Day One

Walk­ing into the Child and Ado­les­cent Psy­chi­a­try build­ing on a bril­liant, Cal­i­forn­ian win­ter day seemed to reflect my feel­ings for the day: bright and opti­mistic. I had def­i­nitely been enjoy­ing my win­ter break, but I couldn’t wait to begin myPrincetern­ship with Dr. Kiki Chang ’88, the Direc­tor of the Pedi­atric Bipo­lar Dis­or­ders Pro­gram who is also an Asso­ciate Pro­fes­sor at Stan­ford Uni­ver­sity School of Med­i­cine, a child psy­chi­a­trist, and admin­is­ters clin­i­cal research. 

Eva­line, the other Princetern, and myself had con­tacted Dr. Chang in the weeks lead­ing up to the Princetern­ship, which helped us choose the best times and dates for all of us. We arrived in the lobby of the psy­chi­a­try build­ing in the morn­ing and waited for Dr. Chang to meet us there – unfor­tu­nately, his son had to be picked up sick from school. Instead, one of his clin­i­cal research coor­di­na­tors, Rosie, hap­pily met us in the lobby and brought us upstairs to her office and the “head­quar­ters” of some of Dr. Chang’s research. While Rosie pre­pared for the upcom­ing “case-ad”, an inter­view with one of the sub­jects from a study, she enthu­si­as­ti­cally answered our ques­tions and pro­vided us with a great back­ground on what we would be sit­ting in on for the morn­ing. We would be observ­ing the lon­gi­tu­di­nal part of one of Dr. Chang’s stud­ies, “Iden­ti­fi­ca­tion of Genetic and Neu­ro­bi­o­log­i­cal Risk Fac­tors for the Devel­op­ment of Early-Onset Bipo­lar Dis­or­der” with a healthy con­trol sub­ject. Although the study focuses on dis­cov­er­ing the pos­si­ble fac­tors of neu­ro­chem­istry, genetic mark­ers, and brain acti­va­tions pat­terns that con­tribute to the onset of bipo­lar dis­or­der, we learned that it is impor­tant to have healthy con­trol sub­jects (those who do not have ADHD or mood prob­lems or a par­ent with bipo­lar dis­or­der) in order to com­pare results and claim significance.

Rosie took us to Meghan Howe’s office, who is one of the Clin­i­cal Research Man­agers, where Dr. Chang quickly wel­comed us and intro­duced him­self to us before Meghan began the “case-ad” with the healthy con­trol sub­ject. The case-ad, in which Meghan inter­viewed the healthy sub­ject about pos­si­ble symp­toms for mood dis­or­der, lasted about a half hour. After­wards, we accom­pa­nied Rosie and the healthy con­trol sub­ject while Rosie admin­is­tered a few follow-up tests. Rosie admin­is­tered the Affect Recog­ni­tion, or the NEPSY test, which is used to eval­u­ate a child’s neu­ropsy­cho­log­i­cal devel­op­ment through test­ing basic and com­plex aspects of cog­ni­tion. We also observed the healthy con­trol sub­ject take the “Mul­ti­Morph” test, which uses a com­puter to morph a pic­ture of a face from one mood to another (i.e., an angry face to a happy face).

When the healthy con­trol sub­ject left, we met Dr. Chang in the lobby where he brought us out­side to the “Nom Nom Truck” (http://nomnomtruck.com/) for a deli­cious Viet­namese meal to-go. While wait­ing for our food, Dr. Chang was enthu­si­as­tic about get­ting famil­iar with our inter­ests, our pas­sions, and our goals, and we found that many of our inter­ests over­lapped. Dr. Chang and I found out that we even share the same res­i­den­tial build­ing, Joline! We brought our lunch to a com­mu­nal meet­ing with many pres­ti­gious psy­chi­a­trists, ana­lysts, researchers, and men­tors who dis­cussed cur­rent research, ways to bet­ter research, and ways to bet­ter col­lab­o­rate. The meet­ing brought together some of the bright­est minds and experts in pedi­atric mood dis­or­ders. Straight from the meet­ing, Dr. Chang brought us to his office for another meet­ing with Rex Huang, the Chief Fel­low of Child and Ado­les­cent Psy­chi­a­try at Stan­ford Hos­pi­tal and Clin­ics. Dr. Chang and Dr. Huang dis­cussed recent patients, any dosage or med­ica­tion changes, and any updates. It was really inter­est­ing to get a glimpse of Dr. Chang’s over­ar­ch­ing role in the clinic and to hear snap­shots of Dr. Huang’s indi­vid­ual and direct work with his patients.

