University of Cincinnati Department of Pediatrics

Robert A. Kowatch, MD, PhD

Title

Director, Psychiatry Research

Appointment

Professor of Psychiatry and Pediatrics

Email

psychiatryresponse@cchmc.org

Phone

513-636-0024

Fax

513-558-3399

Bio

Dr. Kowatch is Professor of Psychiatry and Pediatrics and Director of Psychiatry Research at Cincinnati Children’s Hospital Medical Center. He completed his internship in internal medicine at The Graduate Hospital of the University of Pennsylvania in Philadelphia and his residency in general psychiatry at the Hospital of the University of Pennsylvania. In 2006 he completed a Ph.D. in Cognition and Neuroscience at the University of Texas at Dallas. Dr. Kowatch has authored or co-authored more than 60 articles, 14 book chapters, and two books. He has published in the areas of the diagnosis and treatment of children and adolescents with bipolar disorders, sleep disorders and depression. His articles have been published in the Journal of American Academy of Child and Adolescent Psychiatry, Neuropsychopharmacology, Archives of General Psychiatry, and Journal of Child Neurology, among others. His clinical and research interests are in the biology and treatment of pediatric mood disorders.

Credentials

BA: Northwestern University, Chicago, IL, 1976.

MD: Chicago Medical School, Chicago, IL, 1980.

Fellowship: Child and Adolescent Psychiatry, Hahnemann University, Philadelphia, PA, 1981 to 1983.

Residency: General Psychiatry, Hospital of the University of Pennsylvania, Philadelphia, PA.

Internship: Internal Medicine, Graduate Hospital of the University of Pennsylvania, Philadelphia, PA, 1980 to 1981.

Certifications: Diplomat, National Board of Medical Examiners, 1980; diplomat, Psychiatry, American Board of Psychiatry and Neurology, 1985; diplomat, Child and Adolescent Psychiatry, American Board of Psychiatry and Neurology, 1986; diplomat, American Board of Sleep Medicine, 1988.

Position History

August 1, 1995 – August 31, 2000 Associate Professor of Psychiatry, The University of Texas Southwestern Medical School at Dallas, Dallas, Texas

December 1989 - August 1, 1995 Assistant Professor of Psychiatry, University of Texas Southwestern, Medical Center at Dallas, Dallas, Texas

December 1989 - August 1, 1995 Associate Director, Psychiatric Inpatient Unit, Children's Medical Center of Dallas, Dallas, Texas

January 1987- November 1989 Director, Sleep Disorders Center, Assistant Professor of Psychiatry, Medical College of Virginia, Richmond, Virginia

June 1986 - December 1986 Psychiatric Director, Cumberland Hospital, New Kent, Virginia

August 1985 - June 1986 Attending Staff Psychiatrist, Cumberland Hospital, New Kent, Virginia

Awards and Honors

Best Doctors in America, 2008
Awarded "2005 Best Doctors"
Awarded "2004 Best Doctors"
Chair, Website / Information Technology Committee, American Academy of Child and Adolescent Psychiatry, 1998 to present
Reviewer, National Institutes of Health Biobehavioral and Behavioral Processes Scientific Review Committee (BBBP-6), 2000 to 2004
Member of NIH Biobehavioral and Biobehavioral Processes 6 [BBBP-6] Study Section, 2001 to 2004

Research

Pediatric bipolar disorders and functional imaging

Research Grants and Contracts

Principal Investigator, NIMH Child and Adolescent Clinical Mental Health Award (1 KO 7 MH01057-01). Funded Sept. 1, 1995 to April 1, 2000.

Principal Investigator, NAMI Research Institute, Stanley Foundation Research Awards Program, Development of a Treatment Algorithm for Child and Adolescent Bipolar Disorders. Funded May 6, 1996 to May 1, 1998.

Principal Investigator, NARSAD Independent Investigator Award, Magnetic Resonance Spectroscopy Study of Bipolar Children and Adolescents and Normal Controls. Funded Sept. 1, 1998 to Sept. 1, 1999.

