John M. Kane, MD
Head, Center for Translational Psychiatry
Chairman, Department of Psychiatry, The Zucker Hillside Hospital
Vice President for Behavioral Health Services, North Shore-LIJ Health System
Main Area of Research
Unraveling mysteries of the brain and changing lives.
Early Treatment for Schizophrenia
When John M. Kane, MD, entered psychiatry more than 35 years ago, very little was known about schizophrenia. Since the beginning of his residency at The Zucker Hillside Hospital in Glen Oaks in 1971, Dr. Kane has committed his career to unraveling the mysteries of this brain disorder. He pioneered studies on patients hospitalized for the first time showing florid symptoms such as hallucinations and delusions.
The disease usually begins in late adolescence or early adulthood and it was Dr. Kane and his colleagues who would scan patients' brains and ask them to take a variety of neuropsychiatric tests. They would also turn to parents and teachers for life histories to begin to understand what triggers led to the beginning of this devastating, mind-robbing disease. Then, patients were given the standard fare of treatments or enrolled in experimental drug trials and followed for years so that scientists could track the disease course and treatment response over time.
Dr. Kane and his colleagues helped to determine treatment strategies for relapse prevention and management of treatment refractory patients. When genetic testing became available, they began collecting DNA from patients to look for genes that alter the functioning of the brain and that put people at risk for disturbances in thought processes. And he and his colleagues have found the first genes that put people at risk for schizophrenia.
Because the research was conducted right at the hospital, the findings were quickly translated into patient care. What’s more, they developed a program to identify at-risk teenagers and get them into treatment early enough so that they could prevent or stall the first symptoms of schizophrenia. Now, he and his colleagues are stepping up his department’s research plan to include more advanced brain imaging techniques and genetic studies to assess which patients respond better to specific treatments, and which patients are vulnerable to serious side effects.
Through the center, which is located at The Zucker Hillside Hospital campus of The Feinstein Institute for Medical Research, experienced doctors and researchers are bringing the modern tools of neuroscience to young people in the hopes of discovering new and more effective ways to detect and treat the illness before at-risk adolescents and newly diagnosed young adults experience a downward spiral toward lifelong disability.
Schizophrenia usually emerges with the first psychotic episode in the late teens to early 20s. Individuals experience difficulty in managing everyday life. They face psychotic symptoms such as hallucinations and delusions, paranoia, an inability to think straight, flattened emotions, diminished motivation and pleasure capacity, and loss of social and personal care skills. These symptoms contribute to social isolation and interfere with school, work and relationships, and eventually cause major disability.
The Early-Phase Schizophrenia Center focuses on children and adolescents at risk for schizophrenia or who have already been diagnosed with it, and young adults suffering from their first psychotic episode.
By intervening as early as possible, the researchers are looking for ways to prevent the illness from developing at all or to diminish the severity of the symptoms in individuals already affected, with the overall goal of reducing disability and allowing those affected as normal and healthy a life as possible.
Funding Future Research
Dr. Kane and his group are working to advance the understanding and treatment of this illness in a variety of ways. Attempts are being made to delineate genetic, biological and environmental factors that influence the evolution and course of the illness as well as treatment response, particularly in the earliest stages of illness manifestation. The center uses clinical assessment, pharmacologic response, brain imaging (via magnetic resonance imaging [MRI], functional MRI and positron emission tomography), neurophysiology and cognitive testing, as well as genetics and pharmacogenetics to identify risk factors, biomarkers and illness subtypes. This research may be relevant to the development of new treatments and predicting response, both therapeutic and adverse, to existing treatments.
The genetics researchers are looking for genes that increase risk for schizophrenia, genes that influence brain structure and function, and genes that influence how patients respond to medications. The center’s neuroimaging scientists use various imaging techniques to look inside the brain for abnormalities in structure as well as function. The neuropsychologists at the Early-Phase Schizophrenia Center conduct cognitive tests of thinking and behavior to characterize disease symptoms and improve diagnostic accuracy.
The center is also engaged in longitudinal studies of adverse effects of antipsychotic medications to enhance the benefit-to-risk ratio of long-term treatment. These studies aim to identify factors that influence rates of adherence in medication taking, an area of enormous challenge in a potentially chronic and severe illness such as schizophrenia.
The center brings the modern tools of neuroscience, including genetics, brain imaging, and cognitive and behavioral studies, to young residents of Long Island, Queens and the Bronx. It creates a network that extends to non-academic, public and private community facilities as well as local schools to create a unique national resource for the research, intervention and dissemination of findings for early phase schizophrenia.