Fol­low­ing that meet­ing, we rushed to a meet­ing with Alan Reiss, one of Dr. Chang’s men­tors and head of the neu­roimag­ing lab, for a con­sul­ta­tion on the find­ings of one of Dr. Chang’s more recent stud­ies. Amy Gar­rett, a Research Sci­en­tist and Neu­roimag­ing Man­ager, Ryan Kel­ley and Spencer Boucher, neu­roimag­ing research assis­tants, were also there to dis­cuss the find­ings and the best pos­si­ble way to present and pub­lish them. From what I could under­stand, the study, CAFENE, used MRI to eval­u­ate the neu­ro­log­i­cal response to view­ing images of a fear face, a calm face, or a neu­tral face. It was a great col­lab­o­ra­tive effort and the meet­ing worked as a con­ver­sa­tion, with each per­son pro­vid­ing insight and ask­ing fur­ther ques­tions to bet­ter the under­stand­ing of the findings.

After­wards, Amy Gar­rett and Vic­to­ria Cos­grove met us in Dr. Chang’s office before head­ing off to another meet­ing. Dr. Chang drove us to the “Lucille-Packard Foun­da­tion” donor pre­sen­ta­tion, which we all thought would be a small meet­ing. We were all sur­prised when we walked into a room full of busi­ness suits, but Dr. Chang non­cha­lantly and humbly began his pre­sen­ta­tion. He opened the pre­sen­ta­tion with the impor­tance of fund­ing for Bipo­lar Dis­or­der, espe­cially in accor­dance with its “de-stigmatizing”. Lis­ten­ing to Dr. Chang speak, I real­ized that, despite his suc­cess, he must over­come much adver­sity in order to receive recog­ni­tion or dona­tions for his research. The social stigma of Bipo­lar Dis­or­der dis­cour­ages many peo­ple from donat­ing, espe­cially when there are peo­ple out there who still believe that Bipo­lar Dis­or­der doesn’t exist or is sim­ply an exag­ger­a­tion of teenage “tem­per tantrums.”  Dr. Chang went on to present a sum­mary of his work, dis­cussing comor­bid­ity fac­tors, the dif­fi­culty of apply­ing adult find­ings to chil­dren and ado­les­cents, and how it affects a child’s edu­ca­tion. In the end, the meet­ing came together to brain­storm ideas on how to raise money for Dr. Chang’s incred­i­ble work.

When Dr. Chang dropped us back off at 401 Quarry Road, I walked away with an immense amount of knowl­edge. Not only did all of my back­ground research come together and apply to each of my expe­ri­ences from today, I had learned so much about Dr. Chang’s career and the careers of his col­leagues. Every­one I had met was very enthu­si­as­tic and wel­com­ing, but more impor­tantly, they were all very down-to-earth. Dr. Chang was incred­i­bly per­son­able, friendly, and hum­ble. It was def­i­nitely refresh­ing to see Dr. Chang, a man so mod­est with his suc­cess, in this busi­ness envi­ron­ment because his lik­a­bil­ity was impos­si­ble to deny. Look­ing back, I real­ized Dr. Chang’s per­son­al­ity is evi­dent in all of his rela­tions with his col­leagues we observed today, mak­ing for a very suc­cess­ful, upbeat atmos­phere. Today I learned a lot about pedi­atric bipo­lar dis­or­der, its research, and psy­chi­a­try, but I also learned the impor­tance of per­son­al­ity in the work­place. I can’t wait to start another day with Dr. Chang tomorrow!

Day Two

Tay­lor, fel­low Princetern Eva­line, and Dr. Chang

Eva­line and I met Dr. Chang in the lobby and quickly went to his office where we had a “debrief­ing ses­sion”. Dr. Chang first dis­cussed mind­ful­ness, the art of being aware of our­selves, and con­trol­ling our emo­tions and how this is involved in his future work. He then dis­cussed the grant writ­ing process that accom­pa­nies any research. He filled us in on the dif­fer­ences between mutlti­ple grant pro­pos­als he is writ­ing. We were pretty intrigued by the approval process and review panel, which seems to exist very sub­jec­tively. From what I under­stand, a grant can be approved or turned down based on the opin­ion of one per­son, which makes for a pretty com­pet­i­tive sys­tem. Fur­ther­more, Dr. Chang shared with us the path­way that brought him to his pro­fes­sion. I found his expe­ri­ences relat­able and enlight­en­ing, open­ing up my eyes to options I hadn’t con­sid­ered yet. He is a strong advo­cate for engag­ing in what­ever makes one happy, “you won’t be suc­cess­ful unless you enjoy what you are doing,” he told us. I found these to be pow­er­ful words, espe­cially from such a suc­cess­ful man who really con­tem­plated the steps he took to get him to where he is now. His job embod­ies what he loves to do: he has a bal­ance of research, of clinic involve­ment, or acad­e­mia, of teach­ing, of pedi­atrics, and of travel. Dr. Chang was inter­ested in our lives, as well, and we shared our expe­ri­ences and hopes with him in return. We all seemed to har­bor the “social con­scious” that brought Dr. Chang to medicine.