Principal Investigator, NAMI Research Institute, Stanley Foundation Research Awards Program, Treatment of Comorbid ADHD in Bipolar Children and Adolescents. Funded Sept. 1, 1998 to May 1, 2000.

Principal Coordinating Investigator, NIMH Pediatric Bipolar Collaborative Mood Stabilizer Trial (1 RO1 MH60710-01A1) Funded Dec. 1, 2000 to Dec. 1, 2004, Sites: Children's Hospital Medical Center of Cincinnati, Case Western University and UT Southwestern at Dallas.

Publications, Most Recent

Danner, S., M. A. Fristad, L. E. Arnold, E. A. Youngstrom, B. Birmaher, S. M. Horwitz, C. Demeter, R. L. Findling, R. A. Kowatch and L. G. Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues. Clin Child Fam Psychol Rev. 2009.

Wagner, K. D., L. Redden, R. A. Kowatch, T. E. Wilens, S. Segal, K. Chang, P. Wozniak, N. V. Vigna, W. Abi-Saab and M. Saltarelli. A Double-Blind, Randomized, Placebo-Controlled Trial of Divalproex Extended-Release in the Treatment of Bipolar Disorder in Children and Adolescents, J Am Acad Child Adolesc Psychiatry. 2009.

Nandagopal, J. J., M. P. DelBello and R. Kowatch. Pharmacologic treatment of pediatric bipolar disorder.Child Adolesc Psychiatr Clin N Am 18(2): 455-69, x. 2009.

Findling, R. L., J. A. Frazier, V. Kafantaris, R. Kowatch, J. McClellan, M. Pavuluri, L. Sikich, S. Hlastala, S. R. Hooper, C. A. Demeter, D. Bedoya, B. Brownstein and P. Taylor-Zapata . The Collaborative Lithium Trials (CoLT): specific aims, methods, and implementation, Child Adolesc Psychiatry Ment Health 2(1): 21.2008.

Carlson GA, Findling RL, Post RM, Birmaher B, Blumberg HP, Correll C, DelBello MP, Fristad M, Frazier J, Hammen C, Hinshaw SP, Kowatch R, Leibenluft E, Meyer SE, Pavuluri MN, Wagner KD, Tohen M. AACAP 2006 Research Forum--Advancing research in early-onset bipolar disorder: barriers and suggestions. J Child Adolesc Psychopharmacol. ;19(1):3-12. 2009.

J. P. Pestian, P. Matykiewicz, A. Leenaars, J. Grupp-Phelan, S. Arszman-Lavanier, J. Combs, and R. Kowatch. Distinguishing between completer and simulated suicide notes: A comparison of machine learning methods, Association of Computational Linguistics Proceedings, Columbus, OH, June 2008.

J. P. Pestian, P. Matykiewicz, J. Grupp-Phelan, S. Arszman-Lavanier, J. Combs, and R. Kowatch. Using natural language processing to classify suicide notes. Chicago, IL, American Medical Informatics Association. October 2008.

J. P. Pestian, P. Matykiewcz, R. Kowatch, J. Grupp-Phelan, and A. A. Leenaars. Suicide notes classification using natural language processing: a phenomological perspective. Suicide an Life-Threatening Behavior, Under Review, 2008.

Kowatch, RA. Suicide in children and adolescents with depression. J Clin Psychiatry 69 (11) 1821-1823. 2008.

Pfeifer JC, Kowatch RA, DelBello MP. The use of antipsychotics in children and adolescents with bipolar disorders. Expert Opin Pharmacother. 8(16):2673-87. Review. 2008.

Gleason MM, Egger HL, Emslie GJ, Greenhill LL, Kowatch RA, Lieberman AF, Luby JL, Owens J, Scahill LD, Scheeringa MS, Stafford B, Wise B, Zeanah CH. Psychopharmacological treatment for very young children: contexts and guidelines. J Am Acad Child Adolesc Psychiatry. 46(12):1532-72. 2007.

