Women in Psychiatry Leadership
Today in Johns Hopkins Psychiatry, we see the profound influence of women leaders in every aspect of our work - From inpatient units, research laboratories, educational ranks, to Executive Committees...
Building on our school of medicine’s historical precedent -- set in 1893 -- that women should be admitted on an equal basis with men, a spirit of equality and innovation drives our excellence in medical education, research and patient care. We had an early start in elevating women to the highest ranks in our department, with Dr. Esther Richards serving as our outpatient director from 1920-51.
Here, we offer a window into the women who are leading Johns Hopkins Psychiatry to the next great era of discovery, clinical innovation and improved mental health for all, while spotlighting our strong commitment to a diverse and inclusive workforce.
Nancy Ator, Ph.D.
Ashley Bone, M.D.
Margaret “Meg” Chisolm, M.D.
Jennifer Coughlin, M.D.
Bernadette Cullen, MB, BCh., BAO, MRCPsych
Angela Guarda, M.D.
Kay Jamison, Ph.D.
Rebecca Landa, Ph.D.
Karin Neufeld, M.D., M.P.H.
Erica Richards, M.D., Ph.D.
Gwenn Smith, Ph.D.
Karen Swartz, M.D.
Former Chair, Johns Hopkins University Animal Care and Use Committee
Retired, Professor and Former Director, Division of Behavioral Biology
Department of Psychiatry and Behavioral Sciences
When Nancy Ator took on the role of chair of the Johns Hopkins University Animal Care and Use Committee (ACUC) in 2001, someone warned her it was a thankless job. She has found it to be anything but.
“Frankly, I find that a lot of our faculty do thank me,” she says, “because we are balancing complying with federal government requirements regarding research including attention to humane considerations in this research with consideration for the pressures that faculty are under such as meeting research funding deadlines.”
In this far-reaching role, Ator and her colleagues are responsible for the humane treatment of animals in some 1,300 research protocols universitywide being directed by about 600 principal investigators. The work includes not only reviewing research proposals but also reviewing the veterinary care program, inspecting labs and housing facilities, looking into animal welfare concerns that may be raised, and facilitating site visits from government inspectors as well as from the animal program accrediting body AAALAC International.
The position was a natural fit for Ator, who married young and worked as a research assistant in human research studies for a psychiatrist at the University of Mississippi Medical Center and later a psychologist at Vanderbilt University in Nashville while putting her husband through law school. When he took a job in Washington, D.C., Ator enrolled at the University of Maryland to study psychology. There, she found she enjoyed basic behavioral research in laboratory animals but realized that in order to design her own studies, she would need a graduate degree.
- stayed at UM to earn her master’s in general psychology and Ph.D. in biopsychology, where she focused on behavioral pharmacology in the context of the experimental analysis of behavior, a school of thought started by American psychologist B.F. Skinner. A primary learning process he introduced was how schedules of reinforcement determine predictable patterns of behavior. Research by others had demonstrated the surprising fact that the same dose of a centrally-acting drug could affect different rates and patterns of behavior differently in the same animal in a single experimental session. For example, increasing low rates while decreasing high rates. She fell in love with this type of research.
One of her professors steered her to Johns Hopkins for postdoctoral work in behavioral pharmacology with Roland Griffiths, professor of behavioral biology and of neuroscience, and Joseph Brady, professor and founder of the Division of Behavioral Biology. They told Ator if she would write a research proposal to help support her position, they would welcome her to their lab. “That worked out,” she says of coming to Johns Hopkins in 1978, “and I’ve been here ever since.”
Ator continued to collaborate on numerous studies with Griffiths after joining the faculty of the Department of Psychiatry and Behavioral Sciences in 1982. This was in the period in which the over-prescribing of Valium had become a health concern, and drug companies were trying to come up with new compounds that would alleviate generalized anxiety but not be as sedating or addictive as Valium and similar drugs. Together, they started a line of preclinical research characterizing the behavioral profiles of these novel drugs in contrast to currently prescribed sedative/anxiolytics. In the 1990s, Griffiths shifted completely toward human research while Ator stayed the course in preclinical research, studying in particular how differentiation of subjective and reinforcing effects of psychoactive drugs can inform assessment of abuse potential. In 1997, she became the 49th woman to be appointed full professor in the School of Medicine.
When Brady wanted to step down as director of the Division of Behavioral Biology, he recommended that Ator take his place. In 2001, she became the first woman to join the department’s Appointments and Promotions Committee and served until she stepped down as director of her division in 2019.
