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    BDNF reduces retinal ganglion cell dendritic arborization in situ BDNF reduces retinal ganglion cell dendritic arborization in situ Document Transcript

    • The Journal of Undergraduate Neuroscience Education (JUNE), Spring 2005, 3(2):A42-A52ARTICLEThe Clinical Neuroscience Course: Viewing Mental Health from NeurobiologicalPerspectivesKelly G. LambertDepartment of Psychology, Randolph-Macon College, Ashland, Virginia 23005Although the field of neuroscience is booming, a challenge compulsive disorder). Finally, the maintenance of mentalfor researchers in mental health disciplines is the health is emphasized as topics such asintegration of basic research findings into applied clinical psychoneuroimmunology, coping with stress, and eatingapproaches leading to effective therapies. Recently the regulation are discussed. Important themes emphasizedNational Institute of Mental Health called for translational in this course include (1) the consideration of onlyresearch grants to encourage collaboration between empirically based evidence, (2) the view that mental illnessneuroscientists and mental health professionals. In order represents a disruption of neurobiological homeostasis,for this “clinical neuroscience” to emerge and thrive, an (3) the acknowledgement that, because the brain is aimportant first step is the provision of appropriate course plastic organ, the clinical relevance of environmental andofferings so that future neuroscience researchers and behavioral influences is difficult to overestimate, and (4)mental health practitioners will have a common the recognition of the value of ecologically relevant animalneurobiological base from which to make informed models in the investigation of various aspects of mentaldecisions about the most efficacious treatments for mental illness. Because of the importance of stress maintenanceillnesses. Accordingly, an integrative course, Clinical in mental health, exercises have been developed toNeuroscience, was developed to address these issues. increase students’ awareness of their own copingAfter reviewing the historical origins of this emerging strategies. Finally, several books and movies arediscipline, students are exposed to fundamental overviews incorporated to provide additional points of view of theof neuroanatomy, neurochemistry, and neural topics discussed in the course.development before approaching the neurobiologicalcomponents of several disorders (e.g., schizophrenia, Key Words: clinical neuroscience, neurobiologicaldepression, Tourette’s syndrome, drug abuse, obsessive homeostasis, stress response, mental illnessAs a professor of behavioral neuroscience, I became literature about the role of serotonin in mood functions,increasingly frustrated with the level of preparation I was students get a different perspective when they look atproviding students for future careers as neuroscientists media advertisements for antidepressants and see aand mental health practitioners. Although students were bouncing ball with a sad face taking a drug that makes itexposed to fundamental psychobiological content in my immediately smile. Students learn in the popular PfizerBehavioral Neuroscience course, the amount of time ads that the drug Zoloft (a selective serotonin reuptakeallotted to the coverage of the neurobiological bases of inhibitor; SSRI) causes neurons A and B to share moremental health was very limited—about two lectures at the neurochemicals, resulting in the lifting of the emotionalend of the course. Students interested in careers in the dark clouds and the emergence of the sun. Further, asmental health profession were encouraged to take courses displayed on the Pfizer website (www.pfizer.com), this verysuch as psychopathology in the psychology department simplistic explanation for the treatment of depression isbut the students interested in the role of the brain in mental extended to at least four other disorders: social anxietyillness were frustrated that so little coverage of the brain disorder, post traumatic stress disorder, panic disorder,was included in that course. Thus, a divergence in the and obsessive-compulsive disorder. In class, students areway we were educating our students was apparent; forced to struggle with the roles of glucocorticoids,students were either exposed to neuroscience-related dopamine, noradrenaline, and many other neurochemicalscourses with very little information about applied mental (including serotonin) when considering key factors in theillnesses or to mental illness information with very little genesis of these disorders only to learn by authoritativecoverage of neuroscience. pharmaceutical companies that one simple answer I was also troubled by several disconnects between extends to five major mental illnesses.information covered in our classes and information Another disconnect is related to career choices forgathered by students outside of the classroom. For students interested in both neuroscience and mentalexample, although the complexity of the serotonergic health. Several students, after taking courses in bothsystem is thoroughly covered in the Behavioral neuroscience and clinical psychology, are very excitedNeuroscience course, complete with all the sub-type about a career that merges both these perspectives.receptors, synthesis pathways, agonistic and antagonistic These students hit a wall when they begin searching forpharmacological influences, and an extremely confusing graduate programs as they learn that many clinical JUNE is a publication of Faculty for Undergraduate Neuroscience (FUN) www.funjournal.org
    • The Journal of Undergraduate Neuroscience Education (JUNE), Spring 2005, 3(2):A42-52 A43psychology programs offer and require very few courses approaches that lacked empirical evidence for thison the brain; alternatively, their searches for neuroscience particular disorder. To illustrate this point, the students aregraduate programs rarely yield programs offering practical, introduced to the case of Nadean Cool. Cool, aclinical experience. It is true that a few integrative homemaker in Wisconsin, consulted a psychiatrist in theprograms are emerging, but they are still very rare and early 1990s seeking treatment for depression she wasstudents are often forced to choose between their interest experiencing following an assault on her teenagein neuroscience research and their desire to develop and daughter. Following seven months of extensive hypnosistest actual therapies for patients suffering from mental and use of up to 13 different psychotropic drugs, Cool wasillness. diagnosed with MPD. She was told by her psychiatrist that A final concern relates to students’ frustrations as they her father was the leader of a cult that had exposed her tobegan writing papers in their neuroscience related satanic rituals (including cannibalism of babies) as a child.courses. As they choose disorders for paper topics or Subsequently, the psychiatrist encouraged Cool toresearch projects, students are amazed at the huge confront her father with accusations of childhood abuse;number of research articles related to these disorders only her father had no reply and, a week later, died. During herto learn in their classes that so many disorders lack real six long years of therapy (paid by her insurance in thisefficacious therapies, much less a cure. For example, as I case), she learned that she possessed 126 personalitiesam writing this manuscript, I visited the PubMed database including a heroin addict, the bride of Satan, a teenage(www.ncbi.nih.gov/entrez) and found that there are boy, and a duck. At one point her psychiatrist conducted147,812 research articles on depression and 65,682 an exorcism in the hospital, an event that prompted Cool’sarticles on schizophrenia. This resource base seems to be husband to doubt the effectiveness of this therapeuticoverflowing in relevant articles, so much so that it is approach. Indeed, after all