Singh, M. K., J. C. Pfeifer, D. H. Barzman, R. A. Kowatch and M. P. DelBello. Medical management of pediatric mood disorders. Pediatr Ann 36(9): 552-63. 2007.

Danielyan, A., S. Pathak, R. A. Kowatch, S. P. Arszman and E. S. Johns. Clinical characteristics of bipolar disorder in very young children. J Affect Disord. 97(1-3): 51-9. 2007.

McClellan, J., R. Kowatch and R. L. Findling. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 46(1): 107-25. 2007.

DelBello, M. P. and R. A. Kowatch. Pharmacological interventions for bipolar youth: developmental considerations. Development and Psychopathology, 18:4:1231-1246. 2006.

Kowatch, RA. Evidence Based Guidelines for the Assessment and Treatment of Bipolar Disorder in Children and Adolescents: Do Not Miss the Forest for the Trees. The Journal of Bipolar Disorders: Reviews & Commentaries Vol. V, No. 1: 5, 17. 2006.

Singh, M. K., M. P. Delbello, R. A. Kowatch and S. M. Strakowski. Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children. Bipolar Disord 8(6): 710-20. 2006.

Post, R. M. Findling, R.L. and R. A. Kowatch. Earlier recognition and treatment of prepubertal bipolar disorder. Psychiatric Annals 36(9): 630-36. 2006.

Patel, N. C., M. P. DelBello, R. A. Kowatch and S. M. Strakowski. Preliminary study of relationships among measures of depressive symptoms in adolescents with bipolar disorder. J Child Adolesc Psychopharmacol 16(3): 327-35. 2006.

Patel, N. C., M. P. DelBello, H. S. Bryan, C. M. Adler, R. A. Kowatch, K. Stanford and S. M. Strakowski. Open-label lithium for the treatment of adolescents with bipolar depression. J Am Acad Child Adolesc Psychiatry 45(3): 289-97. 2006.

Wagner, K. D., R. A. Kowatch, G. J. Emslie, R. L. Findling, T. E. Wilens, K. McCague, J. D'Souza, A. Wamil, R. B. Lehman, D. Berv and D. Linden. A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents.Am J Psychiatry 163(7): 1179-86. 2006.

DelBello, M. P., R. A. Kowatch, C. M. Adler, Kevin E.Stanford, Jeffrey A.Welge, Drew H. Barzman, Erik Nelson and S. M. Strakowski. A Double-Blind Randomized Pilot Study Comparing Quetiapine and Divalproex for Adolescent Mania. J Am Acad Child Adolesc Psychiatry 45(3). 2006.

Post, R. M. and R. A. Kowatch. The Health Care Crisis of Childhood-Onset Bipolar Illness: Some Recommendations for Its Amelioration. J Clin Psychiatry 67(1): 115-125. 2006.

Chapters

Kowatch, R.A. Mood Stabilizers In Treatment of Bipolar Disorder in Children and Adolescents by B. Geller and M.P. DelBello. Guilford Press. ISBN-13: 978-1593856786. 2008.

Kowatch, R. A. and M. P. DelBello. Pediatric bipolar disorder: emerging diagnostic and treatment approaches. Child Adolesc Psychiatr Clin N Am 15(1): 73-108. 2006.

Books

R.A. Kowatch, M.A. Fristad, R.L. Findling & R. Post. Clinical Manual for the Management of Bipolar Disorder in Children and Adolescents. APPI 2008; ISBN-13: 978-1585622917

Findling R.F., Kowatch, R.A. & Post R. Pediatric Bipolar Disorders. Martin Dunitz Press, Ltd., London, 2003.

Presentations, Most Recent

Special Interest Group: Bipolar Disorder. American Academy of Child and Adolescent.
Proceedings of the American Association of Suicidology, San Francisco, April 18, 2009.

University of Cincinnati Psychopharmacology Update: On- and Off-Label Uses of Psychotropics in Child Psychiatry. Cincinnati, OH Dec. 2006.

