WATCH 2011 Annual Meeting All-Access Right Here

Friday, May 28, 2010

View New Research Briefing

eThese are topics covered in an online press briefing presented live from the APA Annual Meeting on May 25.
  • Feasibility and Effectiveness of Using E-mail to Screen College Students for Depression 
  • Rurality, Suicide and the Availability of Mental Health Providers 
  • Allergen-Specific IgE And Allergy Symptoms Are Associated With Depression Scores In Patients with Mood Disorders Exposed to Seasonal Pollen-Peaks
  • A Randomized, Controlled Trial of Virtual Reality Exposure with Arousal Control for Active Duty Service Members with Combat PTSD
  • Clinical Features of Olfactory Reference Syndrome
  • Efficacy and Safety of Extended-Release Injectable Naltrexone (XR-NTX) for the Treatment of Opioid Dependence

Attendees: Apply online for CME from APA

If you attended the American Psychiatric Association Annual Meeting in New Orleans you can complete your evaluation online and recieve your CME credit.

Thursday, May 27, 2010

APA Annual Meeting Closes

The American Psychiatric Association's 163rd Annual Meeting brought more than 11,000 psychiatrists from around the world to New Orleans for five days of scientific program, including courses, new research and updates on the development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The meeting included a special addiction track with research and programs by the National Institute on Drug Abuse.

"Pride & Promise: Toward A New Psychiatry" was the theme of the 2010 meeting, which carried out one of APA President Alan F. Schatzberg's primary goals for the year - to bring top scientists to the APA meeting.

"With the science of psychiatry advancing so rapidly, we believed it was important to bring cutting-edge science to the APA meeting, and by all accounts we were successful," Dr. Schatzberg said. "The most common complaint we heard from attendees that there were too many excellent sessions to attend them all."

At the close of the meeting on Wednesday, May 26, Carol A. Bernstein, M.D., officially took office as APA president, leading a new board of trustees, and John Oldham, M.D., became president-elect, as Dr. Schatzberg concluded his presidential term.

The DSM-5 track included interactive sessions that allowed participants to provide feedback on language being considered for new and changing disorders, and each of the 13 DSM-5 work groups provided updates during a series of workshops.

Wednesday, May 26, 2010

Valuing the Positive Emotion

"If Buddha is too good to be true, then Enlightenment is too true to be good,” said Dr. Vaillant while starting the most eloquent and captivating lecture at the 163rd APA meeting in New Orleans titled “Toward a New Psychiatry: Valuing the Positive Emotion,” in which he defended the importance of both paying closer attention to and the promotion of positive emotions in psychiatric patients care.

On the surface, his argument appeared heretical because since psychiatry’s inception as a science predicated upon the tenants of Enlightenment and until the end of the twentieth century, the only emotions that could be induced experimentally were associated with the amygdala. These were the flight-or- fight emotions such as fear and anger that were deemed both real and significant not only because they could be experimentally evoked by sticking electrodes into the amygdala, but also because a causal link involving survival could be easily established. On the other hand, what we now call positive emotions, such as awe, love, compassion, joy, hope, trust, and gratitude were disregarded not only because they could not be measured objectively, but also because they were viewed as inimical to survival since they went against the selfish interests of an individual.

At this point, Dr. Vaillant trail-blazed a new path. He argued that humans and mammals do have a special part in the brains’ limbic system, called the insula, and it is associated with positive emotions based on functional MRI studies. Furthermore, he argued that the primitive insula conferred a survival advantage to mammals during a reptilian age while a more developed contemporary insula allowed homo-sapiens to flourish in the plains of Africa and subsequently spread around the world to form the large ancient cities ranging from Egypt to Mesopotamia. Then, Dr. Vaillant demonstrated his vast knowledge of philosophy, theology, and literature while further advancing his argument for the importance of positive emotions, not only as a necessity for human survival, but as a foundation for human flourishing.

At the end of lecture, based on the Q&A session, there seemed to be a consensus in the room about the significance of positive emotions pertaining to the human self-actualization and achievement of happiness and fulfillment in life. Yet, the last words were spoken by Dr. Vaillant, who left us with a simple question: What will psychiatrists do to promote positive emotions in the future? Perhaps here lies the pride and promise of psychiatry.

Eugene Bukhman, M.D.
Georgetown University Hospital

APA: Mindfulness

2010 Annual Meeting

From the 163rd American Psychiatric Association Annual Meeting in New Orleans.

APA in New Orleans 2010

American Psychiatric Association Annual Meeting in New Orleans, May 2010

Global Disasters: Lessons Learned from New Orleans, Haiti & Chile, APA Annual Meeting, New Orleans, 25 May 2010

Colleagues from around the world participated in the APA Forum "Global Disasters: Lessons Learned from New Orleans, Haiti & Chile," which was organized by the APA, WPA, and the Conflict Management Section and PAHO/WHO.

The Forum was co-chaired by Drs. Karen De Salvo, chair, Internal Medicine at Tulane University School of Medicine and myself. The panelists included General Russel Honore, the former Commander of Joint Task Force Katrina, Dr. Jean Luc Poncelet of PAHO/WHO, and Rand Corporation Clinical Fellow, Dr. Ben Springgate, a native of New Orleans. 

The panelists compared postdisaster lessons learned from New Orleans, Haiti  and Chile, including the recent BP oil disaster in the Gulf. Also discussed was the prevention, mitigation and response of ecological systems and health/mental health consequences, including the health/mental health of caregivers

A robust dialogue with the audience followed, punctuated by General Honore's unequivocal assertion of the current oil disaster in the Gulf being "our Chernobyl" and his impassioned appeal to be mindful of the needs not only of main street and Wall Street, but also of "railroad street," and the vulnerable populations there, including the elderly, the poor and disabled.

The panelists and participants also emphasized the need for public/private and civilian/military institutions collaboration, as well the emergence of new, innovative and effective responses, prevention, mitigation, and response models.

Eliot Sorel, M.D.
Chair, APA Global Disasters Forum

APA Annual Meeting: Ethics, DSM5

A visitor to the 2010 APA Annual Meeting describes her experience at the meeting.