After our debrief­ing ses­sion, Eva­line and I went to lunch at the nearby Stan­ford Shop­ping Cen­ter and ordered sand­wiches from La Baguette – a great, cute café. Over lunch, we were able to reflect on our expe­ri­ence so far and share our excite­ment for the upcom­ing plans Dr. Chang had for us. We met up with Dr. Chang at the clin­i­cal mood dis­or­der meet­ing with other psy­chi­a­trists, psy­chol­o­gists, and ther­a­pists who work in the clinic.  The group dis­cussed intakes, patients’ updates, and Dr. Chang ended the meet­ing by teach­ing the group about clin­i­cal tri­als. He went over inter­ven­tions and whether it be med­ica­tion, ther­apy, edu­ca­tion, CBT, DBT, or mind­ful­ness. He then taught about the effi­cacy of tri­als, whether a sub­ject is in remis­sion or recov­ery, and the dif­fer­ent mea­sures of decid­ing these labels. The impor­tance of NNT (num­ber needed to treat) and NNH (num­ber needed to harm) in clin­i­cal tri­als and med­ica­tions was then dis­cussed, teach­ing us that a med­ica­tion with a low NNT and a high NNH is the most productive.

After­wards, we had the oppor­tu­nity to shadow Dr. Chang in the clinic. We sat in on four appoint­ments, each with a girl in her teenage years. The patients had mood dis­or­ders from depres­sion to bipo­lar dis­or­der, from anx­i­ety to schiz­o­phre­nia. Often, Dr. Chang would first con­verse indi­vid­u­ally with a patient before bring­ing her par­ents in. The meet­ing served pri­mar­ily to dis­cuss dosage, but in order to dis­cern which dosage would be appro­pri­ate, Dr. Chang needed behav­ioral updates from the indi­vid­ual and her fam­ily, as well as any updates on side effects. Dr. Chang filled us in on the back­ground his­tory of each patient, who all seemed to be doing well with treat­ment and expe­ri­enc­ing improve­ments.  See­ing Dr. Chang work in the clinic allowed me to under­stand what it would be like to be a prac­tic­ing psy­chi­a­trist, the types of ill­ness and issues a psy­chi­a­trist might deal with, and the ways in which a psy­chi­a­trist can directly and indi­rectly help a patient. Once again, I walked away with an incred­i­ble amount of new infor­ma­tion and an invalu­able expe­ri­ence that will cer­tainly leave an impres­sion on which med­ical path­way I’d like to take.

Day Three

Today, Eva­line and I had the great oppor­tu­nity to meet with Amy, Spencer and Ryan again in Alan Reiss’s neu­roimag­ing lab. We first met with Amy, who eval­u­ates the neu­rol­ogy of eat­ing dis­or­ders, mood dis­or­ders, and mem­ory in elderly,  to dis­cuss the neu­roimag­ing fMRI. She explained to us the physics and sta­tis­tics of fMRI and explained to us the func­tional con­trasts that we see in a brain scan. Fur­ther­more, we learned about the tra­di­tional vs. orig­i­nal design of task-oriented scans, low­er­ing the per­cent of unus­able scans, and the vari­abil­ity that must be con­sid­ered when eval­u­a­tion a scan. For instance, you must under­stand and con­sider the comor­bid­ity fac­tors, the med­ica­tion, and envi­ron­men­tal fac­tors when eval­u­at­ing a scan. She also went on to lament the dif­fi­cul­ties in recruit­ment for research and acknowl­edged that the lik­a­bil­ity Dr. Chang exhib­ited is extremely help­ful not only for fund­ing and for grants, but for recruit­ment as well. We then spent time with Spencer, who intel­li­gently explained to us the pro­gram “FreeSurfer”, which traces parts of the brain and dis­cerns between white mat­ter and grey mat­ter. He spoke more about struc­tural imag­ing, nor­mal­iza­tion, and the cor­rec­tions that must be done with scans. Spencer showed us some of the faces used dur­ing the CAFENE study we heard about dur­ing a meet­ing on Mon­day, which were amus­ing and gave us all a good laugh. In addi­tion, he talked about the sim­u­la­tion sub­jects must undergo before get­ting a real fMRI scan. They usu­ally place a sub­ject in a sim­u­lated fMRI scan with a video of Sponge­bob or a pop­u­lar tele­vi­sion show play­ing. If the sub­ject moves, the video stops for four sec­onds in hopes of train­ing the sub­ject to stay still. With Spencer, we also talked about his major, cog­ni­tive sci­ence, and how he ended up where he is. I found this to be really help­ful because it gave me a great sense of what some­one can do with a degree or major and how I can use my abil­i­ties in the neu­roimag­ing field.