Psychiatry Annual Meeting, San Diego, CA, Oct. 2006.

University of Wisconsin Psychiatry Update: Child and Adolescent Bipolar Disorder:
It Exists, So What Do We Do About It? Madison, WI Oct. 2006.

Pestian JP, Matykiewicz P, Kowatch R, Grupp-Phelan J, Mazlack L, and Leenaars A. Suicide note classification using natural language processing: A content analysis.
Research Forum: Pharmacotherapy: What Are Predicators of Positive Medication Response in Youth with Bipolar Disorder? R. Kowatch (chair), American Academy of Child and Adolescent Psychiatry Annual Meeting, San Diego, CA, Oct. 2006.

Research Forum: Pharmacotherapy: What Are Predicators of Positive Medication Response in Youth with Bipolar Disorder? R. Kowatch (chair), American Academy of Child and Adolescent Psychiatry Annual Meeting, San Diego, CA, Oct. 2006.

Reunion Des Experts Bipolact: Diagnostic et traitement de désordre bipolaire chez les enfants et des adolescents, Paris, France, Sept. 2006.

Professional Organization Memberships

American Academy of Child and Adolescent Psychiatry
American Sleep Disorders Association
Society of Biological Psychiatry
American College of Neuropsychopharmacology

Committees:

Member, Professional Advisory Council, Child & Adolescent Bipolar Foundation, 1999-present
Institutional Review Board, Cincinnati Children’s Hospital Medical Center, 2004 – present.
Editor: Current Psychiatry for Child Psychiatry - present.
NIH Child Psychopathology and Developmental Disabilities [Formerly BBBP-6] Study Section,
2000- 2005
Chair, Website/Information Technology Committee, American Academy of Child and Adolescent Psychiatry, 1998-2001.
Clinical Pastoral Care Education Committee, Children’s Medical Center of Dallas, 1992-1996.
Site Visitor, Accreditation Committee, American Sleep Disorders Association (ASDA), 1988-1992.
Secretary/Treasurer, Southern Sleep Society, 1990-92.

Books

Findling RF, Kowatch RA, Post R. Pediatric Bipolar Disorders. Martin Dunitz Press, Ltd., London, 2002.

Special Interests

Pediatric bipolar disorders

Editorial Positions:

Journal Reviewerships

Journal of the American Academy of Child and Adolescent Psychiatry, 1994 to present
Journal of Child and Adolescent Psychopharmacology, 1998 to present
Bipolar Disorders2001-Present Journal of Biological Psychiatry, 2002 to present

Editorial Boards

Journal of the American Academy of Child and Adolescent Psychiatry, 1997 to present
Journal of Child and Adolescent Psychopharmacology 2002 –Present Contemporary Psychiatry, 2001 to present
Bipolar Disorders: Reviews and Commentaries, 2002 to present

Current Research

The Longitudinal Assessment of Manic Symptoms (LAMS, R01MH073816) study, currently in its fifth year, is a collaborative, four-site study following subjects with low and high symptoms of mania in children. Funded by the National Institute of Mental Health (NIMH), the LAMS study was designed to use epidemiological methods to ascertain a cohort of children ages 6-12 years with ESM, as well as a comparison group of children without ESM. We have enrolled and completed baseline assessments on 180 subjects in Cincinnati with 600 subjects being enrolled in total. The goal is to follow this cohort for the next 10-20 years and a competitive renewal is being submitted to NIMH for this project in the fall of 2008. There is a high likelihood that this project will be funded again for another 5-year period. The LAMS R01 was submitted to NIMH for another 5 year of funding as a competitive R01 renewal on 3/1/09.
Family Focused Therapy (FFT, NIH R01MH074033) study, an NIMH funded, 5-year study (currently in year 3), is testing the efficacy of a promising new intervention for bipolar adolescents, Family-Focused Treatment (FFT), as an adjunct to carefully controlled pharmacotherapy in a 3-site randomized trial. Dr. Kowatch is the principal investigator for this national effort (R01MH074033).
The Childhood Onset Lithium Project (COLT) is a large multi-site project of lithium in children and adolescents with Bipolar I Disorder. This project is coordinated by Case Western Reserve University via the National Institute of Child Health and Human Development (NICHD).