Tough Questions

It’s no secret that one of the tough questions in American psychiatry—and at this meeting—is how psychiatrists can interact with the pharmaceutical industry without compromising their integrity or the interests of their patients. Over the weekend, the APA Assembly rejected several proposals that would have provided guidance on which relationships can be problematic and are best avoided. (Full disclosure: I chaired a workgroup appointed by the APA Board that wrote of one the documents that was voted down.) Instead, the Assembly adopted a vague statement that psychiatrists should be aware of their conflicts and manage them, without any guidance on how to do either.

I had two interactions this evening, however, that underscored just how important it is for American psychiatry to provide clearer guidance—and just why that may not be easy to do. On the street outside the Hilton, I was approached by someone who asked if I came to the meeting every year. When I said I did, he wanted to know why there were so many fewer sessions this year. “We used to be able to go to sessions from 7:30 in the morning to 10 at night.” I told him that APA had made a decision to phase out industry-supported symposia, both to protect the objectivity of the program and to reduce APA’s dependence on industry funding. He was puzzled by my response. “I come to get education. [He appeared to be referring to CME credits.] Whether it’s good education or bad education, it’s all education.

Good information or bad, so long as we get CME credits, that’s all that matters? As I was pondering the implications of that interaction, I headed over to one of the ubiquitous receptions, where a prominent member of the APA Assembly came over to talk. She wanted me to know, she said, that she’d thought the report of the workgroup I’d chaired—which she’d voted against—was really quite good. There was just one problem. It had recommended that psychiatrists not give talks when they don’t control the content of their presentations. When physicians give promotional talks for industry, they are handed a slide set created by the company. Our workgroup thought it was inappropriate for a physician to be dispatched to mouth the words written by the company that was signing the check. “I give a lot of those talks,” she told me. “They pay my mortgage. There’s no way that I can stop.” Then she smiled, as though she knew I would understand.

I don’t know, of course, how many psychiatrists will listen to just about anything so long as they get CME credits. Or how many are so dependent on drug company money that they can’t imagine living without it. But for this psychiatrist, it was a troubling evening in the Big Easy.

Paul S. Appelbaum, M.D.
APA former past-president

Dreams sometimes come true

In our lives we all have myriad aspirations, but sadly most times things do not work out. Thankfully, our highly elaborate ego defense mechanisms, including plain denial, exist to protect us from seeing things as they really are. Very few people are accepted to their dream schools, marry their dream partners, get their dream jobs, live in their dream homes, or live their dream lives. Maturity consists of accepting both our intrinsic limitations and those of our circumstances. Isn’t it a shock when as we grow up we realize that our parents are also (very!) limited and that we are essentially on our own? Yet, in spite of checks imposed by reality, we keep dreaming.

When Alan Schatzberg invited me to be Chair of the Scientific Program Committee of the APA over one year ago, I accepted that challenge with joy. And almost immediately I started dreaming. I dreamed of a national and international meeting that would be a true one-stop shop for the field of psychiatry. Over the last couple of decades our field evolved in such a way that different groups focused increasingly more on their own networks, organizations, and meetings. Our colleagues started to prioritize more and more their focused meetings, such as those of the Academy of Child and Adolescent Psychiatry, American College of Neuropsychopharmacology, and Society of Biological Psychiatry, among others. The feeling was that the APA Annual Meeting was too busy, too chaotic, and not the place to present the most cutting edge content. As the meeting was based on submissions, we were at the mercy of what came to us.

My dream as I was given the unique opportunity to lead the Scientific Program Committee was to revamp the annual meeting as a one-stop shop to completely fulfill the needs of a variety of constituencies: those who wanted to see the latest discoveries and advances, those who wanted to meet the leaders in our field, those who wanted the best evidence-based clinical data to inform their practice, and those who sought to learn specific topics in CME courses. It is time-consuming and expensive to travel. Why do our members need to do things piecemeal, attending several meetings, when their could all be accomplished at the APA?

The strategy over the course of the past year then became to invite top speakers to the Annual Meeting. We made a strategic plan to invite approximately 50% of the content. Then, in September 2009 I moved halfway around the world, to Australia, to become Director of the John Curtin School of Medical Research at the Australian National University, which is Australia’s national medical research institute. Should I then give up the dream? Of course not! That is why the internet and old fashioned phones exist. We also added Don Hilty as a co-chair of the Scientific Program Committee to make this long distance endeavor possible. But would this really work?

As background, I am very fortunate that another old dream of mine had come true. Those who specialize in addiction know that there is nothing like intermittent reinforcement to really hook someone. My old dream that started in the 90’s was to create a new journal that was conceptually novel, and that would integrate basic and clinical science and would rapidly rise to the top. Molecular Psychiatry, that I founded in 1996 and continue to edit to this day, achieved its editorial goals and it is now the second most cited psychiatric journal worldwide (Impact Factor of 12.5). I make all reviewer assignments and all editorial decisions for all our papers. In 2010 the number of submission is expected to reach 1,000. Due to this demanding “hobby” I am very aware of the latest breakthroughs in psychiatry and in these last 15 years I developed excellent working relationships with the leaders in the field. So, from Australia, I tapped my network of contacts worldwide and was able to invite vast numbers of national and international experts to the meeting. It worked! As the science of psychiatry rapidly advances and starts to impact on practice my bet was that our members would be attracted to the cutting edge. Our standing room only sessions proved that my instinct was right.

As our Annual Meeting rapidly reaches its end, I see my dream come true. This meeting has been a very successful one-stop shop for any psychiatrist of any orientation. All the key areas were covered – by top experts. Sessions of direct clinical relevance were as successful as those that presented the latest developments on scientific basis of psychiatry. Courses were a big hit (thanks, Michele Pato). The incredible staff of the APA and the very keen and dedicated members of our Scientific Program Committee deserve to be congratulated for their tireless efforts. Don Hilty was a superb co-chair. Without them we wouldn’t have been able to put together such a fantastic meeting. Contradicting John Lennon, who famously stated in his song “God” that “the dream is over,” I am delighted that my dream is still alive as the 2010 Annual Meeting is ongoing. Importantly, I am hopeful that the dream will continue to live on through future APA meetings.