During the many years Ator was doing her own research and focused on her own lab, she says she would regularly see announcements from the university touting how great Hopkins is and assume some of it was hype. “Then, once I took over the job of chair of the ACUC and began reading all of the different protocols--especially ones focused on really tough issues like cancer, Huntington’s, ALS, and other challenging diseases--I began to understand firsthand what incredible research goes on throughout the university and how clearly colleagues are invested in it; and I started thinking, ‘Wow, this really is an amazing place!”
Chair, Department of Psychiatry and Behavioral Health, Suburban Hospital
Assistant Professor of Psychiatry and Behavioral Sciences
Director of the McHugh Center
Professor and Former Vice Chair for Education, Department of Psychiatry and Behavioral Sciences
Member, Miller Coulson Academy of Clinical Excellence
In college, Margaret Chisolm set out to study film history within a broader visual arts program. Then she turned to medicine, and psychiatry. More recently, she has found an innovative way to bridge the two fields by incorporating art museum-based methods into medical education. These techniques, involving thoughtful, facilitated discussions prompted by art, can help medical trainees have a deeper appreciation for the human condition, according to Chisolm.
Over the years, her role in education has evolved from overseeing first-year residents to mentoring learners throughout the world in educational scholarship, from undergraduates through faculty. “There are a lot of misconceptions about what it takes to succeed academically at Johns Hopkins,” says Chisolm. “A lot of people think that if they’re not scientific investigators, they don’t have a way forward.” A clinical excellence promotion track Chisolm is helping develop—that rewards clinically excellent faculty for innovation in patient care, as well as teaching—may solve some of these misperceptions, she says. “What I find rewarding is showing people that if they love teaching or if they love developing educational materials for innovative new methods of teaching, they can take what they love and still succeed.”
Chisolm spent about 10 years with Johns Hopkins’ Center for Addiction and Pregnancy, where she worked with drug-dependent pregnant women and published articles about mood disorders, substance use and treatment strategies in this population. Her research efforts advanced to studying burnout in medical education trainees and helping health profession trainees treat all patients with dignity and respect. “That grew out of my addiction work,” she says, “and seeing how even some really great clinicians can have a blind spot toward their attitudes toward patients with addiction and other psychiatric illnesses.”
Now, her educational efforts are incorporating art. In 2019, Chisolm was one of 12 inaugural fellows in an art museum-based health professions education fellowship offered by the Harvard Macy Institute and Cambridge Health Alliance (for which she’s now on the adjunct faculty). Held at the museum of Fine Arts in Boston, the program explores ways to use the museum environment and art appreciation to advance health profession education goals such as honing observation and interpretation skills; team building; and examining assumptions, values and stigma. She is certified as a facilitator of Visual Thinking Strategies and has used this and other arts-based teaching methods with Hopkins pre-health professions students, medical students, residents/fellows, and faculty. She has developed a fourth-year elective for medical students to use the local art museums to explore what it means to be human and a physician, and to live a good life; and – during the pandemic – has offered a 1-week online version of this course several times. These efforts can help transform the way physicians think about themselves, humanity and their mission, she says, and help them flourish both personally and professionally, a topic on which she is an expert. (Dr. Chisolm directs the Paul McHugh Program for Human Flourishing, and – in October 2021 – her latest book, “From Survive to Thrive: How to live your best life with mental illness,” for patients and families will be published by the Johns Hopkins University Press).
While attending on the inpatient unit recently, Chisolm organized a Visual Thinking Strategies break, where she used art to illustrate a point that had come up in rounds regarding observations versus interpretations. “I can use this to help develop critical thinking skills of our residents and other learners, to encourage perspective-taking, empathy and other skills that are relevant to health care,” she says, which will ultimately help patients thrive as well.
Vice Chair for Faculty, Department of Psychiatry and Behavioral Sciences
Vice Chair for Clinical Affairs, Department of Psychiatry and Behavioral Sciences
Director, Community Psychiatry Outpatient Program, The Johns Hopkins Hospital
As a high school student in Ireland, Bernadette Cullen received coaching from her uncle, a career guidance counselor, about areas that might be good for her to think about. One of them was medicine.
She attended a six-year bachelor’s degree/medical school program at Trinity College in Dublin. Cullen did think about a career in psychiatry but didn’t particularly enjoy her psychiatry rotation, so when she finished medical school she pursued a residency in family practice. As part of that experience, Cullen had a six-month rotation in community adult psychiatry with St. Loman’s Hospital in Dublin. Everything clicked.
“It was a new program for community psychiatry and I highly enjoyed it,” Cullen says. “It was a great multidisciplinary team approach, and I really felt part of the team.”