this time, Cool was in worsedifficult for anyone to review all of the relevant research condition than when she initially visited her psychiatrist.that has been conducted (many studies representing Cool filed a malpractice suit against her formerimpressive research carried out by the best scientists in psychiatrist, and the jury, agreeing that her therapy wasthe world); yet, for a patient trying to determine the most not supported by empirical evidence and contributed to hereffective treatment strategies, it is not clear that all of this mental decline, awarded her $2.4 million. After ceasingresearch has produced true advances in the treatment of her MPD/DID therapy, Cool suffers from mild depressionthese devastating conditions. In fact, by 2025, even with but is much better today; the psychiatrist did not lose hisall the relevant research and production of antidepressant license and still practices, although in a different statemedications, depression is forecast to become the second (Lambert and Kinsley, 2005).leading illness in the United States (McEwen and Lashley, Cases such as the one described above convey to2002). students that some therapies offered by clinicians, even A colleague, Craig Kinsley (University of Richmond), when delivered with the best of intentions, can provideexperienced similar frustrations in his courses and more harm than benefits. As techniques that are new ondeveloped a course to address these and other the therapeutic horizon are discussed in the Clinicalconcerns—a course he called Clinical Neuroscience. I Neuroscience course, such as repetitive transcranialfollowed suit the next year and decided to incorporate the magnetic stimulation (rTMS), eye movementcourse into the Randolph-Macon College psychology desensitization and reprocessing (EMDR), dietarycurriculum. It is important to convey that students quickly treatment for autism, and new psychotropic drugs,learn that there are no easy answers to the troubling students learn that a close analysis of the scientificissues described above, but by learning about mental literature is essential before adopting a particularillness and mental health in the context of a approach.neurobiological backdrop, students are more likely toidentify the most effective and innovative mental health Maintenance of Neurobiological Homeostasiscareer and treatment paths in the future. Clinical Neuroscience students learn about the Diagnostic and Statistical Manual (DSM) and the relevant mentalTHEMES OF THE CLINICAL NEUROSCIENCE COURSE illness categories and associated diagnostic criteria;Empirical Evidence however, this traditional diagnostic and categorical systemAlthough students are exposed to research methods is critically reviewed. An alternative approach tocourses in their various majors, it is important to revisit the understanding mental illness, emphasizing the brain’srelevance of certain methodological issues within the adaptive strategy to attempt to compensate for disruptionscontext of specific disciplines. To emphasize the in neurobiological processes associated with mentalimportance of evidence-based therapeutic approaches, functions, is introduced in this course. This newClinical Neuroscience students are exposed to the real perspective suggests that symptoms of mental illness mayworld consequences of exposing patients to therapeutic emerge in the context of the following conditions: (1) asapproaches that lack empirical support. For example, they compensatory actions result in the disruption of normallearn about the recent tragic therapeutic fad in which actions (e.g., obsessive-compulsive disorder), (2) whenpatients diagnosed with multiple personality disorder MPD the neurobiological disruption is so severe that it(now known as dissociative identity disorder; DID) were compromises the brain’s ability to respond (e.g.,exposed to prolonged therapies consisting of hypnosis, Alzheimer’s), or (3) some combination of 1 and 2 (e.g.,multiple drugs, and talk therapy—i.e., therapeutic depression). Thus, mental illness is viewed as a disruption
    • Lambert A Clinical Neuroscience Course A44of neurobiological homeostasis and an emphasis is placed of exercise and antidepressant pharmacotherapy leads toon the maintenance of homeostasis as a protection increased levels of BDNF mRNA (Russo-Neustadt et al.,against the genesis of mental illness symptoms. 2000). Finally, even ECT has been shown to significantlyAccordingly, topics such as coping with stress, eating increase neurogenesis in a dose-dependent fashionregulation, and psychoneuroimmunology are presented to (Madsen et al., 2000). Thus, depression is just oneinform students about various ways to prevent the example of a disorder that clearly seems to be influenceddisruption of neurobiological homeostasis. by modifications in factors associated with Clinical Neuroscience students quickly learn that the neurotrophic/neuroplastic factors.most powerful threat to neurobiological homeostasis ischronic stress. As potential causes for disorders are Importance of Animal Modelsdiscussed in the course (e.g., depression, OCD, Considering the complexity of humans and the challengesTourette’s, schizophrenia, addiction), stress keeps coming associated with systematically investigatingup as a predisposing factor. Students become familiar neurobiological mechanisms of various forms of mentalwith the neurobiology of the acute and chronic stress illness, animal models are presented as a valuable tool forresponses, and the relevance of the terms allostasis and learning more about clinical neuroscience. Whenallostatic load (Schulkin, 2003). The importance of coping conducted appropriately, the development and use ofstrategies and their consequential effects on stress animal models, and the accompanying degree of scientificresponsivity are discussed at several points throughout the control, comprise a critical step to gaining fundamentalcourse. knowledge about conditions that affect other species, including humans. Consequently, the importance ofNeuroplasticity relevant animal models is discussed at several pointsIn my opinion, one of the most influential studies throughout the Clinical Neuroscience course—even inconducted in the field of behavioral neuroscience was the areas in which animal models are a challenge to develop.elegant and simplistic research conducted by Bennett, et For example, although it is difficult to reproduceal. (1964) demonstrating that rats exposed to complex hallucinations and delusions in animals, researchers haveenvironments developed heavier cerebral cortices, larger developed a model simulating an interesting characteristiccortical cell bodies, and more neuronal connections than behavior in schizophrenia patients. Whereas mostimpoverished controls. Parallel studies focusing on the individuals demonstrate prepulse inhibition (PPI), meaninghealth and lifestyles of nuns suggest that these effects that, after conditioning, a “warning” conditioned stimulusextend to humans as well (Snowden, 2001). Following the typically reduces the startle response to a second moreresearch conducted by Fred Gage and his colleagues threatening stimulus, individuals with schizophreniaconfirming that enriched environments also stimulate continue to exhibit the startle response with the sameneurogenesis, there is new excitement about the potential intensity, showing no evidence of habituation.role of the environment in human neuroplasticity Researchers have found that neonatal male rats treated(Kemperman et al., 1997). A recent related study reported with a nitric oxide (a gaseous neurotransmitter) antagonistthat a three-month juggling training program resulted in subsequently developed hypersensitivity to DA agonistsgrey matter expansion in temporal and parietal cortical and PPI deficits, as seen in schizophrenia patients (Blackareas—an effect that was lost after three months of no et al., 1999). Accordingly, several researchers have usedpractice—suggesting that the adage use it or