Julio Licinio, M.D.
Scientific Program Committee
American Psychiatric Association
John Curtin School of Medical Research
The Australian National University
Canberra, Australia

Molecular Psychiatry
Nature Publishing Group
London and New York City

Tuesday, May 25, 2010

Depression in a High-Achieiving Athlete: An Encounter With Terry Bradshaw

In the mid '80’s, as a sport psychiatrist, I was fortunate enough to interview Terry Bradshaw for a cable TV show. The topic was “Why Super Bowl Champs Can’t Repeat." His Steelers of the '70’s had made that look easy, but at the time I did the interview, no other NFL team had been able to win the Super Bowl in successive seasons since.

Terry took the time to talk to me from the barn of his farm in Louisiana. He was accessible and generous with his time. He seemed to enjoy the fact that I was a psychiatrist and kidded me about it. His comments about the conservative mindset that can go along with defending something you’ve won, versus the attacking mindset when you are trying to take something from someone struck me as very insightful and intelligent.

Little did I realize then that the weight of defending all those championships probably laid more heavily on Terry’s shoulders than most. As he later publicly acknowledged, he had suffered from depression for years while playing. He described breaking into tears and sweating profusely after a game, not realizing what the problem was. Because of the prevailing myth that high-level athletes would not become depressed “like regular people,” and the stigma against admitting it if it did occur, none of his teammates, coaches or staff recognized that Terry had an illness. Terry became even more melancholy after retirement (a common phenomenon), sought psychotherapy, and was finally properly diagnosed and prescribed paroxetine, which helped him greatly. He then went on to talk about his depression and treatment publicly, becoming the first very high-profile athlete to do so.

Soon after Terry’s disclosure, the Hall of Fame jockey, Julie Krone, and the Olympic diver Wendy Williams came forward, notably at International Society for Sport Psychiatry Symposia here at the APA convention, which I had the pleasure to chair. Both Julie and Wendy openly discussed the fact that they had taken SSRI’s for anxiety and depressive disorders while competing. They shared with us that the SSRI’s had helped their conditions greatly, and had not negatively impacted their performance, though the illnesses certainly had.
Julie continued to use SSRI’s when riding and became an information source for jockeys and other athletes who were struggling with emotional disorders. Suddenly, there was less stigma to being prescribed a psychiatric medication, or to receiving psychotherapy while competing, and many other well-known athletes have since stepped forward to share their stories.

In my practice, these narratives had made it easier for my athlete patients to try a medication when it is offered. Another welcome benefit is that my non-athlete patients are more open to trying an antidepressant as well. As we discuss side effects, I mention that if Terry Bradshaw can take an SSRI and Julie Krone can compete on it, the medication must be fairly well tolerated, right?

Ronald L. Kamm, M.D.
Distinguished Life Fellow, American Psychiatric Association
Past-President, International Society for Sport Psychiatry

Eating Disorders, DSM5 at the APA

One always has a dilemma at the APA Annual meeting, and I call this the embarrassment of riches problem: there is so much going on that it is hard to choose what to attend. I try to attend a few talks outside my main interests so that I can keep up in other areas. But so much is going on, how does one choose? Sometimes I’ll choose to listen to a well-known expert, and other times I’ll choose a workshop or symposium based on a provocative title. Not infrequently, I will conclude that I made the wrong choice, and will leave and seek out something else. And sometimes I will enter a room almost at random because I want to rest.
I had reviewed the agenda and decided to listen to Kathy Halmi talk about eating disorders. She actually trained at my program (Iowa), and while she left before I got there, we have interacted a number of times, and I highly respect her. She has a no-nonsense way of thinking and presenting material that I like, and I guess what I learned was that--according to her--a core problem of anorexic patients is their sense of ineffectiveness. I guess I had never thought of that before. She provided a review of treatments, and all I can say is that more work is desperately needed.

That afternoon, I sat in on a DSM5 update and listened to Joel Dimsdale talk about proposed changes to the somatoform disorders. Now I have a beef about this: somatization disorder is probably one of the best validated disorders, though is underutilized. The diagnosis stems from Briquet’s syndrome, and was defined and validated by the Washington University group in the 1950’s. I ask: why are we even thinking about removing a valid diagnosis from the manual just because it is underutilized? I then sat in on a friend’s talk (Pinhas Dannon) about the neuropsychology of pathological gambling. He contends that these patients are not impulsive, and hence that pathological gambling is a behavioral addiction. The problem I have with this is that I think they are impulsive, and that’s what I see in my samples. (This is a research interest of mine – yes, we have loads of gambling in Iowa).

Donald W. Black, MD
University of Iowa

Comparative Effectiveness of Psychotropic Drugs

"What Can We Learn From Practical Clinical Trials?" presented data from the latest large practical trials in mood disorders and schizophrenia. Among the highlights were the following. In the United Kingdom’s Balance Study it was found that for bipolar disorder, the combination of the medications lithium and valproate was more effective than valproate alone and that lithium was nonsignificantly better than valproate in preventing relapses and maintaining stability. In addition, the NIMH CATIE study group or Schizophrenia Trials Network reported on the METS Study and found that metformin 2 grams/day produced a 3 kg weight loss in patients with antipsychotic induced weight gain. Other studies described important important results addressing fundamental questions in the treatment of psychotic and mood disorders.

