Tugce Tunalilar ’15, Stanford University

Tugce-TunalilarI arrived the first day at 12.30 at the Child and Psychiatry Clinic to meet Dr. Kiki Chang ’88, who is the director of the Bipolar Disorder Program at the clinic. This was the internship that I have been waiting two years for, and it was great to be finally here. I would call the first day the “introduction and meeting day.”  The first meeting was the laboratory meeting that happens every Wednesday; there are quite a few people working with Dr. Chang and they all gave updates about the projects they are running. I was introduced to the staff and given some basic information about some of the ongoing projects such as the Family Focus Therapy (FFT), Brain Imaging and A-life, an evaluation program for the families in FFT. That meeting was followed by a research meeting with Dr. Jennifer Frankovich, a rheumatologist from Lucile Packard Children’s Hospital, and Cheryl Koopman, a research professor.  The research is about an autoimmune disease called PAN/PANDA that manifests itself by behavioral changes, especially similar to obsessive compulsive disorder (OCD).  It is something that I had no idea about before coming to Stanford, but the group with Dr. Chang, Dr. Frankovic and Prof. Koopman seems to really focus on that study.

The second day was a long one. I started the day off at 10 by watching a patient and parent interview with Jennifer Pearlstein, a research assistant with Dr. Chang, for depression evaluation. It was followed by a phone screen to asses if a family with both bipolar parents were actually eligible for any of the programs in the clinic.  I learned that they have to meet certain criteria like a certain age and symptoms to participate in a program in the clinic. Later on in the afternoon, I observed some of Dr. Chang’s patients who either had bipolar disorder or depression. Dr. Chang asked kids’ parents for their observations of their kids over a period of time, and did some adjustments to the medications. Some of them were on straight bipolar disorder medications whereas some of them were put on antibiotics to test for the possibility of PAN/PANDA.  I noticed that these psychiatric diseases decrease the kids’ functionality very much, and affects them in every aspect of life, from school to social relationships. I gathered so much information about the psychiatric medications and their side effects, as well as more about the nature of bipolar disorder.

The third day was the longest and the most interesting one for me. I started off at the PANS/ PANDAS clinic with Dr. Frankovich and Dr. Chang. They had three patients who either had PAN/PANDA symptoms or some other behavioral changes that were predicted to be related to an infection. It was an interesting experience to see the parents there whose worries were apparent on their faces because I suddenly found myself sympathizing, or at least trying, with them. I know that I can never understand the actual intensity of their feelings, but it was intensive enough for me. After the PANS/PANDAS clinic, I went back to the psychiatry clinic with Dr. Chang to see a Lamictal, a mood stabilizer for bipolar disorder, research patient who has been observed over a certain amount of time. As much as I could gather from a short conversation, the patient was doing much better on Lamictal and his mood has been improving greatly. Unfortunately, that was also my thank you and goodbye call to Dr. Chang, who was very kind to let me shadow him and do other activities in the clinic for three days. However, I was not done! I headed down to the neuroimaging section to talk to Spencer, another research assistant, about MRI imaging and of course about the brain anatomy.  The MRI images that I saw fascinated me, and I could not keep myself from asking more questions about the brain and the effects of bipolar disorder on the brain.  Although not completely understood, there seems to be a correlation between the amygdalar hyperactivation and bipolar disorder and depression. After that, I went to meet Amy Garrett who is a senior research scientist from neuroimaging, and we talked about different studies being conducted on bipolar patients and their amygdalar reactions to therapy.  The studies are really interesting and can pave a way to predict which psychiatric medications can be used based on brain images from patients, which I found to be really exciting news. The last thing on my agenda for the day was to see an actual scan. There are research studies going on for children at risk for bipolar disorder and the MRI scan is a ritual to assess the brain properties and activity. I was with Jennifer and Spencer and I watched Spencer while he was conducting the scan of a young patient. It was fascinating to watch the brain at different states – baseline, resting etc. – and see its different structures. The scan took half an hour, and after that, at around 6.00 p.m., I was unfortunately at the end of my amazing Princeternship experience.

Looking back at it now, I think this internship Tunalilar 1has helped me a lot with realizing my interests. I am a molecular biology major; I knew that I did not want to go to medical school, but I was not sure if I would like to do research in molecular biology either. In general, I had mixed feelings and thoughts about molecular biology in the first place. However, after this internship I realized I actually want to study it.  It helped me realize that I like wet bench work more than clinical work but that I am also leaning more towards neuroscience rather than pure molecular biology. I was also happy to see my interest in research has been revitalized. As a sophomore who is close to choosing her major, I now feel more confident about what I want to do for the rest of my time at Princeton and after. I know that I have a lot to learn, but I think I now have enough motivation to move on with what I want from life, at least as a career.