lose it has animal models of PPI as a bridge between humans andrelevance for the brain (Draganski et al., 2004). animals (Paylor and Crawley, 1997). Case studies are also presented to demonstrate the Students also learn to be critical evaluators of existingplasticity of the nervous system in response to various animal models. They learn that various models designeddevelopmental challenges and medical threats. For to assess a single behavior (e.g., learning) can potentiallyexample, children suffering from severe epilepsy have had tap into very different neurobiological systems or that,an entire hemisphere removed and, subsequently, contrary to Selye’s original thoughts, all stressors are notregained functions after behavioral rehabilitation. Further, created equal when individual responses are evaluated.individuals faced with the challenge of being born without Considering the important differences in animal modelsarms (due to prenatal exposure to teratogens such as designed to assess a single behavior/emotion, caution isthalidomide) have developed amazing flexibility and necessary when selecting the most appropriate animalcontrol of their feet. The ability of humans to use their feet model for a research project. Finally, after learning aboutas hands is a powerful example of a plastic nervous the impact of biological predispositions in neurobiologicalsystem (Lambert and Kinsley, 2005). responses, an emphasis is placed on the importance of Throughout this course students are encouraged to the use of animal models that employ ecologically relevantexamine the role of neuroplasticity in the maintenance of tasks for a specific species.mental health. In the mood disorder component of thecourse, for example, students learn that neurochemicalsassociated with neuroplasticity are appearing increasingly EMPHASIS OF INTEGRATIONimportant as depressed patients are reporting relief Clinical Neuroscience students are taught that it isfollowing activities such as exercise that lead to beneficial to use multiple perspectives to evaluate causesupregulated brain derived neurotrophic factor (BDNF; a and treatments of various mental illnesses. Exploringgrowth factor) (Hill et al, 1993). Further, the combination mental illness from multiple perspectives is comparable to
    • The Journal of Undergraduate Neuroscience Education (JUNE), Spring 2005, 3(2):A42-52 A45 Window/Perspective Focus on Depression viewing a house through multiple windows. Each window Concordance rates in identical twins provides a valuable view of the subject (in this case a Genetic as high as 70% in mood disorders house), although this view provides an incomplete view of suggest that certain, although the entire house. After peering through all the windows, unidentified, genetic factors influence however, a more complete view can be constructed. the expression of depression (Sanders Analogies are made between the endeavor of learning et al., 1999) more about a house through the accumulation of these Areas such as the prefrontal cortex, Neuroanatomical cingulate cortex, hippocampus, views from individual windows and learning more about amygdala, hypothalamus, thalamus, the neurobiology of a particular mental illness by raphe nuclei, and locus coeruleus considering multiple views. Continuing with this analogy, have been implicated in depression most students can not imagine purchasing a house based (Nemeroff, 1998; Ressler and on the view from a single window, a realization that forces Nemeroff, 2000) them to consider the danger of diagnosing or treating a Although serotonin is the most mental illness from the limited view of just one perspective Neurochemical celebrated neurochemical associated (e.g., a purported imbalance of one neurochemical). Even with depression, norepinephrine, when integrative perspectives are considered, however, corticosteroids, and neural growth students are cautioned that this information can rarely factors are additional relevant substances (Holsboer, 2000; Russo- replicate the experiences of the person actually living day- Neustadt et al., 2001) to-day with a particular brain in his/her particular Success rates of ECT and, more environment. See Table 1 for a list of perspectives Neurophysiological recently rTMS, suggest that altered emphasized in the field of Clinical Neuroscience and how neurophysiological activity influences they apply to the representative mental disorder depression symptoms (George et al., depression. 1999; Krystal et al., 2000) Childhood sexual abuse leaves Developmental humans more susceptible to adult- onset depression (Heim et al., 2001); intensity of attention received by mother rats influences stress responsivity later in life (Meaney et al., 1991) Some individuals suffer from Environmental depression symptoms when daylight hours shorten during the winter months (Soldatos and Bergiannaki, 1999) Rats exhibiting a bold exploratory response upon exposure to novel Behavioral/Cognitive stimuli have lower levels of stress hormones (viewed as protection against onset of depression) and live longer lives (Cavigelli and McClintock, 2003); animals exposed to learning paradigms that diminish strength of response/outcome contingencies, as seen in the learned helplessness model, exhibit depression symptomology (Seligman and Weiss, 1980) Figure 1. This figure, depicting the spiraling behavioral pattern Rates of depression are different in associated with an OCD patient’s simple trip to the shopping Cultural various cultures; relationships between mall, illustrates the integration of cognitive/behavioral phases degree of westernization and with proposed OCD neurocircuitry. Such integrative approaches depression rates implicate cultural encourage students to think about neurobiological components of importance (Kleinman and Cohen, 1997) specific symptoms associated with various disorders, a According to Sloman and Gilbert necessary strategy for gaining a complete understanding of Evolutionary (2000), as complex social behaviors underlying mechanisms of such disorders (Lambert and Kinsley, evolved, submissive and passive 2005). behaviors (similar to behaviors observed in some aspects of As students are trained to consider multiple depression) became a strategic neurobiological perspectives when learning about a defense against social threats particular disorder, they are also encouraged to considerTable 1. Windows (perspectives) of Clinical Neuroscience and relevant how these factors integrate with specific cognitive andinformation applied to depression. For more information applying thewindows perspective to additional mental illnesses see Lambert and behavioral symptoms experienced by individuals sufferingKinsley (2005). from mental illness. For example, in Figure 1 the thoughts
    • Lambert A Clinical Neuroscience Course A46and emotions of an OCD patient are mapped on to the activity that directs Doran’s thoughts away from thebrain areas associated with the various phases of a typical impending tics (Lambert and Kinsley, 2005).obsessive-compulsive episode. In this example of an In sum, in a contemporary mental health climate thatindividual walking from his car to a shopping mall, his focuses primarily on the single neurochemical perspective,orbitofrontal cortex is implicated in the initial doubt that the students are reminded throughout the Clinicalcar is unlocked, the cingulate cortex and amygdala are Neuroscience course that mental illness is the product oflikely involved in the onset of fear associated with the multiple factors and, if that is the case, there are typicallypotentially stolen car, the caudate nucleus is shown to multiple therapeutic approaches for specific mentaltrigger the behavioral response of returning to the car to disorders.check if it had been stolen, and the nucleus accumbensmay play a role in reinforcing the entire sequence once the THINKING ABOUT THE FUTUREcar is observed in the parking lot. This approach is not As the field of clinical neuroscience