Jeffrey A. Lieberman, M.D.
Chairman, Department of Psychiatry, College of Physicians and Surgeons, Columbia University Director, New York State Psychiatric Institute Director, Lieber Center for Schizophrenia Research Psychiatrist-in-Chief @ New York Presbyterian Hospital & Columbia University Medical Center

Softshell crab, café au lait and cognitive behavioral neurology …

At mid-day Monday, New Orleans was her classic self with 92 degree heat and 100% humidity. Along with the famed softshell po’ boys and café au lait, did you know that New Orleans is also known for its outstanding excellence in cognitive and behavioral neurology? Yes, at LSU Health Science Center, renowned Cognitive and Behavioral Neurology is headed by New Orleans native Anne L. Foundas MD. As the author of more than 80 refereed papers and PI on numerous grants, Dr. Foundas is recognized as a leader in the rapidly expanding interdisciplinary field of Cognitive Neurosciences. She currently serves as Professor of Neurology and Vice-Chair of Clinical Research in the Department of Neurology, Louisiana State University Health Sciences Center in New Orleans.

Not only is Dr. Foundas and accomplished researcher and author, she is also an extraordinary clinician and award-winning and engaging teacher. The APA is quite fortunate as Dr. Foundas presented at the Annual Meeting on Tuesday, May 25, Advances in Medicine 4 Aging and Dementia: An Update on Neuroscience and Brain Imaging.

While at the Annual Meeting, be sure not to miss one of New Orleans’ finest!

In her words, Dr. Foundas describes her work:

Cognitive Neuroscience is being driven by dramatic advances in neuroimaging and neurophysiologic methods. Anatomical details of the brain can be reconstructed using structural MRI methodologies. Cognitive functions, such as memory and language, can be studied by analyzing subtle, task-related changes in blood flow using functional MRI paradigms. The timing of neural activity can be precisely mapped using cortical event-related potentials (ERP) which can be co-registered with brain images derived from structural and functional MRI. Cerebral ischemia can be studied with diffusion-perfusion weighted imaging, and metabolic studies can be conducted with MR spectroscopy. Motor and cognitive neural systems can be studied using transcranial magnetic stimulation (TMS) methods. In this way, the precise anatomy, function, timing, and physiology of neural events can be studied in humans in vivo. We have utilized these state-of-the-art MRI and neurophysiological methods to study complex cognitive operations in healthy individuals, and then we have applied these methods to study clinical populations including: developmental stuttering, stroke, dementia, and epilepsy.
Our long-term goal is to develop targeted treatment strategies based on the knowledge that we gain from these basic neuroscience studies. Translational research programs are being developed to bridge basic and clinical neuroscience research. Targeted program development includes studies of: development and aging, stress and depression, stroke and neuroplasticity, and epilepsy.

Josepha A. Cheong, MD
Member, Scientific Program Committee

Career, Leadership & Mentorship luncheon/Forum

The first of what we hope would become an APA ritual/tradition took place in New Orleans, on Sunday, May 23rd, 2010 during our annual APA scientific meeting. It was convened by Drs. Gary Weinstein & Eliot Sorel with several MITs & ECPs participating.

We heard thought-provoking presentations from Dr. Steven Koh about the mentorship initiative he started in San Diego, California, complemented by a presentation from Dr. Hind Benjelloun about the Career & Leadership, now Career, Leadership & Membership. This initiative was started three years ago by the Washington Psychiatric Society with a grant from Area III; it was expanded to the New Jersey District Branch this spring and is available to others upon request.

The luncheon/Forum also featured discussions of the APA Assembly Leadership Training Manual, which was developed by the APA Assembly’s Leadership Training Workgroup (LTWG) and will soon be available on APA’s website and could be of value in starting such programs nationwide.

The group intends to develop a Career, Leadership & Mentorship (CLM) workshop for next year’s annual meeting as well as convene as a CLM Forum at that time. A CLM workshop is currently being planned for the XX World Congress of Social Psychiatry in Marrakech, Morocco in October 2010.

Eliot Sorel,MD, Chairman, APA Assembly LTWG
Founder, WPS, Career & Leadership
May 23, 2010

2011 Annual Meeting in Hawaii

Wow! This meeting is flying along and we are already starting to think about 2011. The 2011 Scientific Program Committee had conference calls prior to this meeting, and the APA staff have been planning the upcoming meeting, particularly over the last year! Chair Dr. Tana Grady-Weliky will take the lead and work closely with incoming President Carol Bernstein, M.D., the Committee, the APA Office of Education and APA staff. Dr. Grady is a busy clinician with an interest in women’s health and she is a lifetime medical and psychiatric educator. Based on feedback from 2010, we can make some changes in logistics that “surround” our annual meeting, but I thought hearing about some of Dr. Bernstein’s plans from the 2010 Opening Ceremony might be helpful.

The theme is “Transforming Mental Health Through Leadership, Discovery and Collaboration.” One key theme will be thinking about leadership initiatives, models and programs that foster the development of the next generation of psychiatrists. Dr. Bernstein, also a lifelong medical and psychiatric educator, has gained input from MITs and believes we need to think about generational differences related to their education—we can expect some excellent presentations and discussions on this! Another theme will be scientific discovery, building on this year’s programming in which APA President Alan Schatzberg and Dr. Julio Lucinio encouraged our best researchers to translate findings for clinical practice. We will again invite many of the best scientists in the world. A third theme will emphasize collaborations with patients, families, community organizations, the medical community and allied mental health groups. We want you to think of our annual meeting as the place to meet a broad range of educational needs!

Clearly, a back drop to the program will be health care reform and parity legislation, which will help increase access and reduce discrimination toward patients. We figure to have updates on current events nationally and sessions for members to digest the information, apply it to clinical practice and provide input on their experiences.

Get your planning started for 2011 submissions now and we will see you in Hawaii!!

Don Hilty, MD

Co-Chair, 2010 Scientific Program Committe
Vice-Chair, 2011 Scientific Program Committee

College Psychiatry Specialists Come Together at the APA Meeting

It is wonderful to be here in the revitalized New Orleans for the APA meeting. Especially exciting has been the opportunity for those of us who have focused our career on college psychiatry to come together to share ideas and experiences. The APA meetings have presented this small but growing group with a rare chance to meet.

