38,200 --> 00:42:40,280
LINKS TO NEUROPATHOLOGY AND

1087
00:42:40,280 --> 00:42:41,800
PARTICULARLY IN OCD HAVEN'T BEEN

1088
00:42:41,800 --> 00:42:42,800
ESTABLISHED SO THERE ISN'T SORT

1089
00:42:42,800 --> 00:42:47,440
OF LIKE THE SMOKING--THE END ALL

1090
00:42:47,440 --> 00:42:50,520
BE ALL THAT SEROTONIN IS

1091
00:42:50,520 --> 00:42:53,480
DEFINITELY LINKED WITH OCD AND

1092
00:42:53,480 --> 00:42:56,400
EVEN THOUGH SEROTONIN WORKS,

1093
00:42:56,400 --> 00:42:57,400
SEROTONIN MODULATION WORKS FOR

1094
00:42:57,400 --> 00:42:58,640
OCD WE HAVEN'T PIECED TOGETHER

1095
00:42:58,640 --> 00:42:59,960
THE THREADS OF THAT.

1096
00:42:59,960 --> 00:43:01,760
SO THERE'S ACTUALLY A LITTLE BIT

1097
00:43:01,760 --> 00:43:05,040
MORE EVIDENCE FOR GLUTAMATE

1098
00:43:05,040 --> 00:43:06,000
MODULATION FOR OCD.

1099
00:43:06,000 --> 00:43:10,760
SO, I THINK IT'S IMPORTANT TO

1100
00:43:10,760 --> 00:43:13,000
UNDERSTAND THOSE NEUROBIOLOGICAL

1101
00:43:13,000 --> 00:43:15,400
AND CHEMICAL MECHANISMS BUT JUST

1102
00:43:15,400 --> 00:43:16,680
COMPLETELY ANECDOTALLY WHEN

1103
00:43:16,680 --> 00:43:18,400
WE--WHEN WE DID A STUDY LOOKING

1104
00:43:18,400 --> 00:43:21,200
AT A SINGLE INFUSION OF KETAMINE

1105
00:43:21,200 --> 00:43:23,680
AND THEN PARTNERING IT, THAT

1106
00:43:23,680 --> 00:43:25,520
WITH COGNITIVE BEHAVIORIAL

1107
00:43:25,520 --> 00:43:26,400
THERAPY, THE RESPONSES WERE

1108
00:43:26,400 --> 00:43:28,320
DIFFERENT FOR EACH OF THE

1109
00:43:28,320 --> 00:43:29,600
INDIVIDUALS, SOME PEOPLE HAVE

1110
00:43:29,600 --> 00:43:31,880
VARIABLE RESPONSE TO KETAMINE,

1111
00:43:31,880 --> 00:43:32,600
SOME PEOPLE HAD VARIABLE

1112
00:43:32,600 --> 00:43:36,200
RESPONSE TO EXPOSE AND YOU ARE

1113
00:43:36,200 --> 00:43:37,400
RESPONSE PREVENTION.

1114
00:43:37,400 --> 00:43:40,000
AND IT MAY BE THAT THERE ARE A

1115
00:43:40,000 --> 00:43:42,840
NUMBER OF DEFICITS THAT CAN LEAD

1116
00:43:42,840 --> 00:43:45,680
TO OCD AND 1 OF THE THINGS THAT

1117
00:43:45,680 --> 00:43:46,600
COGNITIVE BEHAVIORIAL THERAPY

1118
00:43:46,600 --> 00:43:53,160
RELIES ON OR WE THINK IT DOES IS

1119
00:43:53,160 --> 00:43:54,200
EXTINCTION LEARNING SO THE

1120
00:43:54,200 --> 00:43:55,640
ABILITY TO LEARN THAT ANXIETY

1121
00:43:55,640 --> 00:43:57,680
GOES DOWN OVER TIME BUT WHAT IF

1122
00:43:57,680 --> 00:43:58,760
THE UNDERLYING NEUROBIOLOGY OF

1123
00:43:58,760 --> 00:44:00,600
THAT IS SOMEHOW BROKEN OR

1124
00:44:00,600 --> 00:44:00,840
DAMAGED?

1125
00:44:00,840 --> 00:44:04,120
THOSE PEOPLE MAY NOT BENEFIT

1126
00:44:04,120 --> 00:44:05,000
FROM COGNITIVE BEHAVIORIAL

1127
00:44:05,000 --> 00:44:06,000
THERAPY, SO THESE TYPES OF

1128
00:44:06,000 --> 00:44:08,880
STUDIES THAT SORT OF CAREFULLY

1129
00:44:08,880 --> 00:44:10,840
LOOK AT MULTIPLE HYPOTHESIS AT

1130
00:44:10,840 --> 00:44:12,520
THE SAME TIME AND BY O MARKERS

1131
00:44:12,520 --> 00:44:15,840
OF RESPONSE MAY HELP US GET TO

1132
00:44:15,840 --> 00:44:16,800
THIS QUESTION.

1133
00:44:16,800 --> 00:44:19,360
>> THANK YOU. 

1134
00:44:19,360 --> 00:44:21,000
>> AND THAT GETS TO ANOTHER

1135
00:44:21,000 --> 00:44:22,800
QUESTION AS FAR AS A

1136
00:44:22,800 --> 00:44:25,400
MULTIPRONGED APPROACH TO OCD.