grows, knowledgeonly helpful to students as they begin to make connections gained from the discipline has the potential to influencebetween neurobiological factors and mental illness many aspects of our society. Accordingly, it is appropriatesymptoms, it is immensely beneficial to OCD patients. Joe to end the course with a brief discussion of some of theseDee, an aspiring screenwriter in California and a patient of controversial issues. For example, the role ofJeffrey Schwartz [neuropsychiatrist and author of Brain neuroscience in the exploration and definition of criminalLock (1996)] reports that he felt a heavy “emotional” behavior is explored in this course. New techniques suchweight lifted as he learned that there were actual brain as brain fingerprinting have been introduced to the fieldareas that were responsible for the OCD symptoms he had with claims that relevant information for specific crimesexperienced most of his life. Once thought to be some held in the minds of suspects can be systematicallymystical curse, he learned that there were tangible determined with a narrow margin of error (Farwell, 2000).reasons for his OCD symptoms, and, if he could learn to The potential danger of the continuation of theinfluence those brain areas through cognitive-behavioral pharmaceutical trend of marketing drugs for “designer”therapy, he could exert some control over the frustrating rather than medicinal reasons is also discussed. Asymptoms. In fact, to this day he carries a piece of paper satirical view of the medicalization of emotions publishedin his pocket with the words caudate nucleus written on it in the tabloid parody, The Onion, is used as a springboardand when he feels OCD symptoms approaching, he to initiate conversation about this issue.reaches into his pocket to remind himself that the anxietyis a result of an overactive brain area, not an actual Zoloft for Everything Ad Campaignimpending threat (Lambert and Kinsley, 2005). The effect Zoloft for Everything campaign will employ print and TVdescribed in this case study is confirmed by a PET ads to inform potential users about the literally “thousands”investigation demonstrating less caudate metabolic activity of new applications for Zoloft. Among the conditions thein OCD patients following participation in a behavioral drug can be used to treat: anxiety associated withmodification program (Schwartz et al., 1996). summer swimsuit season, insecurity over sexual potency Real-world case studies are also presented in this and performance, feelings of shame over taking ancourse to illustrate how multiple factors converge to antidepressant, and a sense of hollowness stemming fromincrease or decrease symptoms of a mental illness. Mort losing an online auction….Do you find yourself feelingDoran, for example, in spite of the challenges associated excited or sad? No one should have to suffer throughwith Tourette’s syndrome, worked diligently to become a those harrowing peaks and valleys. (The Onion, May 14,surgeon and a pilot. He reports that his synchronous 2003).tapping is continuous as he progresses through most of Although students rarely want to admit the value ofhis day, but amazingly, once he enters the operating room, emotions such as sadness, a discussion about thethe tics subside for hours as he conducts delicate evolution and adaptive significance of sadness and anxietysurgeries. There is no denying that the environment in this is appropriate as the prospect of the creation of a societycase is an important factor in the suppression of his tics. that is systematically removing uncomfortable emotionsFurther, Doran calms himself each morning by pedaling from the texture of our emotional lives is emerging. Willfuriously on a stationary bike while smoking a pipe and such actions reduce our motivation to help others? to fightreading a pathology journal. His tics are completely for meaningful causes? Related to such cosmeticsuppressed during this time. After learning about the pharmacology, a discussion of euneurics, a movement tomultiple aspects of Tourette’s syndrome, it is relatively design “better” brains, typically provokes heatedeasy for students to consider this calming behavior and discussion in the Clinical Neuroscience course.hypothesize about why this seemingly bizarre coping Finally, we discuss the role politics plays in theresponse may be effective. Exercise is related to direction of neuroscience research by reviewing the stemendogenous opioid release; additionally, the rhythmic cell debates currently being played out in our society.circular motion and repeated pedaling may be related to Science is no longer restricted to the laboratory bench—itincreased serotonergic release and a subsequent is becoming more and more necessary for scientists toreduction in anxiety. Further, the nicotine in the pipe leave the comfort of their laboratories to speak to thetobacco likely potentiates the effect of other medication or public about the value of certain scientific pursuits.alters the cholinergic receptors in a way that calms the Additionally, with the ethical implications of so manytics. Finally, the pathology text provides a cognitive
    • The Journal of Undergraduate Neuroscience Education (JUNE), Spring 2005, 3(2):A42-52 A47relevant clinical neuroscience topics, great caution is the justification of the students’ determination of copingnecessary as the discipline plays more significant roles in strategies (e.g., did they provide appropriate examples toour everyday lives. support their “profile”?), and the accuracy of their descriptions of the original research are assessed.RELEVANT ACTIVITIES AND ASSIGNMENTS Although students report that it is difficult to evaluate theirStressographies stress responses in the beginning, as they learn about theAs previously mentioned, stress is emphasized as a toxicity of chronic stress, they become increasinglycommon denominator in many mental illnesses. If stress motivated to learn more about their coping tendencies andresponsivity is a critical factor in one’s mental health, incorporate new strategies to maintain neurobiologicalstudents should develop an increased awareness of how homeostasis. The most valuable aspect of this exercise,the stress in their lives influences their mental and physical getting students to become more aware of potential threatshealth. To address this topic, research on coping to their mental health, is more difficult to assess; however,strategies is presented in the Clinical Neuroscience course this point is brought up many times throughout the courseand students learn about the impact of day-to-day and students are asked to think about examples from theirreactions to stress. For example, in a powerful example own lives. Students are certainly more cognizant of theusing an animal model of coping, Cavigelli and McClintock stress and subsequent responses in their lives after(2003) recently showed that two male rat siblings have participating in this self-exploratory exercise and, whenvastly different life spans based on how bold they are they choose to disclose examples in class, they arewhen presented with a novel stimulus. Rats that quickly meaningful additions to lectures and discussions.explore the stimulus have lower levels of stress hormonesand live approximately 30% longer than their shy brother Spit Happenscounterparts. It is important to emphasize that neither of Still focusing on stress, this activity was developed tothese rat groups were exposed to a significant rat reinforce the relationship between stress hormones andtrauma—it was just the day-to-day responses to stress responses. The students learn a good bit about thechallenging stimuli that seemed to make the difference in hypothalamic-pituitary-adrenal (HPA) axis during formalthis study. Based on the notion that these daily responses lectures in the course, but a hands-on demonstration isare important health mediating factors, students are asked more powerful. The purpose of this demonstration is