Osasumwen Benjamin ’13, Stanford University

Osasumwen-BenjaminDay 1: Wednesday, January 23, 2012

The day before my Princeternship was rather hectic. After I finished my neuroscience exam, I quickly packed for my evening flight to San Francisco, where I would be staying in a downtown international hostel. I decided to stay in San Francisco instead of Stanford because I really love major cities and it’s close location to Palo Alto made transportation a breeze! At least, that’s what I expected when I printed out a Google map, left early, but still managed to miss my early train to Milbrae (a Caltrain station – think of Caltrain as a slightly better version of NJ Transit). After a thirty-minute subway ride, I took another thirty-minute Caltrain ride to Palo Alto, the home of Stanford School of Medicine. Since commuting to work is very common, this was a real experience! I ended up arriving right on time and was greeted by a receptionist who told me Dr. Chang was on his way. I spent this waiting time walking around the psychiatry building, absorbing my surroundings: the child and adolescent clinic seemed really warm and inviting, especially with its artwork, children’s games and fish tank.

The clinic’s characteristics contrasted with the serious academic and clinical work of the medical doctors, psychologists and researchers affiliated with the Lucile Packard Children’s Hospital. Dr. Kiki Chang ’88 soon arrived and I followed him to his research group meeting. In a short meeting, Dr. Chang addressed an array of research-related issues for a small group of visiting scholars, research assistants, and lab coordinators. The Comp Lit major I am, I did not understand everything, but learned a little about their research in pediatric bipolar disorder. They use brain scanning as a means of early detection and preventive medicine, especially for children who come from families with a history of the disorder.

After the meeting, I went up to the research wing, where a few assistants showed me several brain images. It was all really interesting! After that, I sat in on one of Dr. Chang’s pediatric consultations while he was supervising a child and adolescent psychiatry fellow. During this meeting, I learned more about the complex nature of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptoccocal Infections) and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome). As the mouthful of names sound, these disorders are really complex because they involve a range of symptoms including autoimmune problems, tics, motor difficulties, OCD, depression, anxiety – just to name a few!

Day 2: Thursday, January 24, 2012

Because Dr. Chang was still [technically] on leave, this day was a lot shorter.
In addition to completing some paperwork, he had to undergo a computerized training for the pharmaceutical company that was funding his research. Interestingly, there was a company overseer there to ensure that he was complying with their guidelines. Since the training was all about ethics, I was glad to see how my knowledge of philosophy could be applied to real-world ethical dilemmas! Afterwards, I talked to a few of his research assistants about the clinical projects they were doing. One of them was running a cognitive behavioral therapy group for children and adolescents with bipolar disorder. Another was training a therapy dog named Raleigh.

Day 3: Friday, January 25, 2012

On my last Princeternship day I spent the morning in Dr. Chang’s office for his clinical consultations. Beforehand, I had a great conversation with Dr. Kim, a visiting scholar from South Korea. She told me about the challenges she faced practicing child & adolescent psychiatry in overbooked Korean clinics. As I am interested in comparative international health, our conversation was very enlightening.

At Dr. Chang’s clinic, Dr. Kim and I observed consultations with two families, both with children exhibiting PANS symptoms. At first, I was a little surprised at how murky their illness was. With simpler ailments, doctor’s can make a diagnosis and patients can be assured that the treatment will most likely work. With pediatric psychiatric disorders, there is definitely no cure-all! Diagnosing and treating a pediatric population requires great skill, patience, perseverance and a really great sense of humor. Dr. Chang is definitely the wittiest doctor I ever met and I saw how his humor definitely puts everyone at ease. In such a demanding field, knowing how to communicate with different people is an essential skill. During one of the consultations, a rheumatologist joined Dr. Chang to help address the patient’s autoimmune issues. It was then that I realized how the unique, interdisciplinary approach I take as a comparative literature major could be useful in medicine. Child psychiatry is a specialty that draws on knowledge from other fields, including psychology, neuroscience and pediatrics.
Despite all the difficulties and controversy of child psychiatry, the great hope is that symptoms are alleviated, so that the children can enjoy being children. Some of these kids had to be out of school for weeks at a time, which, as a Princeton student, I could never fathom! All in all, I am extremely grateful to have had the opportunity to shadow the talented Dr. Chang. This Princeternship was extremely rewarding because it gave me some insight into a medical specialty I might be interested in pursuing.