1137
00:44:25,400 --> 00:44:26,880
REGARDING KETAMINE MEDICATION

1138
00:44:26,880 --> 00:44:29,640
AND THE RAPID EMELIORATION OF

1139
00:44:29,640 --> 00:44:31,640
OCD SYMPTOMS IN THAT STUDY WHERE

1140
00:44:31,640 --> 00:44:32,680
CONSURRENT MEDICATION IS USED

1141
00:44:32,680 --> 00:44:35,160
AND IF SO HOW DID THAT AFFECT

1142
00:44:35,160 --> 00:44:37,160
DURABILITY TO THE RESPONSE?

1143
00:44:37,160 --> 00:44:39,600
>> SAY THE FIRST PART AGAIN?

1144
00:44:39,600 --> 00:44:42,520
>> YEAH, SO WITH THE REGARDING

1145
00:44:42,520 --> 00:44:45,200
KETAMINE INFUSION AND RAPID

1146
00:44:45,200 --> 00:44:47,360
EMELIORATION OF THE OCD SYMPTOMS

1147
00:44:47,360 --> 00:44:49,400
WHERE CONCURRENT MEDICATIONS

1148
00:44:49,400 --> 00:44:50,080
CONTINUED OR--

1149
00:44:50,080 --> 00:44:51,800
>> YEAH, YES, SO IN THAT STUDY

1150
00:44:51,800 --> 00:44:54,800
AND TO GIVE BACKGROUND.

1151
00:44:54,800 --> 00:44:59,040
SO THERE'S ALSO A STUDY DONE, AN

1152
00:44:59,040 --> 00:45:05,640
OPEN LABEL STUDY BY A GROUP AT

1153
00:45:05,640 --> 00:45:06,480
YALE, MICHAEL--LED BY MICHAEL

1154
00:45:06,480 --> 00:45:08,920
BLOCK AND THEY DID AN OPEN LABEL

1155
00:45:08,920 --> 00:45:10,520
STUDY OF IN-PATIENT WHO IS HAD

1156
00:45:10,520 --> 00:45:12,840
OCD AND MAJOR DEPRESSION.

1157
00:45:12,840 --> 00:45:16,880
AND WHAT THEY FOUND IS THAT

1158
00:45:16,880 --> 00:45:18,160
KETAMINE DECREASED DEPRESSIVE

1159
00:45:18,160 --> 00:45:19,600
SYMPTOMS BUT NOT THE OCD

1160
00:45:19,600 --> 00:45:20,440
SYMPTOMS THAT MUCH BUT WHAT'S

1161
00:45:20,440 --> 00:45:22,960
INTERESTING IN THAT STUDY IS

1162
00:45:22,960 --> 00:45:25,640
THAT PEOPLE WERE ON CONCOMITANT

1163
00:45:25,640 --> 00:45:27,360
MEDICATIONS SO AT THE SAME TIME

1164
00:45:27,360 --> 00:45:33,000
THEY WERE TAKING SRIs, TAKING

1165
00:45:33,000 --> 00:45:33,960
GLUTAMATE MODULATORS AND THE

1166
00:45:33,960 --> 00:45:34,920
EFFECTS WERE NOT ROBUST.

1167
00:45:34,920 --> 00:45:37,120
AND SO I'VE ALWAYS HAD THIS

1168
00:45:37,120 --> 00:45:39,080
HYPOTHESIS ON WHAT LED TO THE

1169
00:45:39,080 --> 00:45:40,960
STUDY IS THAT I WONDERED IF

1170
00:45:40,960 --> 00:45:42,840
THOSE DRUGS THAT THEY WERE

1171
00:45:42,840 --> 00:45:44,640
TAKING WERE ACTUALLY INTERFERING

1172
00:45:44,640 --> 00:45:45,360
WITH THE RESPONSE.

1173
00:45:45,360 --> 00:45:46,360
SO THAT'S WHY THAT STUDY WAS

1174
00:45:46,360 --> 00:45:49,920
DONE AS CLEAN AS POSSIBLE SO

1175
00:45:49,920 --> 00:45:51,440
PEOPLE WERE NOT ON ANY KIND OF

1176
00:45:51,440 --> 00:45:53,600
MEDICATIONS AND WE WERE ABLE TO

1177
00:45:53,600 --> 00:45:54,960
SEE THAT ROBUST RESPONSE AND

1178
00:45:54,960 --> 00:45:58,200
THEN IN THE STUDY, THE LARGER

1179
00:45:58,200 --> 00:46:00,800
NIH FUNDED STUDY, ALSO WE DID

1180
00:46:00,800 --> 00:46:04,400
NOT HAVE PATIENTS WHO HAD OR

1181
00:46:04,400 --> 00:46:05,360
WERE ON CONCOMITANT MEDICATIONS

1182
00:46:05,360 --> 00:46:25,200
AND DID NOT HAVE DEPRESSION AS

1183
00:46:25,200 --> 00:46:25,560
WELL.

1184
00:46:25,560 --> 00:46:28,840
--I OFTEN GET THE QUESTION OF

1185
00:46:28,840 --> 00:46:30,040
SHOULD I DO KETAMINE?

1186
00:46:30,040 --> 00:46:34,920
SHOULD I BE ON MEDICATIONS OR

1187
00:46:34,920 --> 00:46:35,440
NOT ON MEDICATIONS?

1188
00:46:35,440 --> 00:46:38,320
THESE ARE SORT OF 2 PARALLEL

1189
00:46:38,320 --> 00:46:38,880
QUESTIONS, RIGHT?

1190
00:46:38,880 --> 00:46:40,400
SO BOTH THE YALE GROUP AND OUR

1191
00:46:40,400 --> 00:46:41,600
GROUP, IT'S IMPORTANT TO STUDY

1192
00:46:41,600 --> 00:46:42,920
BOTH OF THESE PHENOMENON.