Our final stop in the neu­roimag­ing lab was with Ryan, one of the lab’s favorite employ­ees. Ryan was work­ing on final­iz­ing the CAFENE study paper we dis­cussed in the meet­ing on Mon­day and help­fully went over the paper with us — by the end of our meet­ing with Ryan, we really under­stood all the sci­en­tific and com­pli­cated terms from the orig­i­nal CAFENE meet­ing. Ryan told us that CAFENE stood for CAlm­FEar­ful­NEu­tral and explained that the calm face was used as the base­line because bipo­lar kids had a neu­ro­log­i­cal response to the neu­tral face. We first went over the pri­mary analy­sis, the estab­lish­ment of whether or not bipo­lar kids have more acti­va­tion in cer­tain parts of their brain, in this case, the amyg­dala. We then went over the post hoc analy­sis, eval­u­at­ing the genetic impli­ca­tions of the study. This dealt with the SERT allele, which was taken from a blood sam­ple or a saliva test. We learned about the impor­tance and power of inte­grat­ing brain, behav­ior, and genes in a study for the inte­gra­tion pro­vides the best answers to the ques­tions. Ryan also told us about the dif­fi­culty of the research and the change from under­grad­u­ate writ­ing to sci­en­tific writ­ing, which tends to be short and sim­ple, full of lim­i­ta­tions. The morn­ing in the neu­roimag­ing lab taught me a lot about a field that I am find­ing very inter­est­ing and would like to explore more. The expe­ri­ence also showed the col­lab­o­ra­tion between med­i­cine and tech­nol­ogy, some­thing I am also very inter­ested in.

Eva­line and I had lunch at the café down­stairs and went to the cubi­cles upstairs for a lit­tle down­time and some work.  We had been so busy the past two days that it was nice to relax for a while and reflect on what we had learned so far. Every­one we ran into while we were upstairs was so wel­com­ing, engag­ing, and nice – it was a great envi­ron­ment to be in. After our break, we met back up with Dr. Chang and his col­leagues, many of whom we already worked with, for a lab meet­ing. Recruit­ment, updates, announce­ments, and bond­ing options were all dis­cussed dur­ing the meet­ing. Once again, it was great to see how many peo­ple are involved with Dr. Chang’s work and each of their indi­vid­ual and group roles.

After­wards, we were able to see one of the patient’s from Dr. Chang’s clin­i­cal tri­als, which he had taught his col­leagues about in the meet­ing from yes­ter­day.  He had to inter­view the patient on her com­pre­hen­sive his­tory symp­toms of bipo­lar dis­or­der and dis­cuss med­ica­tion with her par­ents. The inter­view was upbeat and Dr. Chang cre­ated a great atmos­phere for the patient, mak­ing her feel com­fort­able dur­ing the process.

Unfor­tu­nately, the end of the inter­view sig­naled our last moments of the Princetern­ship. I am def­i­nitely sad to leave Stan­ford and the expe­ri­ence with Dr. Chang, but I am so glad I got the oppor­tu­nity to learn so much. I would def­i­nitely rec­om­mend this Princetern­ship to stu­dents inter­ested in psy­chol­ogy, neu­ro­science, or med­i­cine. My time at Stan­ford affirmed my inter­est in help­ing those around me and explor­ing med­ical school. I’m extremely grate­ful to Dr. Chang for the oppor­tu­nity to learn more about his area of exper­tise, his career, and his path to suc­cess. It was an invalu­able expe­ri­ence for which I will always be appreciative.