At that point, she was halfway through her family practice residency. She finished this residency, then entered and completed a psychiatry residency in Ireland. After that, she moved to Baltimore with her husband and did a research fellowship in obsessive-compulsive disorder (OCD) and a community psychiatry clinical fellowship at Johns Hopkins before joining the faculty in 2001. She became director of the Community Psychiatry Outpatient Program in 2003, providing administrative and clinical oversight for all staff.
“My heart has always been with the community psychiatry population, particularly the chronically mentally ill,” Cullen says. “I get great satisfaction out of working with them. They’re a great group of patients who demonstrate an amazing resilience given many of the stresses that they have in their lives in addition to their mental illness.”
In this role, Cullen has instituted a number of initiatives and services including an intensive outpatient program, an assertive community psychiatry program (ACT), an advisory board, a campaign to encourage patients to stop smoking, “telepsychiatry” appointments for urgent situations for patients in ACT, and standardized assessments for all patients.
She also supports research studies of Johns Hopkins investigators and conducts some of her own research, such as investigating automated text messages to help prevent relapse in patients with schizophrenia and how to decrease appointment no-show rates among community psychiatry patients. One of her recent studies found that individuals with schizophrenia were more likely to live longer if they took their antipsychotic drugs on schedule and regularly saw their mental health professional.
In 2017, Cullen took on an additional role within the Department of Psychiatry and Behavioral Sciences, as vice chair for clinical affairs. Here, her day-to-day activities include communicating with the faculty about any ongoing clinical endeavors or issues, and developing initiatives to improve clinical services throughout the department. This year at The Johns Hopkins Hospital she formed a Constant Observation (CO) Workgroup to review and redefine the process of when and how inpatients are put on CO, and a Discharge Initiative Workgroup to streamline the discharge process across the inpatient units. She also established a Psychotherapy Training Initiative Committee to review current psychotherapy training levels among outpatient and inpatient hospital therapists and social work staff at both the East Baltimore and Bayview campuses. As part of Johns Hopkins’ Clinical Communities, she is involved in a project to decrease readmissions at both The Johns Hopkins Hospital and other Johns Hopkins medical centers in the Baltimore-Washington area, including Johns Hopkins Bayview Medical Center, Howard County General Hospital, Sibley Memorial Hospital and Suburban Hospital.
“I want to make sure we’re continuing to provide the highest quality care for our patients,” she says. “We’re doing a lot of quality-related initiatives, trying to improve things and make sure that we’re at our best.”
Director, Eating Disorders Program
The Johns Hopkins Hospital
The Stephen and Jean Robinson Associate Professor of Psychiatry
Department of Psychiatry and Behavioral Sciences
You might say Angela Guarda took a path less traveled to psychiatry.
She studied molecular biology as an undergraduate at Johns Hopkins but found it too far removed from understanding the whole person. Then, a psychology elective piqued her interest. She enrolled in a graduate program in psychology but it included too little basic science for her taste, so she quit to take a position as a laboratory technician in Joseph Coyle’s neuroscience lab at Johns Hopkins.
“I kept flip-flopping between molecular science and humanism,” she laughs, “which culminated with getting rejected from acupuncture school and then deciding to apply to medical school.”
Finally, in psychiatry, she found her perfect balance. “Psychiatry encapsulates what it is to be human—understanding what drives our behavior, thoughts and feelings,” Guarda says. “Practicing psychiatry is a privilege. It allows a glimpse into people’s lives and experiences, an opportunity I don’t think is possible in many other fields. And it’s a very rewarding specialty, especially so because the vast majority of patients benefit from treatment.”
As a psychiatry resident at Johns Hopkins, Guarda enjoyed working with young female patients and became interested in anorexia nervosa—a puzzling, often crippling condition with the highest mortality of any psychiatric disorder. She applied to do an exchange program with The Maudsley Hospital in London, working in the eating disorders program under Janet Treasure, one of the field’s best known clinicians and researchers. When she returned, Paul McHugh, then chairman of the psychiatry department, offered her a position as assistant director of the eating disorders program.
The job didn’t come without challenges. It was the mid-1990s, and managed care was rapidly shortening hospital stays and changing the delivery of health care in the U.S. The average inpatient stay on the eating disorders unit for a patient with anorexia nervosa plummeted from three months to six weeks. Guarda was hired to keep the program viable.
A positive development that emerged from these changes in the health care landscape, she says, was the creation of less costly partial hospitalization or day programs for treating eating disorders. At Johns Hopkins, the partial hospitalization and inpatient programs are fully integrated, with treatment provided in the same location by the same treatment team. As patients transition from inpatient to the partial hospitalization program, treatment focus shifts from medical, psychiatric and nutritional stabilization to relapse prevention. Patients prepare and cook meals, go to restaurants and shop for groceries, initially guided by staff and later independently, as their time in the program and clinical supervision decreases.