1193
00:46:42,920 --> 00:46:44,320
IN OUR STUDY WE'RE USING AT THE

1194
00:46:44,320 --> 00:46:47,200
TIMA MINE ALSO AS A PROBE, A

1195
00:46:47,200 --> 00:46:48,040
BRAIN FUNCTION AS WELL SO IT'S

1196
00:46:48,040 --> 00:46:52,200
IMPORTANT TO GET THE MOST ROBUST

1197
00:46:52,200 --> 00:46:52,840
RESPONSE.

1198
00:46:52,840 --> 00:46:53,800
>> WOULD USING THE CONCURRENT

1199
00:46:53,800 --> 00:46:55,080
MEDICATIONS OR IF THEY WERE

1200
00:46:55,080 --> 00:46:56,520
ADDED WOULD THAT AFFECT THE

1201
00:46:56,520 --> 00:46:58,760
DURABILITY OF THE RESPONSE, YOU

1202
00:46:58,760 --> 00:46:59,600
THINK?

1203
00:46:59,600 --> 00:47:01,800
>> I'M NOT SURE, IT'S AN OPEN

1204
00:47:01,800 --> 00:47:03,880
QUESTION, SO, IN THIS STUDY, WE

1205
00:47:03,880 --> 00:47:04,800
BASICALLY JUST STUDIED

1206
00:47:04,800 --> 00:47:06,680
INDIVIDUALS WHO WERE NOT ON

1207
00:47:06,680 --> 00:47:08,600
MEDICATION BUT WE HAVEN'T DONE A

1208
00:47:08,600 --> 00:47:11,280
STUDY TO SEE LIKE, IF YOU THEN

1209
00:47:11,280 --> 00:47:14,640
ADD MEDICATIONS BACK ON TOP OF

1210
00:47:14,640 --> 00:47:16,800
IT, OR REPEATED INFUSIONS OF

1211
00:47:16,800 --> 00:47:19,120
KETAMINE OR ADDING ON EXPOSURE

1212
00:47:19,120 --> 00:47:20,640
AND RESPONSE PREVENTION, SO THAT

1213
00:47:20,640 --> 00:47:22,760
WOULD BE--THAT WOULD BE AN

1214
00:47:22,760 --> 00:47:27,520
INTERESTING QUESTION, OPEN

1215
00:47:27,520 --> 00:47:27,840
QUESTION.

1216
00:47:27,840 --> 00:47:28,200
>> WONDERFUL.

1217
00:47:28,200 --> 00:47:28,960
ANOTHER QUESTION, SO SOME OF

1218
00:47:28,960 --> 00:47:31,400
YOUR WORK HAS BEEN IN HOARDING

1219
00:47:31,400 --> 00:47:33,440
DISORDER, WHAT'S THE DIFFERENCE

1220
00:47:33,440 --> 00:47:36,320
BETWEEN OCD AND HOARDING

1221
00:47:36,320 --> 00:47:36,600
DISORDER?

1222
00:47:36,600 --> 00:47:38,360
>> YEAH, SO WITH HOARDING

1223
00:47:38,360 --> 00:47:39,480
DISONNEREDDER WHAT'S INTERESTING

1224
00:47:39,480 --> 00:47:44,720
IS HISTORICALLY BECAUSE OF THE

1225
00:47:44,720 --> 00:47:45,640
YALE-BROWN OBSESSIVE COMPULSIVE

1226
00:47:45,640 --> 00:47:48,600
CHECK LIST, LIKE THE WAY YOU

1227
00:47:48,600 --> 00:47:50,360
OBSESS OBSESSIONS AND COMPUGZS

1228
00:47:50,360 --> 00:47:51,640
AND YOU LOOKA AT THESE THEMES

1229
00:47:51,640 --> 00:47:53,800
AND 1 OF THE THEMES WAS HOARDING

1230
00:47:53,800 --> 00:47:54,880
ISSUES HOARDING SYMPTOMS SO

1231
00:47:54,880 --> 00:47:59,760
WANTING TO KEEP ITEMS.

1232
00:47:59,760 --> 00:48:02,480
AND SO HISTORICALLY THAT SORT OF

1233
00:48:02,480 --> 00:48:05,880
BECAME PART OF 1 OF THE SUBTYPES

1234
00:48:05,880 --> 00:48:08,280
OF OCD AND YET, MY MENTORS AND

1235
00:48:08,280 --> 00:48:11,720
SENIOR FOLKS IN THE OCD FIELD

1236
00:48:11,720 --> 00:48:13,680
ACTUALLY EXCLUDED PEOPLE THAT

1237
00:48:13,680 --> 00:48:15,080
HAD THESE SYMPTOMS FROM CLINICAL

1238
00:48:15,080 --> 00:48:16,440
TRIALS BECAUSE THEY HAVE THIS

1239
00:48:16,440 --> 00:48:19,560
INIF YOUITION THAT IT WAS A

1240
00:48:19,560 --> 00:48:23,080
LITTLE BIT DIFFERENT AND INDEED,

1241
00:48:23,080 --> 00:48:24,400
HOARDING DISORDER HAS BECOME A

1242
00:48:24,400 --> 00:48:28,040
NEW DIAGNOSIS IN THE DSM 5 AS OF

1243
00:48:28,040 --> 00:48:31,000
2013 AND IT'S PHENOMENAL

1244
00:48:31,000 --> 00:48:32,760
LOGICALLY DIFFERENT SO YOU KNOW,

1245
00:48:32,760 --> 00:48:35,520
OCD YOU HAVE INTRUSIVE THOUGHTS

1246
00:48:35,520 --> 00:48:37,160
THAT CAUSE ANXIETY, PEOPLE WITH

1247
00:48:37,160 --> 00:48:38,200
HOARDING DISORDER ARE REALLY

1248
00:48:38,200 --> 00:48:40,760
ATTACHED TO THEIR ITEMS AND IT'S

1249
00:48:40,760 --> 00:48:43,000
NOT EXPERIENCES INTRUSIVE OR

1250
00:48:43,000 --> 00:48:44,440
DISTRESSING, THEY ARE ARE

1251
00:48:44,440 --> 00:48:47,400
ATTACHED TO THEIR ITEMS.