It is only right to first thank the recent and past APA leaders who have been instrumental in supporting this group. Michelle Riba (who established the task force on college mental health during her presidency), Paul Appelbaum, Steve Sharfstein (and earlier on Leah Dickstein) have been strong personal and intellectual supporters of this enterprise. The College mental health committees in their various forms have benefitted from the excellent leadership of Rachel Glick, David Fassler and more recently Jerry Kay as well. And Carol Bernstein has already shown great interest and support for our work-especially as related to the area of residency training in college mental health.

The college psychiatrists attending the meeting have shared a variety of programs including two symposia loosely based on the text that Jerry Kay and I recently released (Mental Health Care in the College Community/Wiley), a college mental health overview course presented by the psychiatrists based at the Duke University counseling service and an informal meeting of the college caucus this morning.

It is of particular benefit for the college psychiatry folks to have a chance to meet since many of us work as lone psychiatrists in our services and are often not well enough integrated into our university departments of psychiatry--even those of us who work at some very large universities. As was clear from all of the meetings, we deal with a unique population in a highly complex setting; often without the benefit of sufficient collegial support and consultation. Our conversations have focused on the challenges in providing care to ever growing numbers of students needing care and support and the challenges of working in systems (i.e., universities) that are not primarily focused on providing medical and mental health care. The meeting provided a chance for those of us with many years of experience to share ideas with our junior colleagues. It is really gratifying to see a young group of psychiatrists taking an active interest in this area.

The APA thus remains an important outlet and resource for our group as we continue toward establishing college psychiatry as an exciting training opportunity and a sub-specialty within psychiatry.

Thanks again to the APA and to our hosts in New Orleans.

Victor Schwartz, MD

New Research Poster: ADHD Comorbid with Anxiety, Mood Disorders

Among children and adolescents with attention-deficit/hyperacitivity disorder, more than 80 percent had a diagnosis of at least one other psychiatric disorder, most commonly oppositional defiant disorder and conduct disorder, according to new research being presented at the American Psychiatric Association’s Annual Meeting. A group of researchers, led by Isaac Szpindel, M.D., sought to assess comorbidity types and frequencies and age and gender characteristics in a large sample of children and adolescents ages 3 to 18 years with attention deficit hyperacitivity disorder.

Anxiety disorders were equally prevalent among boys and girls. Mood disorders were more common among girls and more common among older children/adolescents. In the preschool age group, communication disorders were common, but decreased with age. Among preschoolers, oppositional defiant disorder was more common among males.

The research was presented poster on Tuesday, May 25, at the American Psychiatric Association Annual Meeting in New Orleans.

Researchers concluded that ADHD is highly comorbid and exhibits specific age and gender characteristics that evolve with age, and understanding of these features can aid in the formulation of differential diagnoses and in the choice of medication in children/adolescents with ADHD.

New Poster: Researchers Recommend Early Treatment of Paranoid Delusions

Based on a case study analysis and literature review, researchers suggest an approach involving early intervention and more aggressive treatment to help prevent violence in adolescents experiencing paranoid delusions. The research poster was presented on Tuesday, May 25 during the American Psychiatric Association’s Annual Meeting.

Paranoid delusions are exaggerated fears of others in a person’s mind that may impair functioning at school and work and in personal relationships. The possibility exists that when anger escalates in the mind of an adolescent experiencing paranoid delusions, it may erupt at some point into violent behavior.  The case report describes an adolescent homicide that could potentially have been prevented by providing earlier psychiatric care. The case involved a 16-year-old female with paranoid ideations that built until she killed her younger sister.

The researchers recommend an approach to help prevent crimes that focuses on early interventions and more aggressive treatment. Because the first medical professional who may become aware of problems is often a primary care provider, the treatment approach was developed to be useful to to pediatricians, family practitioners, and other primary care providers. 

The researchers suggest that the family should be educated about the child’s paranoid ideation and associated aggressive behavior with a focus on improving the overall insight of the family and the patient about the psychosis. They also suggest clinicians gain more clinical history about the paranoia in order to help patients improve their reality testing.

Musings about Food: Food and the Brain, Food for Thought, and New Orleans Food

I started off my afternoon with research poster sessions by new investigators, primarily students, residents, and other trainees. I had a fascinating discussion with one of the young investigators about cancer treatment and mental illness in the elderly. This was an epidemiologic study by Simha Ravven, which raises interesting questions about whether psychiatric history affects access and response to cancer treatment. Later on I went to a fascinating session chaired by Dr. Nora Volkow as part of the NIDA (National Institute on Drug Abuse) track at the meeting. She talked about overeating as an addiction and the role of dopamine and frontal lobes in the modulation of eating behavior. I decided I still needed to stimulate my dopamine brain pathways with a great dinner with my wife and great friends at Commander Palace. This is a restaurant with a tradition of great food with a wonderful ambience. After letting my frontal lobes go off line enough to enjoy my evening, it was back to feeding my mind today. Today I spent some time at the Scientific Program Committee, which started planning for the APA meeting in Hawaii. It should be a good one, both from the science and fun aspects. I then attended informative sessions on the neuroscience of dementia, and a medical update on overlap of medical and psychiatric disorders in causing psychiatric symptoms. All in all a satisfying couple of days and evenings.

Iqbal “Ike” Ahmed, M.D.
Member, APA Scientific Program Committee
Deputy Rep., Hawaii

New Research Poster: Eating Disorder Treatment Protocols

Patients with eating disorders who underwent an integrated yet individualized treatment protocol significantly improved not only in the eating disorder illness, but across a range of areas, including decreases in depression and anxiety, according to research presented at the American Psychiatric Association’s Annual Meeting in New Orleans.

The study was conducted in a large integrated private group practice that addressed eating disorders and comorbid conditions simultaneously, using both verbal and non-verbal treatments such as art therapy in both outpatient and residential settings. A multidisciplinary team provided patients with integrated individual and group therapy, psychoeducuation, nutritional counseling, and medication.

The research poster, Effectiveness of Eating Disorder Treatment in Real World Settings: Comprehensive Assessment and Outcome (#NR7-37), was presented on Wednesday, May 26, at the APA Annual Meeting.