toto keep a journal in which they evaluate the stressors and illustrate differences in cortisol levels during non-stressedstress responses in their own lives. At the completion of and stressful conditions. One stressful activity that I havethe project, as students review their stress response used, rock climbing, is very effective. In Richmond, VA,patterns, they develop a coping profile (based on an the facility Peak Experiences houses a 50 ft. wall that hasinformal type of meta-analysis) as they determine their a “leap of faith” component in which students are asked toown coping strategies—active, passive, flexible—and the jump from a tiny platform to a bar that looks too far away toimpact stress has on their medical and mental conditions. grasp. Of course, the students wear protective gear and aWe also discuss strategies to mitigate stress responsivity qualified person belays them from below. Although, theand students evaluate their success utilizing these activity is technically safe, my personal experience is thatstrategies (e.g., increased perception of control, affiliative the prospect of jumping to that tiny bar from such asocial contact, exercise). Just as individuals with diabetes dangerous height provokes a “terror-like” response. Theconsider the relationship between blood glucose and limbic brain structures seem to trump the higher corticalinsulin as being critical for their physical health, students structures as they send danger messages throughout thelearn to think of the relationship between stress levels and CNS.coping strategies as being important for maintaining Cortisol samples are collected using salivette tubesmental health. Daily evaluations of one’s stress levels and purchased from Salimetrics (State College, PA;an increased awareness of the effectiveness of coping www.salimetrics.com). Because it takes a few minutes forstrategies employed to meet life’s challenges may lead to cortisol to reach peak levels, saliva samples are collectedmore efficient responding and serve as a buffer, a mental about a minute following the jump (the climb and jump takeinsulin of sorts, against stress-induced mental illness. about three to five minutes). Using this collection Although this activity can be used in many ways, I technique (described in detail in the materials provided byhave asked students to turn in reaction-type papers based Salimetrics), students hold a small cotton dental roll in theiron their journals. In these papers, they are asked to mouths for a minute and then place the saliva-soaked rollsdiscuss the types of stressors encountered in their lives, in a tube that will later be centrifuged to extract the saliva.coping strategies/profiles utilized, evidence of impact on Saliva samples can be sent to Salimetrics for enzymethe immune system, and success at incorporating new immune assays (EIAs), or, if an instructor has access to astrategies to mitigate chronic stress activation. Students microplate reader, complete kits can be purchased forare also asked to identify an original research article assays [see Kalman and Grahn (2004) for arelated to some aspect of stress and coping that interests comprehensive account of incorporating EIAs into thethem and describe the hypothesis, methodology, and behavioral neuroscience laboratory; additionally,results of this study—as well as a description of how such Salimetrics provides day-long workshops for anyoneresearch is relevant to clinical neuroscience. In these interested in learning how to do the salivary cortisolassignments, the appropriate use of the relevant terms, assays]. Assays conducted at Salimetrics run about $13 per sample. Also relevant in this activity, students notice
    • Lambert A Clinical Neuroscience Course A48their high adrenaline levels as they find themselves Book Relevance for courseshaking so much that it is nearly impossible to place the Why Informative and entertaining review of thecotton tube in the containers. The cortisol levels from this Zebras stress literature; Sapolsky includes interestingstressful activity are subsequently compared to baseline Don’t Get stories and analogies that facilitate Ulcers understanding and perceived relevance of thelevels; additionally, many issues can be discussed when (Sapolsky) stress research.the data are eventually evaluated (e.g., sex differences, An investigative report of the genesis ofcircadian effects). Focusing on behavior, the diverse pharmacotherapy—especially for the treatmentindividual behavioral responses observed during this of schizophrenia; this critical account willactivity are discussed. For example, in my most recent Mad in prompt many questions from students related to Americaclass, some students managed to climb the wall and the ethics of how the mentally ill have been (Whitaker)promptly sit on the platform, refusing to even stand up, treated in this country and the future of themuch less jump (passive response), whereas others development of the most efficacious treatmentsclimbed and quickly jumped to the bar (active response). for mental illness.Students are asked if their responses to this significant A beautifully written first-hand account of what it An Unquiet is like to suffer from bipolar disorder; being athreat correspond to coping responses to less threatening Mind psychologist herself, Jamison’s personalstressors (as described in their stressographies). (Jamison) accounts and insights are especially interesting for psychology and neuroscience students. Movie Title Relevant content Written by an accomplished behavioral Living with schizophrenia; early treatments for neuroscientist, this book emphasizes the point A Beautiful schizophrenia; overcoming challenges of Blaming the that, although pharmacological treatments are Mind disorder to win and accept a Nobel Prize Brain: The standard fare in psychiatric care, there is no Development of sensory perceptions; truth about clear evidence that disorders such as challenges faced when the brain is suddenly drugs depression are directly caused by a chemical At First Sight exposed to a new sensory stimulus (in this And mental imbalance that is best treated by chemical case visual stimuli); plasticity of the brain health intervention (i.e., drugs). On the contrary, Neurochemistry of movement disorders; (Valenstein) Valenstein reminds us that a stimulating and sensitivity of the brain to endogenous nourishing environment is important in the Awakenings maintenance of a healthy brain. neurochemicals/drugs; adventure of scientific discovery If students are interested in the origin of the Ethics and personal consequences associated many fundamental aspects of neuroscience, with the utilization of genetic engineering to they’ll enjoy this wonderful account of the real Minds produce a “perfect” society; story-line suggests lives of the pioneers of clinical neuroscience. Behind the that one’s potential in life can rarely be Finger is a superb historian who tells Gattaca Brain determined by genetic screening (also compelling stories about these bold individuals (Finger) interesting is that the letters in the title of this and the context of their lives that led to the film are derived from the letters used to label genesis of many groundbreaking discoveries the nucleotide bases of DNA) and theories in neuroscience. Powerful story of the impact of an altered This autobiographical book provides an honest Life is coping strategy (in this case a father account of what it is like to have your immune Beautiful influences his son’s perception of the horror of system taken hostage by a disease, in this being in a concentration camp) case, leukemia. Handler, then a young aspiring Neurodegenerative disease; excitement of the actor, describes his emotions, desires, fears, Lorenzo’s Oil Time on scientific process; dietary treatments and strategies for survival. After becoming Fire: My Fundamental information relating to the acquainted with the field of Osmosis comedy of immune system (but presented in a