Throughout treatment, family and group-based behaviorally-focused therapy helps patients reframe and counter negative thoughts and feelings about food and weight and practice healthy coping strategies.
Guarda and the Johns Hopkins program are known for treating medically and psychiatrically complex cases and for the program’s rapid rates of weight restoration for patients with restrictive eating disorders. Faster weight gain means shorter lengths of stay and a higher likelihood of reaching a normal weight by discharge, which is important since reaching a normal weight is the best predictor of recovery from anorexia nervosa. Faster weight gain also decreases the cost and time needed to reach weight restoration, shortening time in the hospital and away from home. All nutrition is meal-based. Despite never using feeding tubes, the program has the highest published rate of weight restoration for anorexia nervosa. Most patients leave Johns Hopkins at a normal weight, able to eat a wide range of foods across a variety of social settings—something they were unable to do without intense anxiety, if at all, prior to admission.
Guarda also conducts research studies. Her clinical research is focused on assessing outcomes of intensive treatment programs and increasing the efficacy of hospital-based treatment. She is also involved in translational research examining biological mechanisms that underlie the driven nature of eating disorders. This work includes neuroimaging studies assessing brain activation in appetitive, reward and anxiety-related neural circuits in response to food stimuli in patients with anorexia nervosa.
Guarda says the greatest personal satisfaction she gets is bearing witness to her patients’ progress: “I have treated many patients with life-threatening anorexia who are now therapists, nurses, teachers and lawyers, who enjoy full and productive lives, have children and partners…To witness and to be part of their recovery is a privilege and immensely rewarding.”
Co-Director, Mood Disorders Center
The Johns Hopkins Hospital
The Dalio Professor in Mood Disorders
Professor, Department of Psychiatry and Behavioral Sciences
Kay Jamison grew up in a military family, living in many places during her childhood. But her curiosity in the way the brain worked was a constant.
“I was always interested in psychology, or the way people go through the world with different temperaments and different capacities,” she says.
Jamison threw herself into psychology and zoology studies at the University of California, Los Angeles, where she earned her bachelor’s degree in psychology and her Ph.D. in clinical psychology with specializations in comparative psychology and psychopharmacology. She completed a predoctoral internship at UCLA’s Neuropsychiatric Institute before beginning her career as an assistant professor in the UCLA Department of Psychiatry. During this time she struggled with the early manifestations of bipolar disorder but was only diagnosed a few months after beginning her academic career. She co-founded and was director of UCLA’s Affective Disorders Clinic for 10 years, where she loved teaching, doing research, and treating patients.
In 1987, Jamison moved to the Department of Psychiatry and Behavioral Sciences at Johns Hopkins. Several years later, in 2005, she became the co-director of the Johns Hopkins Mood Disorders Center.
“It is a great group of people studying some of the most interesting problems and aspects of psychiatry and psychology,” says Jamison. “They are really bright, tremendous clinicians and tremendous scientists. It’s a great privilege to work with them.”
In 1995 she wrote a memoir detailing her experience of bipolar illness. The book, “An Unquiet Mind,” was on the New York Times Bestseller List for more than five months and has been translated into more than 30 languages. She has written several books since, about suicide and grief, exuberance, and artistic and scientific creativity. Film director Paul Dalio, who has bipolar disorder, was so moved by Jamison’s book “Touched with Fire,” which documents artists with mental illness, that he was inspired to make a film about the relationship between two poets with bipolar disorder.
Jamison is the coauthor of “Manic-Depressive Illness: Recurrent Depression and Bipolar Disorders,” which is considered the classic textbook on bipolar disorder and the author of “Robert Lowell, Setting the River on Fire,” a Pulitzer Prize finalist for biography in 2018.
Jamison, the recipient of a MacArthur Fellowship (the so-called “Genius Award”) in 2001, has received numerous awards for her work, including a “Hero of Medicine” award from Time magazine, the American Suicide Foundation Research Award, and the Falcone Prize for Research in Affective Illness. She is a fellow of the American Academy of Arts and Sciences and the Royal Society of Edinburgh, as well as a recipient of the Lewis Thomas Prize and the Sarnat Prize from the National Academy of Medicine.
Today, Jamison balances her time writing books, overseeing public awareness programs about mental illness, teaching, and working in the Mood Disorders Center. She is currently writing a new book, “All the Dark Night: Healing the Mind.”