The study integrated comprehensive initial and outcome assessments of eating disorder symptoms, anxiety and depression, life functioning, and eating behavior into private practice. Study participants showed significant improvement in eating disorder scales, significant decrease in anxiety and depression scores, and improvement in overall- and within-family-functioning.

Dramatic improvements with the flexible treatment model were statistically and clinically significant across a range of psychosocial areas, the researchers concluded.

Researchers also identified variables that predict dropout risk, including the long duration of the eating disorder illness and an external locus of control, or a belief that events in their lives are controlled by external forces. “The greatest potential to further increase patient benefit in the future will be realized by keeping dropouts in treatment,” the researchers concluded. “There is reason for hope: eating disorders do actually respond to treatment, outcome benefits can be measured, as demonstrated in our study.”

NAMI Applauds America’s Exemplary Psychiatrists

Under the radar for many, for the 20th consecutive year, NAMI, the National Alliance on Mental Illness, is here at the annual conference to honor some of the APA’s members for the dedication to people living with mental illness. This year, 22 doctors are receiving the NAMI Exemplary Psychiatrist Award, among NAMI’s highest honor because nominations are made by people who need their help the most—individuals and families who are personally affected by mental illness.

Today, we honored psychiatrists who have “gone the extra mile” in their commitment to their professional, most importantly, to the communities and the lives of those they help.

As the nation’s largest grassroots mental health organization, we send a NAMI ‘congratulations’ to Ira D. Glick, M.D.; Michael T. Compton, M.D.; Branko Radulovacki, M.D.; Mary Lynn Tyson, M.D.; J. Raymond DePaulo, Jr., M.D.; Alvin B. Michaels, M.D.; RP Rajarethinam, M.D.; Paul F. Goering, M.D.; Jeffrey T. Hardwig, M.D.; Stephen Olson, M.D.; Nancy T. Block, M.D.; Vesudev N. Makhija, M.D.; Margaret Tompsett, M.D.; Nils Rosenbaum, M.D.; Lewis A. Opler, M.D.; Nicholas E. Stratas,M.D.; Shivkumar S. Hatti, M.D.; Mathew Sipple, D.O.; Jacqueline Bickham, M.D.; John Oldham, M.D.; Thomas A. Simpatico, M.D.; and James Reinhard, M.D.

--Michael J. Fitzpatrick, M.S.W., Executive Director, NAMI

Return to New Orleans

This is my first time back to New Orleans since Katrina, and I was looking forward to returning to this city—except, of course, the heat and humidity. The meeting is always full of activity – meetings, lectures and symposia to attend (or participate in), friends to see, and the dinners. And in New Orleans, there are so many fine restaurants that the difficulty is choosing one. I always find it helpful to use the Tripadvisor website.

Unfortunately, my Saturday plane was canceled and I missed a symposium in which I was supposed to serve as discussant. Frustrating, as I understand it went well, and there was standing room only.

After a few meetings, I went over to the convention center to register, which very easy with the self-service terminals, and then ambled around the book exhibit. This is always a great place to browse and see what new books are out. I avoid the drug company exhibits. These days the reps look so bored, I kind of feel sorry for them. I met Nancee Blum, a friend and colleague, and we jointly decided to attend the Guttmacher lecture featuring Robert Simon and Ken tardiff on violence. These are two giants in that tiny field, and I was anxious to learn a few new insights. The lecture was in a large room that was packed with people, and facility staff were quickly placing more chairs in the back of the room.

Dr. Simon began with an analysis of the tragic murder of Wayne Fenton. Sad, but instructive. He met with a psychotic patient in a locked, private office on a weekend without anyone around. The patient’s father ran errands and returned only to find Dr. Fenton bludgeoned to death.
After the lecture, Nancee and I made an executive decision to return to the hotel. On our way, we ran into a former trainee and relaxed at the Riverwalk and caught up. We then returned to our French Quarter hotel on the streetcar.

Donald Black, M.D.
University of Iowa Carver College of Medicine

APA Goes 'Green,' Covers Diversity Issues

"As always, it is fantastic to be back at APA, attending great sessions and courses, visiting with long-time friends from distant places, and meeting/mentoring medical students and residents. APA continues its strong work on diversity issues and the APA/SAMSA Minority fellow workshop "Disability or Difference? The Cultural and Clinical Needs of Deaf Patients" was well received. It highlights how at this meeting, the synergy between young members, who are passionate and inquisitive, can create stimulating workshops with mentors and APA members in the audience guiding them along the way.

In addition, it is wonderful to see that APA has been moving forward with its adoption of technology and going 'green'. Fewer booklets and materials are printed, and with more content going digital, APA is on track for the future where attendees can create an 'avatar' and browse at the meeting in a hybrid virtual and real world, attending sessions as well as mingling with those who are able to attend in person.

I look forward to each APA, and continue to be in awe of the amazing content created by its members and fashioned into 'curriculum tracks' by the scientific program committee."

John Luo, M.D.

Monday, May 24, 2010

Women's Mental Health at the APA

Shari I. Lusskin MD and C. Neill Epperson, MD

We are pleased to report that women's mental health topics are alive and well at the APA Annual meeting in New Orleans.

Neill and Natalie Rasgon, MD, played to a standing room only crowd at the crack of dawn (at least in New Orleans) on Sunday. Their workshop was entitled Mood Disorders in Women of Reproductive Age. After a concise review of the relationship between estrogen and mood across the lifespan, Natalie focused on depression during the perimenopause transition. She then shared her PET scan data on how estrogen effects brain metabolism in peri- and postmenopausal women. Neill followed with a lively discussion of the controversy surrounding the use of estrogen during the menopause. She shared her not- even-in-press-yet data from her fMRI research on the individual and interactive effects of estrogen and serotonin on brain activation in perimenopausal women using a working memory task paradigm.