1252
00:48:47,400 --> 00:48:47,680
EXCUSE ME.

1253
00:48:47,680 --> 00:48:50,840
AND 1 OF THE OTHER KEY

1254
00:48:50,840 --> 00:48:54,640
CHARACTERISTICS OF HOARDING

1255
00:48:54,640 --> 00:48:57,000
DISORDER IS WANTING TO ACQUIRE

1256
00:48:57,000 --> 00:48:58,800
ITEMS SO THERE'S A LOT GOING IN,

1257
00:48:58,800 --> 00:49:01,320
NOT A LOT GOING OUT AND IT

1258
00:49:01,320 --> 00:49:02,640
RESULTS IN CLUSTER THAT

1259
00:49:02,640 --> 00:49:04,680
IMPAIRING LIVING SPACES SO YOU

1260
00:49:04,680 --> 00:49:08,680
OFTEN SEE PEOPLE WHO HAVE, YOU

1261
00:49:08,680 --> 00:49:12,240
KNOW THEIR BEDS, YOU KNOW, 1 OF

1262
00:49:12,240 --> 00:49:14,000
THE KEY THINGS WE HAVE TO SEE IS

1263
00:49:14,000 --> 00:49:15,640
LIKE THEY CAN'T SLEEP IN THEIR

1264
00:49:15,640 --> 00:49:17,200
BEDS, PEOPLE ARE JUST REALLY

1265
00:49:17,200 --> 00:49:19,280
HAVE A LOT OF ITEMS IN THEIR BED

1266
00:49:19,280 --> 00:49:21,600
OR THEY CAN'T USE THEIR KITCHEN

1267
00:49:21,600 --> 00:49:24,640
FOR COOKING BECAUSE THEY HAVE

1268
00:49:24,640 --> 00:49:26,440
THINGS INSIDE OF THE OVEN OR ON

1269
00:49:26,440 --> 00:49:28,160
TOP OF THE OVEN WHICH CAN ALSO

1270
00:49:28,160 --> 00:49:33,040
BE A HUGE FIRE HAZARD AS WELL.

1271
00:49:33,040 --> 00:49:35,680
SO IT'S DIFFERENT AND ALSO

1272
00:49:35,680 --> 00:49:38,520
THERE'S BEEN A LOT OF LITERATURE

1273
00:49:38,520 --> 00:49:40,160
THAT'S COME OUT, RANDY FROST AND

1274
00:49:40,160 --> 00:49:42,640
[INDISCERNIBLE] WERE SOME OF THE

1275
00:49:42,640 --> 00:49:44,720
FIRST TO SORT OF IDENTIFY

1276
00:49:44,720 --> 00:49:47,080
HOARDING DISORDER AND DO THE

1277
00:49:47,080 --> 00:49:48,720
COGNITIVE MODEL BUT SINCE THEN,

1278
00:49:48,720 --> 00:49:52,120
A LOT OF DIFFERENT GROUPS HAVE

1279
00:49:52,120 --> 00:49:54,240
SHOWN DIFFERENT NEUROBIOLOGICAL

1280
00:49:54,240 --> 00:49:56,160
UNDERPINNINGS OF OCD AND

1281
00:49:56,160 --> 00:49:56,400
HOARDING.

1282
00:49:56,400 --> 00:49:58,480
>> I HOPE THAT DOESN'T APPLY TO

1283
00:49:58,480 --> 00:49:59,400
KITCHEN JUNK DRAWERS BECAUSE

1284
00:49:59,400 --> 00:50:02,400
THEN I MIGHT ACTUALLY HAVE THAT.

1285
00:50:02,400 --> 00:50:03,840
>> YEAH, I GET THAT--I JUST WANT

1286
00:50:03,840 --> 00:50:05,000
TO ADDRESS THAT FOR A MOMENT

1287
00:50:05,000 --> 00:50:12,360
BECAUSE I GET THAT A LOT BECAUSE

1288
00:50:12,360 --> 00:50:16,680
PEOPLE SEE HOARDING, HOARDING

1289
00:50:16,680 --> 00:50:17,600
DISORDER REFLECTED IN THEMSELVES

1290
00:50:17,600 --> 00:50:21,360
IN TERMS OF CLUTTER BUT IT'S

1291
00:50:21,360 --> 00:50:22,320
SOMETHING THAT ATTACHMENT TO

1292
00:50:22,320 --> 00:50:23,600
ITEMS IS SOMETHING THAT AFFECTS

1293
00:50:23,600 --> 00:50:24,320
ALL OF US.

1294
00:50:24,320 --> 00:50:26,080
AND PEOPLE WITH HOARDING

1295
00:50:26,080 --> 00:50:26,880
DISORDER ARE NO DIFFERENT THAN

1296
00:50:26,880 --> 00:50:28,600
PEOPLE WHEN ON DON'T IN TERMS OF

1297
00:50:28,600 --> 00:50:30,400
THEIR ASH TACHMENT TO ITEMS

1298
00:50:30,400 --> 00:50:30,600
RIGHT?