The Stanley Early Onset Bipolar Trial is a two-site project funded by the National Alliance on Mental Illness (NAMI)/Stanley Research Foundation. Children’s Hospital of Milwaukee is working with us on this project. The aim of this project is to conduct a controlled trial of risperidone, valproate and placebo in children, ages 3-7 years, with bipolar disorder.
Placebo Controlled Trial of Risperidone vs. Valproate In Young Children With Bipolar Disorders funded by NAMI/Stanley Foundation Research Awards Program.
The aim of this project is to conduct a controlled trial of risperidone, valproate and placebo in children, ages 3-7 yr. with bipolar disorder. Sixty subjects will be enrolled in this protocol. To date, 45 subjects have been enrolled.
The Evaluation of LAMICTAL as an Add-on Treatment for Bipolar I Disorder in Children and Adolescents, 10 to 17 Years of Age.
This is a GSK sponsored clinical trial that is a multicenter, parallel group, placebo-controlled, double-blind, randomized withdrawal trial of Lamictal as add-on maintenance treatment in male and female outpatient child and adolescent subjects, 10 to 17 years of age, who have been diagnosed with bipolar I disorder. The overall objective of the study is to evaluate the efficacy, safety, and tolerability of Lamictal compared to placebo, when added to conventional mono- or dual-therapy (mood stabilizer and/or antipsychotic) in children and adolescents with bipolar I disorder.
Status: Enrolling subjects.
Assessment and Monitoring of Pediatric Subjects Who Have Made A Serious Suicide Attempt.

Suicide is one of the leading causes of death in children and adolescents. It is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds. The major aim of this project is to develop an accurate method for estimating the likelihood of repeated suicide attempt by integrating patient-specific clinical risk factors, natural language processing of speech samples and biologic markers, into a risk assessment estimate. We theorize that the optimal approach for estimating the risk of a medically serious attempt or completed suicide integrates clinical factors, biomarkers and analysis of specific speech samples. After this sample of high-risk subjects is identified, they will be given the option of enrolling in a one-year monitoring study where they will be contacted by text-message either bi-weekly or monthly, to monitor for the re-emergence of suicidal ideation.

The study design for this proposal is a cross-sectional analysis of 30 patients who come to CCHMC’s Emergency Department for attempted suicide and 30 patients seen in the ED without any current or past history of suicidal ideation or attempts – “non-suicidal controls”. The lower limit of the sample size is large enough to power a pilot study. The upper limit will be used if additional funding is secured. The purpose of this pilot project is to train and organize the research team and to successfully collect pilot data that may be used for a larger, longitudinal study. Subjects and families are assessed by trained PIRC and ED staff from Area C, Shock Trauma and PIRC rooms in the ED.
Oxley Foundation Project: Improved Diagnosis and Treatment of Pediatric Mood Disorders Through Integrated Clinical Genomics

The goal of this project is to use genetics to improve diagnosis and treatment for children with mood disorders The Cincinnati Children’s Genetic Variation and Gene Discovery Core is an institutional (non-profit) laboratory centralizing the production and analysis of DNA related data. Equipped with state-of-the-art instrumentation the facility provides services for translational research for gene based studies, DNA sequencing, microsatellite genotyping, DNA extraction from blood, saliva, and other tissue, high throughput custom SNP genotyping on the Illumina platform, and whole genome genotyping on the Affymetrix and Illumina platforms. The advanced genomic and analytic services that the Genetic Variation and Gene Discovery Core provides, and the large child psychiatry inpatient service, which averages 2,200 patient admission/year at Cincinnati Children’s, are ideal for conducting psychiatric genomic studies. We have the patient population with complex mood disorders, the technology, and analytic tools to develop the following project.