Shari had the honor of teaching a course on Sunday afternoon with her fabulous colleagues from the University of British Columbia in Vancouver, Shaila Misri, MD, Diana Carter, MD, and Deirdre Ryan, MD. Now in it's almost 20th year, the course, Management Disorders in Pregnant and Postpartum Women, which was founded by Shaila, was sold out as usual. The audience included psychiatrists from as far North as St. Johns in Newfoundland, as far South as Sao Paolo, as far East as Bologna, Italy, and as far west as California. Several people have attended the course before but returned for the latest updates in perinatal psychiatry. New this year was an hour and fifteen minute question and answer period which was fascinating for all of us. As usual, we ourselves learned a tremendous amount as we heard about the clinical experiences of our audience members.

Kathy Wisner and Meg Spinelli gave a course on Sunday focusing on infant morbidity and mortality in women with perinatal psychiatric disorders.

On Tuesday, Neill has assembled a great panel for a symposium entitled "Mood, Memory, and Myths: What Really Happens at Menopause" (SO 84) from 2-5 PM. She will be joined by Ellen Freeman, PhD, Claudio Soares, MD, PhD, and Anita Clayton, MD. Join us for what is certain to be an informative, entertaining, and provocative traipse through the menopause life-experience.

Committees, Food, Mentoring at the APA

It has been a busy, but fun time at the APA meeting and New Orleans. The meeting itself is a whirlwind of activities, academic presentations, business of the association, legislative advocacy issue, social activities, and networking. APA assembly work focused on how to address member concerns through action papers submitted by representatives from the district branches on topics such as healthcare reform, interactions with pharma, budgetary challenges of the APA among many others. While it is indeed “like sausage being made”, the activity is important to have the voice of the APA membership being heard and incorporated in the APA policy and activities. The committees such as the ones participated in such as the Scientific Program committee is where the annual meeting planning comes to fruition, and where we daily review how the meeting is going and hopefully learn from our successes and mistakes and plan for each days events.

One of the fun things I have done, other than the social activities and New Orleans food, has been to talk to medical students and trainees. I am optimistic about the future of our field. After talking to some of the speakers and audience members it seems there is a great demand for more space and time to discuss topics such suicide and SSRIs, and antipsychotic polypharmacy in interactive formats. The meeting has been off to a great start with some exciting sessions and activities coming up. We had the convocation of fellows Monday. Carrie Fisher (Princes Leia of Star Wars) was the scheduled be speaking. She is known to speak with humor and poignancy about her own experience wit h mental illness. Later this week also have Terry Bradshaw, the former Pittsburgh Steelers is going to be talking about his experience of depression at an event sponsored by the APA Foundation. For now, I am running out to the next event…………..

Iqbal “Ike” Ahmed, M.D.
Member, APA Scientific Program Committee
Deputy Rep, Hawaii

Career, Leadership, and Mentorship Development: Making it Our Priority

Hello to all the residents and early career psychiatrists!!! The annual APA meeting proves itself year after year to be the prime place for young psychiatrists to learn how the APA can be a vital resource for your growth as a physician. I speak personally from experience attending the annual meeting as a medical student, through residency, and now as an early career psychiatrist practicing out of Washington DC. Not only are the educational sessions unmatched, but the networking opportunities are profound. It is at our annual meeting that we connect with colleagues from across generations and from across the world to learn about the practice of psychiatry from a variety of perspective.

I encourage all of you to join the APA if you are not already a member. In addition, I strongly urge all of you residents and early career psychiatrists to get involved with the APA at the local level through your "district branch," your local APA organization. It is at the local level that you will be exposed to a variety of opportunities for leadership roles and mentorship possibilities. And it is at the local level where we better understand how we can have more of an impact in our field and for our patients. My involvement with the APA locally and nationally and my attendance at the annual meetings has fueled my career and my passion for psychiatry tremendously.

I hope to see you all in Hawaii for APA 2011!!!

Hind Benjelloun
Area 3 Early-career Psychiatrist Representative

New Research Poster: Tai Chi Benefits Depressed Older Adults

Use of Tai Chi, a mind-body exercise, in combination with antidepressants, provides additional improvements in older adults with depression, according to new research being presented at the American Psychiatric Association’s Annual Meeting.

Older adults with depression are at increased risk for decline in health functioning, morbidity and mortality, including suicide. Fewer than half of elderly depressed patients achieve remission and functional recovery in response to initial use of antidepressants alone.

Researchers Helen Lavretsky, M.D., M.S., and Michael Irwin, M.D. at UCLA studied a group of older adults with major depression and compared the use of an antidepressant combined with use of Tai-Chi-Chih (TCC, a brief standardized version of Tai Chi) to use of an antidepressant combined with a health education program. The older adults each participated in two hours per week of either Tai Chi or the health education program.

The new research poster was presented Monday, at the APA Annual Meeting in New Orleans.

The Tai Chi and health education participants demonstrated comparable improvement in the severity of depression. However, people in the Tai Chi group demonstrated significantly greater improvement in resilience, health-related quality of life, and cognitive function (memory, attention, and executive function).

Tai-Chi intervention has an advantage in that it is easily translatable to the community and can be readily implemented among adults with physical limitations. Researchers concluded that “complementary mind-body interventions can improve partial response to antidepressants via stress-reduction, improved physical functioning, increased socialization, and reduced risks of polypharmacy.”

New Research: Video Games and Aggression

Players of violent video games have significantly higher feelings of aggression and differences in brain activity during both cognitive motor activity and resting periods, according to research results to be presented by at the American Psychiatric Association’s Annual Meeting in New Orleans.

There has been increased interest in the influence violent video games on the behavior of players and recent research shows an increase in aggression due to the intensive use of first person shooter games (FPSG) but little is known about the influence of the games on the brain activity.

Researchers led by Gregor R Szycik, Ph.D., with Hannover Medical School in Hannover, Germany, investigated intensive use of first person shooter games on the brain function of young male adults, particularly looking at both the possible impact of such games on morphological and functional structure of the brain and its relation to processing cognitive tasks. Subjects had to complete questionnaires and underwent fMRI scanning while they relaxed.

The research poster (#NR3-12) was presented May 24 at the APA Annual Meeting in New Orleans.