1299
00:50:30,600 --> 00:50:32,000
LIKE WE HANG ON TO THINGS

1300
00:50:32,000 --> 00:50:34,200
BECAUSE MAYBE THEY'RE USEFUL OR

1301
00:50:34,200 --> 00:50:36,680
MAYBE THEY'RE AESTHETICALLY

1302
00:50:36,680 --> 00:50:38,080
BEAUTIFUL, OR WE THINK THAT WE

1303
00:50:38,080 --> 00:50:39,200
WILL USE IT 1 DAY.

1304
00:50:39,200 --> 00:50:42,160
SO THAT'S THE KITCHEN RIGHT?

1305
00:50:42,160 --> 00:50:45,840
LIKE MAYBE  I'LL USE THIS

1306
00:50:45,840 --> 00:50:47,280
SOMETIME BUT PEOPLE WITH

1307
00:50:47,280 --> 00:50:48,640
HOARDING DISORDER HAVE THAT

1308
00:50:48,640 --> 00:50:51,120
ATTACHMENT TO THE EXTREME SO

1309
00:50:51,120 --> 00:50:53,080
EVERY OBJECT IS IMBUED WITH

1310
00:50:53,080 --> 00:50:54,160
MEANING AND SIS 95 CANC AND SOME

1311
00:50:54,160 --> 00:50:55,600
OF THE PEOPLE WITH HOARDING

1312
00:50:55,600 --> 00:50:57,440
DISORDER TEND TO BE THE MOST

1313
00:50:57,440 --> 00:50:58,600
CREATIVE WAYS AS WELL BECAUSE

1314
00:50:58,600 --> 00:51:00,400
THEY CAN THINK OF DIFFERENT USES

1315
00:51:00,400 --> 00:51:03,000
FOR SOMETHING NWITH REGARDS TO

1316
00:51:03,000 --> 00:51:05,400
THAT, YOU KNOW IN PARTICULAR

1317
00:51:05,400 --> 00:51:06,480
WITH SENIOR CITIZEN AND HOARDING

1318
00:51:06,480 --> 00:51:08,240
DO HAVE YOU ANY COMMENTS ON

1319
00:51:08,240 --> 00:51:08,760
THAT?

1320
00:51:08,760 --> 00:51:09,680
>> YEAH, SO THERE'S BEAUTIFUL

1321
00:51:09,680 --> 00:51:12,920
WORK COMES OUT OF UCSD LOOKING

1322
00:51:12,920 --> 00:51:15,960
AT MODIFICATIONS FOR HOARDING

1323
00:51:15,960 --> 00:51:17,120
DISORDER TREATMENTS FOR OLDER

1324
00:51:17,120 --> 00:51:23,760
ADULTS AND AT THE VA AND WHAT'S

1325
00:51:23,760 --> 00:51:25,800
INTERESTING IS THAT THEY'RE

1326
00:51:25,800 --> 00:51:28,600
PAIRING COGNITIVE BEHAVIORERAL

1327
00:51:28,600 --> 00:51:29,840
THERAPY FOR HOARDING DISORDER

1328
00:51:29,840 --> 00:51:32,760
AND AND THIS IS TACKLING

1329
00:51:32,760 --> 00:51:33,720
THOUGHTS ABOUT HOARDING DISORDER

1330
00:51:33,720 --> 00:51:36,000
IN WAYS THAT MODIFY IT FOR OLDER

1331
00:51:36,000 --> 00:51:38,800
ADULT ANDS THEY HAVE COG FIELD

1332
00:51:38,800 --> 00:51:40,000
FUNCTIONSATIVE IMPAIRMENT,

1333
00:51:40,000 --> 00:51:41,200
CALENDARING, SORTING ORGANIZING,

1334
00:51:41,200 --> 00:51:43,160
THESE EXECUTIVE FUNCTIONING

1335
00:51:43,160 --> 00:51:44,640
SKILLS AND THEY'RE SEEING REALLY

1336
00:51:44,640 --> 00:51:45,760
BEAUTIFUL EFFECTS ON THAT.

1337
00:51:45,760 --> 00:51:50,600
THANK YOU FOR THE QUESTION.

1338
00:51:50,600 --> 00:51:51,520
>> PSYCHEDELICS HAVE RECEIVED

1339
00:51:51,520 --> 00:51:52,720
RENEWED ATTENTION IN

1340
00:51:52,720 --> 00:51:54,600
THERAPEUTICS IS THERE ANY ROLE

1341
00:51:54,600 --> 00:51:57,600
OF PSYCHEDELICS IN OCD?

1342
00:51:57,600 --> 00:51:58,600
>> OH RYES.

1343
00:51:58,600 --> 00:52:01,280
THIS IS A QUESTION I GET A LOT

1344
00:52:01,280 --> 00:52:04,640
AND 1 OF THE THINGS I WILL SAY

1345
00:52:04,640 --> 00:52:06,080
IS THAT, WELL, MAYBE I WILL

1346
00:52:06,080 --> 00:52:10,800
SHARE SOME SLIDES ABOUT IT

1347
00:52:10,800 --> 00:52:12,560
IT'S IMPORTANT FOR ME TO MAKE

1348
00:52:12,560 --> 00:52:14,240
SHOULDURE THAT WHEN PEOPLE ASK

1349
00:52:14,240 --> 00:52:15,560
ME ABOUT PSYCHEDELICS IT TOUCHES

1350
00:52:15,560 --> 00:52:19,960
ON THE WORK I DO IN KETAMINE.

