Cayenne Nikoosh Carlo (ccarlo@ucsd.edu)

Lab PI:  Charles F. Stevens MD, Ph.D.
Undergraduate Institution:  University of Alaska, Fairbanks
Med-into-Grad Clinical training area:  Neurogenetics
Main clinical mentors:
Children’s Hospital – Pediatric Neurology:  Doris Trauner, MD (dtrauner@ucsd.edu) – autism
VA/Psychiatry:  Martin Paulus, MD (mpaulus@ucsd.edu) – PTSD, social phobia, addiction

Quote:
“I greatly value my Med-into-Grad experience. If you have an interest in conducting clinical research or are contemplating a change of career paths I would highly recommend you apply to the Med-into-Grad program. Either way, after participating in the program you will be able to view your current research from a clinical perspective, which is infinitely valuable when you are writing grants, educating the general public, or giving scientific talks.”

Rationale for Med-into-Grad training:
Medical Training and Identification of medically-relevant research issues:
Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs:
Diagnostic, therapeutic, and Research collaborations:
Long term impact.:
Advice for new trainees--Autumn preparatory quarter:
Advice for new trainees--Winter clinical training quarter:
Take home perspective on Med-into-Grad at UCSD:

Rational for Med-into-Grad training: I am a 5th year Ph.D. candidate in the Neuroscience Program at the University of California, San Diego, in Charles F. Stevens’ laboratory at the Salk Institute. The purpose of my thesis is to examine how neuroanatomical characteristics in an emotion processing area of the brain, the amygdala, could vary across non-human primate species and influence the development of social and emotional behavior. The amygdala is a brain region critical for detection and interpretation of emotionally salient information and thus could be dysfunctioning in populations suffering from alterations of mood and emotion. I aim to determine the following from my thesis work: 1) define the neuroanatomical differences or similarities present in amygdala nuclei and subnuclei across nonhuman primate species using unbiased stereological measurements of cell number and region volumes; 2) determine the correlation between social and ecological characteristics, with potential roles in social interaction, and differences in amygdala anatomy of NHP species. This cross species study focuses on Old World (OW) and New World (NW) primates. Considering differences in social interactions across species will give us an evolutionary perspective on how we, as humans, have developed into highly social beings capable of maintaining large and intricate, yet stable, social networks.

Medical training and identification of medically-relevant research issues:  I spent most of my clinical training at an out-patient pediatric neurology clinic. During my time there I observed the clinic doctors evaluate and treat patients. The diagnoses varied some but most presented with autism or genetically based, metabolic disorders, the specialty areas of the 2 doctors I spent the most time shadowing. After interviewing each patient we would privately discuss the diagnosis, tests needed to confirm the diagnosis (if a new patient), and the treatment options. I enjoyed these discussions because I learned what kinds of questions you need to ask patients in order to make a diagnosis. My other clinical experience was at the VA Hospital where I shadowed the doctor on-call for the psychiatric consult service. This meant I saw a wide range of psychiatric needs at different stages, e.g. an outpatient who was feeling paranoid vs. a disoriented inpatient who had just gotten out of surgery. From these two, very different clinical experiences I learned more how people live and cope with having a neurological disorder.

Research collaborations: There were no research collaborations that resulted from my clinical training.

Long term impact: My long-term research goals are to integrate neuroanatomical measures, genomics, and functional imaging techniques to focus on investigating diseases of disparity within underrepresented populations. Prior to graduate school I was a research assistant at the NIMH where I ran fMRI experiments with mostly normal control subjects. Occasionally, we would run inpatients diagnosed with schizophrenia. Even though I enjoyed patient-based research I joined a lab at UCSD whose focus was on a different species. Through the Med-into-Grad program I confirmed my desire to conduct patient-based research and discovered that I did not want to attend medical school after completing my Ph.D. I believe that my recent exposure to the clinical population will continue to remind me in the future to always ask: What population of people is my basic research going to help? It will be useful to ask this question when writing grants or preparing to give talks.

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs: My clinical exposure was limited to neurology and psychiatry. Interestingly, these two fields use a lot of the same drugs to treat different disorders. In the neurology clinic physicians mainly ordered structural MRIs to rule out the possibility of the patient having a tumor, ischemic tissue, or general brain malformations and overnight EEGs to confirm seizure-like brain activity. Psychiatry seemed to rely on DSM-IV Axis I and II differential diagnosis at patient intake for diagnosis and then prescribed one of the sometimes many drugs normally used to treat the disorder.

Diagnostic & Therapeutic collaborations:  I have not developed any therapeutic products or improved diagnostics.

Student-specific experiences: I think it is important for each student to consider what he or she wants to get out of the Med-into-Grad program. Make a list of rank-ordered goals and try to shape your Med-into-Grad experience to fit what is most important to you. It was important for me to relate my Med-into-Grad subspecialty, neurogenetics, to my research so I focused disorders that affect the amygdala. Since I am studying the morphology of the amygdala across different species, it was helpful to think about the human functional consequences of any changes in the volumes or cell numbers of that region.

Advice for new trainees:  I spent a great deal of time trying to create my neurogenetics preceptorship, i.e. making contact with the right doctors who specialized in a combination of genetics, psychiatry, and neurology. In retrospect, it would have been most helpful to begin contacting physicians at the beginning of fall quarter. I found the self-study histology to be most relevant and directly, helpful to my research. I focused my self-study histology on the disorders that cause pathologic changes in the human amygdala.   

Take home perspective on Med-into-Grad at UCSD:  I greatly value my Med-into-Grad experience and it was well worth taking an extra year to graduate. The clinical experience I gained will continue to positively influence my research directions. If you have an interest in conducting clinical research or are contemplating a change of career paths I would highly recommend you apply to the Med-into-Grad program. Either way, after participating in the program you will be able to view your current research from a clinical perspective, which is infinitely valuable when you are writing grants, educating the general public, or giving scientific talks.