very psychoneuroimmunology, this book will help Jones terrors entertaining, humorous manner!) students appreciate the clinical impact of (Handler) Supersize Me Toxic impact of fast-food consumption emotional ups and downs on the challenged, Living with OCD; power of OCD in disrupting fragile immune system. Students also enjoy one’s life [Leonardo DiCaprio (Howard Hughes learning that Handler survived his battle with The Aviator character) was coached by neuropsychiatrist leukemia and went on to secure a role in the Jeffrey Schwartz; hence, the portrayal of OCD recent popular series Sex and the City. symptoms is very realistic] A fictional thriller written by a medical doctorTable 2. Representative popular movies used in the Clinical that provides an exciting backdrop for theNeuroscience course. (For additional popular movies appropriate discussion of the development of psychotropic Acceptablefor neuroscience courses see Wiertelak, 2002.) drugs and the ethics of “personality designer Risk (Cook) drugs”; a second story line related to a theory of fungus-induced hallucinations in the “Salem Of course, it may not be possible to arrange such a Witches” is also very interesting for students.dramatic activity for all courses. The same point can be Table 3. Representative popular books used in the Clincialmade with other creative stressors; for example, prior to Neuroscience course.taking a challenging exam. The behavioral responses maynot be as elaborate in some stressful situations, but the Relevant Books and MediaHPA axis response will still be affected. Several relevant books and movies are incorporated into the Clinical Neuroscience course to provide additional
    • The Journal of Undergraduate Neuroscience Education (JUNE), Spring 2005, 3(2):A42-52 A49points of view for the students. Typically, several movies of animal models to investigate symptoms and responses(e.g., A Beautiful Mind, Awakenings) are identified and frequently observed in various mental illnesses. Now thatstudents choose four to five movies that interest them from the course has become a permanent component of thethe recommendations. After viewing the movies out of Randolph-Macon curriculum, systematic assessment ofclass, students complete a reaction paper at appropriate the students and their entrance into graduate schools andtimes throughout the course in which they discuss the professional careers is necessary to determine the valuerelevant issues portrayed in the film—assessing the of the course in the education of pre-professionals inaccuracy of information included. Further, students are disciplines related to mental health.asked to examine “real” research on the topic by locatingtwo studies from the scientific literature that are related to REFERENCESthe topic of interest and including a description and Bennett EL, Diamond ML, Krech D, Rosenzweig MR (1964)evaluation of these studies in the reaction paper. Finally, Chemical and anatomical plasticity of brain. Science 206:649-pairs of students are assigned an oral presentation of one 654.of their movie reviews and related scientific literature, Black MD, Selk DE, Hitchcock JM, Wettstein JG, Sorensen SMallowing all students to learn about the interesting studies (1999) On the effect of neotatal oxide synthase inhibition inidentified by other students. Typically these oral rats: A potential neurodevelopmental model of schizophrenia. Neuropharmacology 38: 1299-1306.presentations are professional PowerPoint presentations Cavigelli SA, McClintock MK (2003) Fear of novelty in infant ratsand greatly enhance the content of the course (see the predicts adult corticosterone dynamics and an early death.appendix for specific details of this assignment). A list of Proc Natl Acad Sci USA 100:16131-16136.several movies and their relevant content is provided in Cook R (1994) Acceptable risk. New York, NY: GP Putnam’sTable 2 (for a more complete list of relevant movies for Sons.neuroscience courses see Wiertelak, 2002). Farwell L (2000) Interview with Mike Wallace on Highlights of CBS 60 Minutes featuring brain fingerprinting. Retrieved January 8, 2004, from:CONCLUSION www.brainwavesxcience.com/Highlights60Minutes.htmThe Clinical Neuroscience course provides an opportunity Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May Afor instructors to address some of the “disconnects” in the (2004). Neuroplasticity: changes in grey matter induced byfield of mental health described earlier in this article. As training. Nature 427:311-312.relevant neuroscience information is introduced to the Finger S (2000) Minds behind the brain. New York, NY: Oxfordmental health discipline, the face of mental health research University Press.and therapy is changing. These changes need to be George MS, Nahas Z, Kozel RA, Goldman J, Molloy M, Oliver Nreflected in academic curricula so that our students are (1999) Improvement of depression following transcranialbetter prepared to make informed decisions concerning magnetic stimulation. Curr Psychiatry Rep 1:114-124. Handler E (1996) Time on fire: My comedy of terrors. New York,their career paths in this burgeoning field. Due to its NY: Little, Brown and Company.interdisciplinary nature, the Clinical Neuroscience course Heim C, Newport DJ, Bonsall R, Miller AH, Nemeroff CB (2001)fits easily into psychology, biology, or neuroscience Altered pituitary-adrenal axis responses to provocativecurricula. My experience has been teaching the course as challenge tests in adult survivors of childhood abuse. Am Jpart of a psychology curriculum; specifically, this course is Psychiatry 158:575-581.an upper-level elective that is recommended for students Hill RD, Storandt M, Malley M (1993) The impact of long-terminterested in mental health and mental illness (both exercise on training on psychological function in older adults. Jneurobiological and clinical career trajectories). As Gerontol 48:12-17.discerned by observing the syllabus provided in the Holsboer F (2000) The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology 23:477-501.appendix, the course is demanding but, thus far, the Jamison KR (1996) An unquiet mind. New York, NY: Vintagestudents have never complained about the workload—on Books.the contrary, their subjective reports have been positive Kalman BA, Grahn RE (2004) Measuring salivary cortisol in theabout all the readings and activities. In the Randolph- behavioral neuroscience laboratory. J Undergrad Neurosci EduMacon program, the Clinical Neuroscience course can be 2:A41-A49.taken along with two other courses in the psychobiology Kempermann G, Kuhn HG, Gage FH (1997) More hippocampalcategory (e.g., Behavioral Neuroscience, Comparative neurons in adult mice living in an enriched environment.Animal Behavior, Neurocognition) to comprise an Nature 386:493-495.“emphasis” in psychobiology. Because fundamental Kleinman A, Cohen A (1997). Psychiatry’s global challenge. Sci Am 276:86-89.neurobiological information is included in the course, the Krystal AD, West M, Prado R, Greenside H, Zoldi S, Weiner RDRandolph-Macon College program does not require (2000) EEG effects of ECT: Implications for rTMS.students to take the Behavioral Neuroscience course as a Depression and Anxiety, 12:157-165.prerequisite, but that is certainly a possibility in other Lambert KG, Kinsley, CH (2005) Clinical neuroscience: Theprograms. After completing this course, initiated students neurobiological foundations of mental health. New York, NY:are often interested in conducting relevant clinical Worth.neuroscience research projects as part of Randolph- Madsen TM, Treschow A, Bengzon J, Bolwig, TG, Lindvall O,Macon’s Summer Undergraduate Research Fellowship Tingstrom A (2000) Increased neurogenesis in a model of(SURF) program or as a senior project. Typically, these electroconvulsive therapy. Biol Psychiatry 47:1043-1049. McEwen BS, Lashley EA (2002) The end of stress as we know it.research projects involve the development and validation Washington, DC: Joseph Henry Press.