1351
00:52:19,960 --> 00:52:23,120
SO, PSYCHEDELICS IS ACTUALLY A

1352
00:52:23,120 --> 00:52:25,040
VERY BROAD TERM AND THERE ARE

1353
00:52:25,040 --> 00:52:27,600
DIFFERENT CLASSES THAT SOMETIMES

1354
00:52:27,600 --> 00:52:30,760
GET SORT OF ALL PUT INTO THE

1355
00:52:30,760 --> 00:52:32,640
CATEGORY OF PSYCHEDELICS BUT

1356
00:52:32,640 --> 00:52:33,320
CLASSICAL PSYCHEDELICS ARE

1357
00:52:33,320 --> 00:52:35,640
THOUGHT TO BE THINGS THAT AFFECT

1358
00:52:35,640 --> 00:52:43,240
THE SEROTONIN TO A RECEPTOR AND

1359
00:52:43,240 --> 00:52:45,000
THEN ATYPICAL PSYCHEDELICS AND

1360
00:52:45,000 --> 00:52:47,680
INTACT O GENS, DISSOCKIA

1361
00:52:47,680 --> 00:52:48,280
TIFFANIESTHETICS AND

1362
00:52:48,280 --> 00:52:49,200
CANNABINOIDS GET IF THERE BUT

1363
00:52:49,200 --> 00:52:50,600
THEY HAVE DIFFERENT EFFECT ON

1364
00:52:50,600 --> 00:52:56,200
COGNITION AND EMOTION AND SOCIAL

1365
00:52:56,200 --> 00:52:56,560
RELATEDNESS.

1366
00:52:56,560 --> 00:52:59,760
AND SO INTACT O GENS FOR

1367
00:52:59,760 --> 00:53:01,400
EXAMPLE, IT'S CALLED A MATH O

1368
00:53:01,400 --> 00:53:03,600
GENERATED AND THESE ARE THINGS

1369
00:53:03,600 --> 00:53:06,800
LIKE MDMA, SO PEOPLE FEEL LIKE

1370
00:53:06,800 --> 00:53:10,040
EMPATHY BUT I'M PART OF THE

1371
00:53:10,040 --> 00:53:10,680
AMERICAN PSYCHIATRIC ASSOCIATION

1372
00:53:10,680 --> 00:53:12,160
COUNCIL ON RESEARCH AND 1 OF THE

1373
00:53:12,160 --> 00:53:13,920
WORK PRODUCTS THAT WE HAVE BEEN

1374
00:53:13,920 --> 00:53:17,280
FOCUSING ON IS TRYING TO EDUCATE

1375
00:53:17,280 --> 00:53:19,640
ON WHAT'S THE STATUS OF RESEARCH

1376
00:53:19,640 --> 00:53:22,960
FOR PSYCHEDELICS AND MENTAL

1377
00:53:22,960 --> 00:53:25,960
HEALTH AND IMPATHOGENS AND THESE

1378
00:53:25,960 --> 00:53:43,120
OTHER CLASSES.

1379
00:53:43,120 --> 00:53:43,960
 APPROVAL OF A BAND NEW THERAPY

1380
00:53:43,960 --> 00:53:49,080
WHICH MEANS BEFORE FDA APPROVAL

1381
00:53:49,080 --> 00:53:50,120
THEY ARE GIVING THE GREEN LIGHT

1382
00:53:50,120 --> 00:53:54,000
FOR IT TO BE STUDIED MORE.

1383
00:53:54,000 --> 00:53:55,080
AND SIMILARLY WITH SILO SIGNIN

1384
00:53:55,080 --> 00:53:57,520
IN THE TREATMENT OF DEPRESSION,

1385
00:53:57,520 --> 00:54:00,640
IT'S GOT THIS BREAK THROUGH

1386
00:54:00,640 --> 00:54:04,040
THERAPY DESIGNATION AND THEY'RE

1387
00:54:04,040 --> 00:54:06,600
ALSO PROMISING DATA ON IOWASCA

1388
00:54:06,600 --> 00:54:08,840
BUT TO DATE THERE'S INSUFFICIENT

1389
00:54:08,840 --> 00:54:12,040
DATA OF FDA APPROVAL OF ANY

1390
00:54:12,040 --> 00:54:14,720
PSYCHEDELIC COMPOUND FOR ROUTINE

1391
00:54:14,720 --> 00:54:15,600
USE IN PSYCHIATRIC DISORDERSA

1392
00:54:15,600 --> 00:54:16,880
THE THIS TIME SO IF YOU HAVE 1

1393
00:54:16,880 --> 00:54:19,440
TAKE AWAY IN TERMS OF

1394
00:54:19,440 --> 00:54:20,640
PSYCHEDELICS AND MENTAL HELT, WE

1395
00:54:20,640 --> 00:54:21,960
DON'T HAVE ENOUGH EVIDENCE TO

1396
00:54:21,960 --> 00:54:23,200
DATE.

1397
00:54:23,200 --> 00:54:23,800
SO CERTAINLY THAT'S

1398
00:54:23,800 --> 00:54:24,440
DISPROPORTIONATE WITH THE HYPE

1399
00:54:24,440 --> 00:54:27,440
YOU MAY BE SEEING IN NEWS MEDIA

1400
00:54:27,440 --> 00:54:29,360
OUTLETS AND OTHER PLACES.