Founder and Executive Director, Center for Autism and Related Disorders (CARD)
Vice President, Kennedy Krieger Institute
Professor, Department of Psychiatry and Behavioral Sciences
The Johns Hopkins University School of Medicine
In Baltimore, the word autism is nearly synonymous with Rebecca Landa.
In the 1970s and ‘80s, when Landa was studying speech pathology and working as a speech-language pathologist, very little was known about autism. Only those who were most severely impaired were properly diagnosed. “But what was clear is that it was one of the more challenging neurodevelopmental disorders,” she says. “I thought if I could learn how to help children with autism talk and communicate more effectively, that I would pretty much be able to help any child, so I became very devoted to learning how to do that.”
As Landa pursued a doctorate in speech and hearing sciences at the University of Washington and then postdoctoral training in psychiatric genetics at Johns Hopkins, the community was first becoming aware that autism was heritable. It wasn’t uncommon for Landa to test a child for autism only to have the parents inquire about a sibling of that child with his or her own social or communication difficulties. These children weren’t being diagnosed but were struggling, Landa says.
Working at the Johns Hopkins University School of Medicine and Kennedy Krieger Institute, where she saw some of the most complex patients, Landa realized that families needed a centralized place to receive coordinated care for children on the autism spectrum. In 1995, she started the interdisciplinary Center for Autism and Related Disorders (CARD) at Kennedy Krieger. It has grown to a group of 170 employees seeing over 4,000 different patients a year from birth to age 21. The center, which combines outpatient clinical diagnostic and intervention services, and educational, research and outreach programs, generates innovative, evidence-based approaches to diagnosis and individualized treatment options for children and their families. It has served as a model for numerous other centers in North America, Asia and Europe.
“It’s rewarding because people with autism are beautiful within, and have considerable potential, but it’s often not evident based on their behavior or the way that they interact with people, or maybe because of some of their sensory, motor or cognitive limitations,” says Landa. “I love helping them break through some of the barriers that they have developmentally, or that they have acquired because of their developmental difficulties. And I love helping parents and teachers learn to see those strengths and possibilities in children and equipping them to support the children in their journey for success.”
Over the years, Landa has become well-known both for her clinical and research expertise, including developing diagnostic criteria for young children with autism for clinicians and for parents, and promoting early interventions for infants and toddlers with signs of autism. She has followed the infant siblings of children with autism into their teens looking for the earliest signs of autism and understanding learning processes, finding about 20% of siblings develop autism as well. She also has noted that autism has a prodromal period before symptoms occur, and is now funded by the National Institutes of Health to do preemptive interventions with high-risk infants between eight and 12 months of age.
In addition, Landa serves as a co-principal investigator for the National Institute of Health’s ECHO (Environmental influences on Child Health Outcomes) study, an investigation to understand effects of environmental exposures on children’s health. She is also a co-principal investigator for the Centers for Disease Control and Prevention’s SEED (Study to Explore Early Development) study, a multi-year study in the U.S. to help identify factors that put children at risk for autism and other developmental disabilities. Landa has been the recipient of numerous awards for her work, including the National Institute of Mental Health Shannon Award for excellent and innovative research and the Rita Rudel Prize for Developmental Neuropsychology.
Landa says she has enjoyed sharing her skills through mentoring of clinicians, students and others. Many who have worked in her clinic or lab after earning undergraduate degrees have gone on to pursue PhDs or other higher education, helping to add to the greater knowledge base and specialists in this area.
Clinical Director of Psychiatry, Johns Hopkins Bayview Medical Center
Associate Professor, Department of Psychiatry and Behavioral Sciences
The Johns Hopkins University School of Medicine
It was time spent on a remote Indian reservation that attracted Karin Neufeld to the field of psychiatry. Now, she’s one of the world’s leading experts in preventing and treating delirium.
Neufeld, who grew up in Manitoba, Canada, completed her bachelor’s and medical degrees in a joint program at the University of Manitoba, then finished a rotating internship with McGill University in Montreal. After that, she spent a year practicing general medicine in The Pas, a northern town in Manitoba, which included one day a week at an Indian reservation clinic. There she observed a high burden of alcohol and substance use disorders, as well as psychiatric problems and poverty. The experience of making a difference in the lives of patients with many challenges compelled her to go into psychiatry.
“The medical and behavioral health needs were very great in this population,” she said. “While there were practitioners to help with the medical problems, the need for psychiatric services for mental and substance use disorders was high and the expertise in treating these conditions, very scarce. This inspired me to want to learn more to be of greater service for people with these needs.”