    • Lambert A Clinical Neuroscience Course A50Meaney MJ, Aitken DH, Sapolsky RM (1991) Postnatal see and hear and know what are foul and what are fair,handling attenuates certain neuroendocrine, anatomical, what are bad and what are good, what are sweet and whatand cognitive dysfunctions associated with aging in female are unsavory....And by the same organ we become madrats. Neurobiol Aging 12:31-38. and delirious, and fears and terrors assail us...All theseNemeroff CB (1998) The neurobiology of depression. Sci Am things we endure from the brain when it is not healthy...In 278:28-35. these ways I am of the opinion that the brain exercises thePaylor R, Crawley JN (1997) Inbred strain differences in prepulse greatest power in the man. inhibition of the mouse startle response. Psychopharmacology Hippocrates, On the Sacred Disease (Fourth century, B.C.) 132:169-180.Ressler KJ, Nemeroff CB (2000) Role of serotonergic and Introduction noradrenergic systems in the pathophysiology of depression and anxiety disorders. Depress Anxiety 12:2-19. The emphasis of this class is a generally new areaRusso-Neustadt AA, Beard RC, Huang YM, Cotman CW (2000) known as Clinical Neuroscience—which is simply an Physical activity and antidepressant treatment potentiate the exploration of the neurobiological foundations of mental expression of specific brain-derived neurotrophic factor health and mental illness. We’ll focus mostly on empirical transcripts in the rat hippocampus. Neuroscience 101:305-312. work—avoiding some of the psychobabble that you mayRusso-Neustadt AA, Ha T, Ramirez R, Kesslak JP (2001) see on Dr. Phil or hear on Dr. Laura. The “scientific Physical activity-antidepressant treatment combination: Impact literature” will be our guide as we explore the most likely on brain-derived neurotrophic factor and behavior in an animal causes and most effective treatments of the many mental model. Behav Brain Res 120:87-95. disorders that haunt our society. With the newSanders AR, Detera-Wadleigh SD, Gershon ES (1999) Molecular genetics of mood disorders. In Neurobiology of mental illness developments in genetics and brain imaging, these are (Charney DS, Nestler EJ, Bunney BS, eds) pp 299-316. New exciting times to be interested in clinical neuroscience. I’ll York, NY: Oxford University Press. rely on videos, lectures, readings, and class discussions toSapolsky RM (1998) Why zebras don’t get ulcers. New York, introduce you to the world of clinical neuroscience this NY: Freeman. semester.Schulkin J (2003) Rethinking homeostasis: Allostatic regulation in physiology and pathophysiology. Cambridge, MA: MIT Texts Press. Lambert KG, Kinsley CH (2005) Clinical Neuroscience:Schwartz JM, Beyette B (1996). Brain lock: Free yourself from Neurobiological Foundations of Mental Health. obsessive-compulsive behavior. New York, NY: HarperCollins. Jamison KR (1995) An Unquiet Mind: A Memoir of MoodsSchwartz JM, Stoessel PW, Baxter LR, Martin KM, Phelps ME and Madness. (1996) Systematic changes in cerebral glucose metabolic rate Whitaker R (2002) Mad in America: Bad Science, Bad after successful behavior modification treatment of obsessive- Medicine, and the Enduring Mistreatment of the Mentally compulsive disorder. Arch Gen Psychiatry 53:109-113. Ill.Seligman MEP, Weiss JM (1980) Coping behavior: Learned helplessness, physiological change and learned inactivity. Grading Behav Res Ther 18:459-512. Three in-class exams……….…………….………………55%Sloman L, Gilbert P (2000) Subordination and defeat: An Four Movie Reviews.……...……………………………...10% evolutionary approach to mood disorders and their therapy. Mahwah, NJ: Erlbaum. Independent Paper and Oral Presentation……………..10%Snowden D (2001) Aging with grace. New York, NY: Bantam Stressography……………………………………...……….5% Books. Integrative Final Exam……………………………...…….15%Soldatos CR, Bergiannaki JD (1999) Sleep in depression and the Class Participation………………………………………….5% effects of antidepressants on sleep. In: Pharmacotherapy for mood, anxiety, and cognitive disorders (Halbreich U, Movie Reviews Montgomery SA, eds) pp 255-272. Washington, DC: Because there are so many movies related to topics that American Psychiatric Press. will be discussed in class, I thought they would be anThe Onion (2003). Pfizer launches “Zoloft for Everything” ad effective springboard for thinking about some of the campaign (Parady). Retrieved January 8, 2004, from http://www.healthyskepticism.org/reports.2003/0514.htm. relevant issues in a more applied way. Seven movies areValenstein ES (1998) Blaming the brain: The truth about drugs listed in the tentative syllabus and will be held on reserve and mental health. New York, NY: Free Press. in the library; you are required to write reviews for FOURWiertelak EP (2002) And the winner is: Inviting Hollywood into of these movies (hopefully you’ll watch all of them). Each the neuroscience classroom. J Undergrad Neurosci Edu 1:A4- review should be typed (no more than five pages) and A17. consist of the following components:Whitaker R (2002) Mad in America. Cambridge, MA: Perseus 1. General description of relevant topic in movie. Books 2. An evaluation of the way the relevant “neuro/health- related science” was presented in the film.APPENDIX 3. A description of two references/articles thatSyllabus: Clinical Neuroscience (Psych 335) empirically evaluated a research question related toMen ought to know that from nothing else but the brain this topic (PubMed is a wonderful resource to use).come joys, delights, laughter and sports, and sorrows, A copy of these articles should be attached to yourgrief, despondency, and lamentations. And by this, in an paper. As you probably know, it takes about a weekespecial manner, we acquire wisdom and knowledge, and