1401
00:54:29,360 --> 00:54:33,760
AND THEN, SPECIFICALLY IN TERMS

1402
00:54:33,760 --> 00:54:37,640
OF THIS CATEGORY OF CLASSICAL

1403
00:54:37,640 --> 00:54:39,560
PSYCHEDELICS, SILO SIGNIN AND

1404
00:54:39,560 --> 00:54:44,160
OCD HAS HAD SOME INITIAL

1405
00:54:44,160 --> 00:54:45,360
PROMISING CASE REPORTS IN AN

1406
00:54:45,360 --> 00:54:50,360
OPEN LABEL STUDY AND  THERE'S A

1407
00:54:50,360 --> 00:54:54,040
GROUP AT YALE STUDYING SILO

1408
00:54:54,040 --> 00:54:54,880
SIGNIN GETTING PROMISING RESULTS

1409
00:54:54,880 --> 00:54:57,680
AND NOW LEADING ON TO A LARGER

1410
00:54:57,680 --> 00:55:00,800
MULTISITE STUDY PARTNERING WITH

1411
00:55:00,800 --> 00:55:01,280
INDUSTRY.

1412
00:55:01,280 --> 00:55:06,040
AND I'VE BEEN REALLY INTERESTED

1413
00:55:06,040 --> 00:55:09,640
IN MDMA FOR OCD AND THIS IS

1414
00:55:09,640 --> 00:55:14,400
AGAIN, THIS IS  INDUCES PRO

1415
00:55:14,400 --> 00:55:16,720
SOCIAL EFFECTS AND FEELINGS OF

1416
00:55:16,720 --> 00:55:17,800
INTROSPECTION AND CONNECTION

1417
00:55:17,800 --> 00:55:18,720
WITH OTHERS.

1418
00:55:18,720 --> 00:55:20,120
SO I'M REALLY EXCITED THAT WE'VE

1419
00:55:20,120 --> 00:55:23,040
BEEN FUNDED NOW TO DO A PILOT

1420
00:55:23,040 --> 00:55:25,000
STUDY OF MDMA AND OCD.

1421
00:55:25,000 --> 00:55:29,200
AND THE IDEA HERE IS THAT YOU

1422
00:55:29,200 --> 00:55:34,720
KNOW, YOU KNOW COULD MDMA,

1423
00:55:34,720 --> 00:55:36,720
EXPOSURE AND RESPONSE PREVENTION

1424
00:55:36,720 --> 00:55:37,440
IS REALLY WONDERFUL THERAPY

1425
00:55:37,440 --> 00:55:38,720
ABOUT YOU IT'S REALLY HARD TO DO

1426
00:55:38,720 --> 00:55:41,120
SOMETHING THAT IS YOUR GREATEST

1427
00:55:41,120 --> 00:55:43,040
FEAR RIGHT?

1428
00:55:43,040 --> 00:55:45,280
AND SO, CBT IS TYPICALLY LIMITED

1429
00:55:45,280 --> 00:55:47,960
BY DROP OUT SO COULD WE PARTNER

1430
00:55:47,960 --> 00:55:51,880
MDMA WITH OCD IN ORDER TO GET

1431
00:55:51,880 --> 00:55:53,640
PEOPLE TO BE ABLE TO ENGAGE MORE

1432
00:55:53,640 --> 00:55:57,480
WITH THIS VERY EFFECTIVE THERAPY

1433
00:55:57,480 --> 00:56:02,880
OR COULD MD MA EVEN BY ITSELF BE

1434
00:56:02,880 --> 00:56:04,360
HELPFUL FOR OCD?

1435
00:56:04,360 --> 00:56:06,880
WE KNOW MDA IS KNOWN TO MODIFY

1436
00:56:06,880 --> 00:56:10,640
SOCIAL CUES AND INCREASE

1437
00:56:10,640 --> 00:56:11,640
ACTIVITY IN THE NUCLEUS SERIES

1438
00:56:11,640 --> 00:56:13,600
POINTS CUM BENS WHICH IS

1439
00:56:13,600 --> 00:56:14,400
IMPLICATED IN OCD.

1440
00:56:14,400 --> 00:56:15,480
SO WE'RE REALLY EXCITED ABOUT

1441
00:56:15,480 --> 00:56:15,840
THAT WORK.

1442
00:56:15,840 --> 00:56:19,720
SO THANK YOU FOR ASKING.

1443
00:56:19,720 --> 00:56:20,360
>> THANK YOU.

1444
00:56:20,360 --> 00:56:23,440
AND THE FINAL QUESTION WE HAVE

1445
00:56:23,440 --> 00:56:25,280
HERE GOOD TO WRAP UP WITH ARE

1446
00:56:25,280 --> 00:56:27,400
THERE ANY NEW FDA APPROVED OCD

1447
00:56:27,400 --> 00:56:30,040
MEDICATIONS ON THE HORIZON?

1448
00:56:30,040 --> 00:56:31,760
>> YEAH, I KNOW WE'RE

1449
00:56:31,760 --> 00:56:34,920
PARTICIPATING IN A PHASE 3 STUDY

1450
00:56:34,920 --> 00:56:40,200
OF A DRUG CALLED TRIUZOL E, IT'S

1451
00:56:40,200 --> 00:56:41,720
AN INDUSTRY SPONSORED STUDY AND

1452
00:56:41,720 --> 00:56:43,120
WE PARTICIPATE INDEED THE PHASE

1453
00:56:43,120 --> 00:56:46,320
2 STUDY, SO THIS IS A GLUTAMATE

1454
00:56:46,320 --> 00:56:47,640
MODULATING DRUG THAT IS BUILDING

1455
00:56:47,640 --> 00:56:49,040
ON WORK WITH [INDISCERNIBLE], SO

1456
00:56:49,040 --> 00:56:54,920
IT HAS A MOETY THAT HAS BETTER

1457
00:56:54,920 --> 00:56:59,040
METRICS TAB O--IT IS METABOLIZED

1458
00:56:59,040 --> 00:57:00,120
BETTER THROUGH AND HAS LESS

1459
00:57:00,120 --> 00:57:05,440
LIVER SIDE EFFECTS THAN THE

1460
00:57:05,440 --> 00:57:05,840
ORIGINAL COMPOUND.