In 1988, Neufeld came to Johns Hopkins for a residency in psychiatry and then a fellowship in community psychiatry that included earning her master’s of public health degree. She then joined the faculty, working with the community psychiatry program, managing patients with substance use and schizophrenia.
From 1998-2001, Neufeld accepted a three-year visiting scientist position at the All India Institute of Medicine in New Delhi, where she continued to teach, see patients with psychiatric residents and publish in the area of psychiatric epidemiology. She also began working with a group studying opioid use disorders, which inspired her interest when returning to Johns Hopkins to become associate medical director of the Addiction Treatment Services Clinic. Neufeld also became co-director of a Topics in Interdisciplinary Medicine (TIME) course for medical students, in which they learn about substance use disorders and how to intervene and treat patients. After eight years, she moved r to The Johns Hopkins Hospital to head the Psychiatry Consultation Service. During that time, she observed the many patients affected by delirium, and became interested in the condition and its treatment. In 2014, she was appointed Clinical Director of Psychiatry at Johns Hopkins Bayview Medical Center.
In these roles, Neufeld has both worked to build joint consultation services with the Department of Medicine for patients with both substance use disorders and psychiatric concerns, and delved head-first into her studies of delirium. She has published about the development of robust delirium measurement methods as well as the use of medications to manage and treat delirium. Her work has transformed the prevention and management of delirium at Johns Hopkins and other hospitals around the world; helped shepherd delirium research into practice guidelines for groups like the Society for Critical Care Medicine, and systematic reviews by the Agency for Healthcare Research and Quality; and influenced the science and practice of delirium risk management in the fields of psychiatry, geriatrics, surgery, anesthesiology and critical care medicine, and neurology.
Neufeld also started and chairs the Johns Hopkins Delirium Consortium, started in 2010. This group, which meets once a month, includes about 100 clinicians from diverse departments such as anesthesiology, orthopedics, nursing and rehabilitation medicine focused on fostering delirium research and sharing best practices in delirium treatment and prevention. Consortium members have received over $14 million in National Institutes of Health funding for delirium research.
Neufeld says she has been excited to note the group’s effect on changing patient care at Johns Hopkins. A 2010 study of the post-anesthesia care unit indicated that about half of patients over 70 were delirious as they recovered from surgery. “This is no longer the case,” she says. “Patients are doing so much better.” Physical therapists at Bayview now come to the PACU to get people walking and to begin rehabilitation early. There also has been an overall increase in recognition of the need for sedation reduction in the ICU and during surgical anesthesia, monitoring for withdrawal syndromes in those with substance use disorders, protecting sleep/wake cycles and offering cognitive stimulation to vulnerable patients, especially those older with some mental decline. “This is a huge sea change in terms of caring for people - such that we do a better job with both their bodies and their brains. It’s very gratifying…We want to continue pushing forward the ways in which we can help patients.”
More recently, she has been investigating a specific cause of delirium called Wernicke’s encephalopathy, a neurological condition caused by a deficiency in B vitamins such as thiamine. Quick treatment with thiamine infusions can reverse the symptoms, she says, potentially preventing some patients from significant long-term disability from cognitive impairment. .
“I’ve just completed a study of ramelteon as an agent that might actually prevent delirium, and during that study we were just really pleasantly surprised at how alert and awake patients are, even after very major surgeries,” she says.
Chair and Medical Director, Department of Psychiatry and Behavioral Health, Sibley Memorial Hospital
Assistant Professor of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine
Growing up in the suburbs of Washington, D.C., Erica Richards says she was always interested in medicine. As part of a medical, science and computer science honors program at her high school, she says she was able to conduct science experiments others may not experience until college.
Richards was a biology major at Spelman College in Atlanta when she attended a conference for the Student National Medical Association that set the stage for her career in psychiatry. While there, she heard about the National Institutes of Health’s Undergraduate Scholarship Program (UGSP), which offers college scholarships and summer research training with a mentor at the NIH as well as a guaranteed job there after graduation. Richards was awarded that scholarship for her last two years of college. “That’s when I really started thinking about not only psychiatry, but research,” she recalls.
After college, Richards pursued a combined M.D./Ph.D. program at the University of Maryland School of Medicine, earning a Ph.D. in neuroscience along with her medical degree. During this training, she says, “I became more and more interested with the brain, including not only the neurology component, but I also was fascinated by how this affects mood and influences our personalities.”
After an internship and residency in psychiatry at Johns Hopkins, Richards returned to the NIH for five years, initially to pay back her scholarship time, completing a clinical research fellowship in the Mood Disorders and Anxiety program and later working as an attending physician for the National Institute of Mental Health (NIMH)’s Psychiatric Consultation Service. Her research interests included the use of ketamine for treatment-resistant depression, and the role of inflammation in the pathophysiology of depression.
