Patricia Rosebush, M.Sc.N., MD, FRCP(C)

Head of Inpatient Psychiatry, St. Joseph’s Hospital
Associate Professor, Psychiatry and Behavioural Neurosciences, McMaster University
Psychiatry Inpatient Service
9-Tower
St. Joseph’s Healthcare, Hamilton
50 Charlton Avenue East
Hamilton, Ontario  L8N 4A6
Canada
Tel:  905-522-1155, ext. 34386
E-mail: rosebush@hhsc.ca

Dr. Rosebush is the Head of Inpatient Psychiatry at St. Joseph’s Hospital, in Hamilton, Ontario, and an Associate Professor in the Department of Psychiatry & Behavioural Neurosciences, McMaster University.  She lives in Toronto with her husband and three children.  She belongs to numerous professional national and international organizations and is active on many committees, while serving on the editorial boards of several international journals such as the Journal of Clinical Psychiatry. She is widely published, has authored several book chapters.  Her research has been supported by the Medical Research Council of Canada, the Ontario Mental Health Foundation, and the Stanley Foundation.  She has developed an educational and clinical research program that has been highly successful within the medical school as well as the residency program.  The nature of the clinical/academic structure on the unit has permitted the generation of a number of important data sets, which form the basis of her clinical research.  These include:

• Prospective study of first onset psychosis: Since 1988, Dr. Rosebush has treated and studied over 500 first-onset psychosis patients.  Efficacy of psychopharmacological treatments, course of illness, and the short and long term neurological sequelae have been recorded prospectively in this large comprehensive database.  Dr. Rosebush, with her husband, neurologist and neuroscientist, Dr. Michael Mazurek, has combined her substantial clinical experience with laboratory experimentation. For example, they described the persistent loss of tyrosine hydroxylase immunoreactivity in the substantial nigra after neuroleptic medication.

• Neuroleptic malignant syndrome (NMS): This often fatal condition develops in a minority of patients being treated with anti-psychotic medications. Dr. Rosebush has personally studied and followed 46 such patients with this condition.  Her sample is the largest in the world and she has elucidated the biochemical profile, proposed a model for the pathophysiology of the condition, determined the most effective treatment, identified new risk factors and studied when patients can be treated with neuroleptics again.

• The neuropsychiatry of inherited metabolic disorders such as adult-onset Tay Sachs disease, metachromatic leukodystrophy and adrenoleukodystrophy:  Adrenoleukodystrophy is an inherited X-linked peroxismal disorder that preferentially affects the adrenal cortex, testes, and brain and may occur at almost any age. Psychiatric symptomatology is present in many of the adult-onset cases reported in the literature and may be one of the earliest manifestations of these diseases. The majority of patient’s psychiatric disturbances have signs and symptoms typical of mania. Psychosis and cognitive impairment may also be prominent. Metabolic diseases such as adrenoleukodystrophy are probably underecognized as a cause of psychiatric illness. Increased awareness of these disorders will lead to accurate diagnosis, appropriate treatment selection, and genetic counselling in psychiatric populations.

• Catatonia: To date, Dr. Rosebush has prospectively studies 120 episodes of catatonia in 95 patients with attention to phenomenology, response to treatment, underlying diagnoses and prognosis. This constitutes by far the largest study of such a population in the world and she has published a series of articles describing the genesis, treatment and long term follow up of these patients.

• Neurological side effects of Risperidone: Drs. Rosebush and Mazurek have carefully studied the long-term effects of Risperidone, an atypical antipsychotic that acts on both dopamine and serotonin receptors and was thought to have a lower incidence of neurological side effects than older compounds such as halorperidol. They have demonstrated that while in early trials in patients with schizophrenia, Risperidone was reported to have a more favourable EPS profile than its predecessors, this agent can produce the full spectrum of neurological side effects associated with the typical antipsychotic drugs. These sequelae include dystonia, akathisia, parkinsonism, neurological malignant syndrome (NMS), and tardive dyskinesia.  They are currently funded by the Stanley Foundation to carry out a 2-year randomized trial of another atypical agent, olanzepine vs. haloperidol in first onset psychosis.

• Late-onset delusional disorder: Dr. Rosebush has been prospectively studying and following 70 patients with this condition from the time of their first presentation. Stability of diagnosis, response to treatment, medication side effect profile, underlying medical/neurological illnesses, prognosis and outcome are addressed in her studies.

• Conversion disorder:  Since 1990 Dr. Rosebush has personally studied and followed and treated 40 patients with severe conversion disorder.  Development of effective treatment has been the focus of this study.  Increased awareness of this disorder will lead to earlier detection and appropriate treatment.

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