1461
00:57:05,840 --> 00:57:07,360
AND YOU CAN ALSO TAKE IT 1 TIENL

1462
00:57:07,360 --> 00:57:10,280
A DAY, SO WITH THESE KIND OF

1463
00:57:10,280 --> 00:57:11,000
CHEMICAL IMPROVEMENTS, NOW

1464
00:57:11,000 --> 00:57:12,880
THEY'RE STUDYING IT, THE PHASE 2

1465
00:57:12,880 --> 00:57:14,760
STUDY, WAS PRESENTED AND HAD

1466
00:57:14,760 --> 00:57:15,760
PROMISING ENOUGH FINDINGS THAT

1467
00:57:15,760 --> 00:57:17,840
THEY WENT ON TO THIS LARGER

1468
00:57:17,840 --> 00:57:19,840
PHASE 3 STUDY, AND SO, THAT IS

1469
00:57:19,840 --> 00:57:22,840
THE DRUG THAT I SEE THAT IS THE

1470
00:57:22,840 --> 00:57:24,880
CLOSEST TO FDA APPROVAL SO IF

1471
00:57:24,880 --> 00:57:28,000
THEY GET GOOD RESULTS FROM THIS

1472
00:57:28,000 --> 00:57:29,400
PHASE 3 STUDY, THEN IT WILL BE

1473
00:57:29,400 --> 00:57:33,080
THE FIRST DRUG APPROVED SINCE

1474
00:57:33,080 --> 00:57:35,240
THE 1990S FDA APPROVED FOR OCD.

1475
00:57:35,240 --> 00:57:37,000
SO THAT'S REALLY EXCITING AND,

1476
00:57:37,000 --> 00:57:39,040
YEAH, THANK YOU FOR THAT

1477
00:57:39,040 --> 00:57:39,440
QUESTION.

1478
00:57:39,440 --> 00:57:41,720
I'M JUST REALLY EXCITED FOR THE

1479
00:57:41,720 --> 00:57:43,520
HORIZON AND HOPE FOR THE FIELD

1480
00:57:43,520 --> 00:57:44,920
AND FOR THOSE PEOPLE WHO ARE

1481
00:57:44,920 --> 00:57:47,640
JUST EARLY ON MAYBE GOT

1482
00:57:47,640 --> 00:57:49,080
DIAGNOSED WITH OCD, THERE'S A

1483
00:57:49,080 --> 00:57:50,520
WHOLE WORLD OF THINGS, FIRST

1484
00:57:50,520 --> 00:57:53,040
LINE TREATMENTS THAT HAVE

1485
00:57:53,040 --> 00:57:54,000
INCREDIBLE RESEARCH, PIONEERING

1486
00:57:54,000 --> 00:57:55,720
NEW TREATMENTS THAT ARE, YOU

1487
00:57:55,720 --> 00:57:58,640
KNOW WE'RE COLLECTING DATA ON

1488
00:57:58,640 --> 00:58:02,840
AND SO THERE'S A LOT OF HOPE OUT

1489
00:58:02,840 --> 00:58:03,680
THERE.

1490
00:58:03,680 --> 00:58:04,360
>> WONDERFUL.

1491
00:58:04,360 --> 00:58:05,680
WELL DR. RODRIGUEZ, THANK YOU

1492
00:58:05,680 --> 00:58:08,600
VERY MUCH FOR SHARING YOUR WORK

1493
00:58:08,600 --> 00:58:13,480
AND OFFERING US SOME DEEPER

1494
00:58:13,480 --> 00:58:15,240
INSIGHTS INTO OCD, ON HOARDING,

1495
00:58:15,240 --> 00:58:17,640
ALSO ABOUT MY KITCHEN DRAW WHICH

1496
00:58:17,640 --> 00:58:19,200
IS REASSURING AS WELL?

1497
00:58:19,200 --> 00:58:20,080
MINE TOO!

1498
00:58:20,080 --> 00:58:20,480
MINE TOO!

1499
00:58:20,480 --> 00:58:22,720
YOU ARE NOT ALONE, SIR.

1500
00:58:22,720 --> 00:58:22,920
YEAH.

1501
00:58:22,920 --> 00:58:26,200
>> WELL, THANK YOU AGAIN AND TOO

1502
00:58:26,200 --> 00:58:26,840
THE NIH COMMUNITY.

1503
00:58:26,840 --> 00:58:31,040
WE WOULD LIKE TO WISH ALL OF YOU

1504
00:58:31,040 --> 00:58:32,440
A WONDERFUL AFTERNOON.

1505
00:58:32,440 --> 00:58:35,360
>> I JUST WANT TO MAKE A PLUG

1506
00:58:35,360 --> 00:58:37,800
FOR THE INTERNATIONAL OCD

1507
00:58:37,800 --> 00:58:38,600
FOUNDATION, NONPROFIT GROUP CAN

1508
00:58:38,600 --> 00:58:40,000
ANSWER A LOT OF QUESTIONS AND

1509
00:58:40,000 --> 00:58:41,880
LINKS TO CARE SO INTERNATIONAL

1510
00:58:41,880 --> 00:58:42,240
OCD FOUNDATION.

1511
00:58:42,240 --> 00:00:00,000
THANK YOU SO MUCH.