While working at the NIMH, Richards started her own private practice and served as an assistant professor for Georgetown University Medical Center, where she trained psychiatrists in the combined Georgetown/NIMH psychiatric liaison fellowship. It was during this time that Johns Hopkins made the lifelong Washington resident an offer to come back that she couldn’t refuse: chair and medical director of the Department of Psychiatry and Behavioral Health at Sibley Memorial Hospital.
“I was really excited about the opportunity to come to Sibley, because it allowed me to finally return to Johns Hopkins and extend their stellar reputation for providing quality psychiatric care to patients in the D.C. area,” Richards says.
Since 2017, she has been working to expand and build up the department. The three full-time psychiatrists and one full-time psychiatric nurse practitioner at the medical center now provide care and services throughout the day, including serving an acute care inpatient unit, longitudinal outpatient psychiatric care, hospital-wide consults and emergency room coverage for psychiatric emergencies.
“It’s rewarding because we’re able to really educate people about mental health,” Richards says. “Certainly that goes for our patients and their families, but it also goes for our hospital at large—the people who work here and our surrounding community.”
Collaboration among the doctors, nurses, social workers and other specialties is an important factor in helping patients recover, adds Richards: “With our average length of stay slightly over one week, we’re able to see people get better and get them back to their lives.”
Her future vision for Sibley is to continue to grow the electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) programs as well as to provide specialty outpatient clinics that focus on a variety of illnesses including women’s mood and anxiety disorders, and treatment of adolescent and young adult populations. She is also working on developing enhanced collaborations with psychiatrists who work near Sibley. In addition, recognizing the importance of both medication management and therapy, Richards is working to incorporate a social work team that can provide long-term outpatient therapy.
Director, Division of Geriatric Psychiatry and Neuropsychiatry
Johns Hopkins Bayview Medical Center
Richman Family Professor for Alzheimer’s and Related Diseases
Professor, Department of Psychiatry and Behavioral Sciences
As a neuropsychology graduate student in the 1980s, studying neurotransmitters involved in the development of Alzheimer’s disease, Gwenn Smith ran to the library any time a new paper came out from Don Price, the former head of neuropathology at Johns Hopkins.
“These were among the first neurochemical studies in the Alzheimer’s postmortem brain,” says Smith, “and it is really what informs a lot of the human imaging work we do.”
Smith grew up in the New York area and remembers seeing a lot of media attention regarding the treatment of individuals with mental illness. “Just being exposed to that was really very striking, even at a relatively young age,” she recalls. Smith originally thought about a clinical career conducting therapy with patients, but as an undergraduate at the University of Pennsylvania, she inquired about a lab where she could try research, and was introduced to researchers Ruben and Raquel Gur. At the time, they were doing the first positron emission tomography (PET) imaging scans of the human brain. The work was inspiring.
“The isotope was shipped by helicopter from the end of Long Island to Philadelphia” so the Gurs could use it to study glucose metabolism in the brain, Smith says. “We were doing different types of brain scans, and also presenting different stimuli to patients and looking at patterns of activation in the brain. It sounds sort of routine now, but back in the early ‘80s, it was pretty novel.”
From there, Smith’s interests moved toward neurobiology and psychopharmacology, realizing that to treat patients most effectively clinicians needed to know more about the biology of psychiatric illness. She went into a graduate program combining neuropsychology—the study of the biological basis of behavior—with neuroscience. Since then, she has studied a number of psychiatric and neurological conditions, all through the lens of understanding the dynamic chemical function of the brain and trying to inform the development of more effective treatments by using imaging data.
Smith was a faculty member at the New York University School of Medicine, the University of Pittsburgh School of Medicine and Albert Einstein College of Medicine before coming to Johns Hopkins in 2008. She was attracted by the institution’s strong history in basic science research, clinical psychiatry programs and imaging studies.
In 2015, Smith became director of the Division of Geriatric Psychiatry and Neuropsychiatry, where she considers one of her most important missions to support the faculty, in addition to building and developing collaborations with complementary departments including radiology, neurology and neurosurgery, and growing the division.
“What’s most rewarding is to see my colleagues succeed and to see them get promoted. It is wonderful for me to go to conferences, and to hear how great the faculty are and how great the quality of treatment is,” Smith says. She also enjoys giving copies of her research articles and university press releases about them to study participants. “They find it really rewarding, and it gives them direct evidence of the important contribution they have made.”