    • The Journal of Undergraduate Neuroscience Education (JUNE), Spring 2005, 3(2):A42-52 A51 to get items from interlibrary loan if we don’t have it neuroscience and forensics, cultural influences and mental in the library. illness, music and the brain, and plasticity of the human 4. Your views of the relevance of this particular topic in brain. the field of mental health.Small groups of students will be assigned to one of the Examsrecommended movies and will subsequently be expected There will be three in-class exams that will count 55%to make an oral presentation of each movie at appropriate toward your final grade. The nature of these exams will betimes throughout the course; this presentation will quite eclectic with diverse types of questions ranging fromcontribute to your class participation grade. These fill-in-the-blank to essay format. If you know in advancepresentations should last no longer than 15 minutes and that you will miss a scheduled test I will allow you to take itshould address the relevant questions mentioned above. before the test day; however, if you miss an exam, you willIt is fine to show a few short clips of key scenes of the have to take a pre-final exam during the last week ofmovie if it adds to your presentation. classes. The pre-final will cover the material missed by the students required to take the exam—hence, only oneStressographies pre-final exam will be written. The nature of the finalAs we learn about the stress response and the importance exam will be an essay take-home format enabling you toof coping strategies, you will be asked to keep a daily integrate the diverse aspects of the information coveredjournal describing the nature of the stressors you during the semester.encounter in your life (e.g., acute, chronic, mild, intense,physical, psychological) and your subsequent responses Schedule(e.g., passive, active). Also, as we learn about effective Introduction to the Brain and Clinical Neurosciencecoping strategies, you will be asked to examine your own Class 1 Introductioncoping responses to determine a “coping profile” (e.g., Class 2 View and discuss video Back from Madnesspassive, active, flexible) and propose ways to modify these (HBO Productions)strategies and introduce “maintenance coping” (e.g., Class 3 *CN: Ch 1: Clinical Neuroscience Emergesincreased exercise, increased social support) to provide a Reading: Psychiatry’s Downfall—chapter frombuffer against the toxicity of the chronic stress response. Hobson and Leonard’s Out of its mind:More details about how to describe the stressors and Psychiatry in crisis; Video case of Nadeansubsequent responses will be made available at the time Cool, Multiple Personality Disorderof the assignment. Your journal is yours to keep but you (Dissociative Identity Disorder)will be expected to write a reaction type of paper using Class 4 Evolution of Clinical Neuroscience CN: Chpinformation in your journal later in the semester. This 2: Research, Treatment, and Points of View:assignment will force you to become more aware of your Historical Perspectivesday-to-day coping strategies so that modifications can be Fundamentals: Establishing Homeostasismade to enhance your neurobiological health. Class 5 CN: Ch 3: Macroanatomy and the Dynamic BrainStudent Paper/Presentations Class 6 CN: Ch 4: Microanatomy andEach student will select a topic that is not covered Neurotransmissionextensively in class but related to the clinical neuroscience Class 7 CN: Ch 5: Neurochemistry &subject matter (see list below) and write a paper (appx. 12 Psychopharmacology Reading: Chapter 1pages) on the topic. I expect you to include about 10 (Introduction) to Valenstein’s Blaming thereferences in this paper—at least seven should be Brain; Movie Review: Awakeningsempirical articles whereas up to three may be more Class 8 Exam Ipopular readings or reputable web sites. Please use APA Class 9 CN: Chp 6: Neurodevelopment over theformat when referencing your articles. Topics should be Lifespan; Video cases of hemispherectomy,submitted to me by the deadline in the syllabus. Only one brain plasticity; Movie Review At First Sightstudent can work on a particular topic. During the lastweek of class, student presentations are scheduled—each Disruptions of Homeostasis: Representative Clinicalstudent will make a 10-15 minute presentation (preferably Disordersa PowerPoint presentation) of his/her topic. An outline of Class 10 CN: Ch 7: Disorders of Anxiety: Obsessive-the talk should be distributed to the students at the time of Compulsive Disorder and Tourette’sthe presentation. Possible topics include: autism, ADHD, Syndrome; Video cases: Dr. Mort Doran (BBCAlzheimer’s disease, Parkinson’s disease, panic disorders, Documentary) and Arachnaphobia (ScientificPTSD, Huntington’s chorea, the role of behavioral therapy American Frontiers video series); Moviein mental illness, eye movement desensitization Review: The Aviatorreprocessing (EMDR), repetitive transcranial magnetic Class 11,12 CN: Ch 8: Mood Disorders: Majorstimulation (rTMS), contemporary utilization of Depression and Bipolar Disorderpsychosurgery, diet and mental health, estrogen and Class 13 Roundtable Discussion of An Unquiet Mindcognition, St. John’s wort for depression therapy, Class 14 CN: Chapter 9: Schizophrenia; Movieneurobiology of sexual orientation, the placebo effect, Review: A Beautiful Mind
    • Lambert A Clinical Neuroscience Course A52Class 15 Schizophrenia, Cont; CN: Chp 10: Drug AddictionClass 16 Continue Addiction; Video: The Hijacked Brain (PBS Series: Moyers on Addiction)Class 17 Exam IIMaintaining HomeostasisClass 18 CN: Ch 11: Coping with Stress; Movie Review: Life is Beautiful; Discussion of “Spit Happens” Cortisol/Coping ActivityClass 19,20 CN: Ch 12: Psychoneuroimmunology;Class 21 Movie Review: Osmosis Jones; Stressography Assignment DueClass 22 CN: Ch 13: Eating Regulation and Associated Disorders; Movie Review: Supersize MeEthical and Professional IssuesClass 23 CN: Epilogue: Ethical Issues and the Future of Clinical NeuroscienceClass 24 Discussion/Presentation of Mad in America (Each student/s will be assigned a chapter to present to the class); Movie Review: GattacaClass 25 Exam IIIClass 26,27 Individual Presentations; Distribution of Take- home final exam*CN=Clinical Neuroscience (Lambert & Kinsley)Received March 16, 2005; revised May 16, 2005; accepted May 17,2005.The author would like to thank Dr. Craig Kinsley for insights andcollaborative efforts related to the development of the ClinicalNeuroscience course. Additionally, the comments of Dr. Barbara Lomand three anonymous reviewers are greatly appreciated—they ultimatelyenhanced the quality of this manuscript. Finally, the support of theRandolph-Macon College Psychology Department and Administrationplayed an important role in the development of this course andsubsequent incorporation into the psychology curriculum.Address correspondence to: Dr. Kelly G. Lambert, Department ofPsychology, Randolph-Macon College, Ashland, VA 23005. Email:klambert@rmc.edu Copyright © 2005 Faculty for Undergraduate Neuroscience www.funjournal.org