In the lab, Smith has focused her work largely on geriatric depression, mild cognitive impairment and Alzheimer’s disease, with some methods being applied to other disorders, including schizophrenia and traumatic brain injury. Recent studies of hers have found that deep brain stimulation, in which a medical device is implanted into the brain to stimulate a particular circuit, may be helpful for people with Alzheimer’s disease over age 65 and could help normalize the brain circuits that drive the eating disorder anorexia nervosa. She also has studied changes in brain chemistry with brain stimulation in patients with Parkinson’s disease in collaboration with faculty in the Departments of Neurology and Neurosurgery.
Another project of Smith’s is studying changes in the neurotransmitter serotonin that occur in the brains of patients with Alzheimer’s disease even before the buildup of the proteins tau and amyloid classically associated with memory problems. She is starting a treatment study that targets the serotonin system based on the imaging work.
“The overall goal is to identify changes in the brain that occur in in the early stages of neurodegenerative disease,” she says. Often, a change in behavior such as in mood or anxiety will appear before clinicians can document a change in memory or motor symptoms as in Alzheimer’s or Parkinson’s disease. “We would like to develop more sensitive measures to detect change in behavior to identify these illnesses earlier and then sort out the most effective treatments.”
Vice Chair for Education, Department of Psychiatry and Behavioral Sciences
Director of Clinical and Educational Programs, Johns Hopkins Mood Disorders Center
Myra S. Meyer Professor in Mood Disorders
Karen Swartz’s career in psychiatry almost seems predestined. “I was the person that everyone always talked to about their issues, so everyone joked that of course I would be a psychiatrist,” says Swartz. Fortunately, she says, none of them had serious concerns that would have required a trained mental health professional, but she found the role rewarding.
Swartz says she has always been excited about the brain. Coming from a family with several doctors, the idea of going into medicine made sense for her. She majored in chemistry in college but learned she wanted a career that incorporated science in a way that was more interactive with other people. Then in medical school at Johns Hopkins, as Swartz completed rotations in different departments, she found she loved psychiatry and getting to interact with the patients. She stayed on for an internship and residency in psychiatry, and completed a fellowship at Johns Hopkins’ Affective Disorders Consultation Clinic and postdoctoral work in psychiatric epidemiology before joining the faculty in 1997.
The next year, Swartz was called on to help out with a local crisis. In 1998, three high school students in the Baltimore area committed suicide within a two-month period. Community representatives approached Johns Hopkins for help, and with her background in mood disorders and public health, Swartz found herself speaking to high school students and teachers about depression.
Then, with seed money from local business leaders, Swartz and colleagues created the Adolescent Depression Awareness Program (ADAP), a school-based program to educate high school students, faculty and parents about adolescent depression. The three-hour curriculum, now taught primarily by counselors and teachers in high schools (who bring back the lessons to their students after being trained), has been presented to over 108,000 high school students in the Baltimore-Washington area and 20 other states. The program has received an Outstanding Merit Award from the Maryland Foundation for Psychiatry, and a National Institute of Mental Health-funded clinical trial demonstrated that the lessons learned had lasting effects on students. Information about teen depression has since been made available through a free mobile app, mADAP.
Donors have provided additional monies to create a sophisticated ADAP online training program that Swartz and associates are working on now. When that is completed in less than a year, she says, “we will be able to offer the training to any high school teacher in the country.” [Update note: the ADAP online training site has launched.]
Swartz has balanced work with the ADAP program with serving as clinical leader of the Mood Disorders Program at Johns Hopkins, providing specialty care for patients with mood disorders in inpatient, day hospital, consultation clinic and outpatient settings. She has become nationally recognized for her clinical expertise in the diagnosis, formulation and treatment of patients with mood disorders. One of her research interests is studying mood disorders in women.
In 2018, Swartz took on an additional role, as vice chair for faculty for the Department of Psychiatry and Behavioral Sciences, where she has enjoyed mentoring young faculty. “It’s really important, especially for junior faculty, to have advocates who can be a source of information or someone they can talk to about issues that come up…Academic medicine is a challenge, and it’s very demanding. If you find work that you’re passionate about, then you are much more likely to be successful.”
Swartz says she enjoys balancing these different roles.
“I’m someone who likes having different things going on—I’m never bored,” Swartz says. “But what I love most is taking care of patients and interacting with the patients and their families. Everything else really builds out of that. If you look for a theme in my career, it’s education about mood disorders. I love teaching residents and medical students about mood disorders so they will be in a better position to take good care of patients. I love teaching the patients and their families about mood disorders so they can be more active partners in care. And in the vice chair role, I enjoy helping younger faculty members understand the system so they’re in a position to make more informed choices about their careers.”