The groups differed in the aggression scores, with the FPSG players showing significantly higher levels of felt aggression. The research also showed differences in brain activity during cognitive and motor resting periods between the FPSG users and the control group. “This frontal increase in DMN may indicate executive dysfunctions of FPSG users having influence on the high scores in the aggression questionnaire,” the researchers concluded.

In addition to Szycik other member of the research team included Bahram Mohammadi, M.D., Thomas F. Münte, M.D., Amir Samii, M.D., Wolfgang Dillo, M.D., and Bert T te Wildt, M.D.

If a Patient Googles Me, What Do They Find?

Technology is changing the way we practice psychiatry in many regards. There are electronic records, communication methods (email, blackberries), decision-support tools, databases and more. Furthermore, there is more information available publically, about professionals, than ever before. What does this mean for psychiatrists and psychiatric residents?

Today, the Group for the Advancement of Psychiatry conducted a workshop on the above topic to help attendees reflect on how they use email and how to manage information in the public sector that relates to clinical care. The first fictitious case presentation involved doctors and patients using email. There are several issues and some “rules-of-thumb about this:

  • We have to make sure the email is “secure” with encryption for privacy and confidentiality
  • According to the American Medical Informatics Association, emails are literally part of the official record, which means we (and patients) need to be mindful of the content
  • We and patients need to choose a mode of communication that best fits our goal: email for minor communication (e.g., scheduling appointments, offering a web site resource, to check in across time zones); telephone for brief discussions that need to go back and forth a bit (preferably not cell phones which are usually not private)
  • Timing is an important part of choosing the mode, as emergencies or immediate upcoming events are not best handled by email
  • Psychiatrists need to learn the pros and cons and then teach the residents, who are often more savvy with technology and who must adapt use of technology from personal to professional use—a big transition

Another key transition for us has to do with use of Facebook and this was the second fictitious case presentation at the workshop. A resident came to supervision bewildered that a patient had visited his Facebook page to join as a “friend”. Several issues arise and here are some “rules-of-thumb about this:

  • There are some headings to make some comments and pictures private on Facebook, though absolute privacy is not likely
  • Saying “no” to the request should be discussed with care to current and past patient experiences
  • As students and residents develop their professional careers, how should their Facebook be changed? For those in practice, should we have one?
  • Information out there about us (and patients) on Google, when discovered, should be openly discussed in the doctor-patient relationship

Overall, a few themes apply to both cases. There are generational differences that affect how we use technologies, as well as how we perceive their impact. Technology stretches the “frame” or context of the doctor-patient relationship, which used to be just in the office (other than incidental contacts). Technology accentuates the quantity and perhaps the complexity of doctor-patient relations. It is important for psychiatrists and residents to reflect on these issues in order to see what “works” depending on the context of clinical care and apply some of these “rules-of-thumb”.

Don Hilty, M.D.
Co-Chair, APA Scientific Program Committee
University of California, Davis

Medical Home Concept Discussed

The Trainee in Each of Us:

We physicians are intellectually curious creatures who engage in life-long learning. The APA Annual Meeting is an opportunity to exercise our intellectual curiosity as a necessary element of updating clinically meaningful skills. These skills can be translated into our own practices, and into the education of medical students, residents, and fellow trainees.

The Annual Meeting provides a myriad of topics of interest to attendees. Sessions trigger new ideas and challenge attendees to learn and think in new ways. Thus far, I have selected sessions as diverse as spirituality in psychiatry, CBT practice challenges, and most notably the newly emerging concept of the “medical home.” This multi-faceted concept refers to a clinical setting where patients receive comprehensive, coordinated healthcare, including mental healthcare. In this important era of healthcare analysis and reform, Dr. Eliot Sorel, along with Drs. Frank DeGruy and Michael Houston, provided an intellectually stimulating overview of the medical home goals and challenges. As noted in President-elect Carol Bernstein’s remarks in the opening session, this concept is of utmost importance as we aim to lead the way in healthcare, liaise with our medical colleagues, and provide the best in patient care.

Those of us attending this year’s Annual Meeting will undoubtedly use the knowledge gained in order to better ourselves and our clinical practices. This information also can serve as a springboard to discussion with our peers and medical students, residents, and fellows. In striving to be clinically competent, comprehensive, and caring, we must never underestimate the importance of remaining curious; that is, the importance of recognizing the trainee in each of us.

Jeanne Lackamp, M.D.
Assistant Professor of Psychiatry
University Hospitals/Case Medical Center, Cleveland, Ohio
Council on Adult Psychiatry, APA

Psychiatry's Place in the Medical Home

The MEDICAL HOME: Is there a place for Psychiatry in it? symposium “sold out”, standing room only !

Our Medical Home symposium was a smashing success with an overflow, standing room only audience from across the USA and overseas on Sunday, May 23rd, 2010 !

Drs. Frank de Gruy, Chairman of Family Medicine, University of Colorado, School of Medicine at Denver, Michael Houston, former WPS President, of Washington DC and I presented. Dr. De Gruy, focused on Primary Care Perspectives, Dr. Houston on Economic Factors, and I on Health Policy Implications.

A robust dialogue followed addressing liability, confidentiality, training, clinical outcomes, services management, sustainability, health policy, information technology and innovation. Several of the participants expressed the wish that our APA offer more educational choices on psychiatry & primary care integration in next year’s scientific program.The Assembly’s unanimous endorsement of our Psychiatry & Primary Care Integration position statement, hours before, and our Medical Home symposium were synergistic, complementary and contributed to a spirited participation both on the floor of the Assembly and in our symposium. To quote Dr. de Gruy, “Psychiatrists are gold” in the context of his primary care & psychiatry integration model, as we think in an integrative, biopsychosocial model, understand the nuances of human behavior and are trained to approach our patients in that wholistic model, thus be invaluable members of a psychiatry & primary care collaborative and/or integrated team.

By the way, the APA Assembly’s unanimous endorsement on Sunday May 23rd 2010, would not have been possible without the very generous support and guidance of Dr. Gary Weinstein, Immediate Past Speaker of the Assembly, Dr. Jack McIntyre, Former APA President and Former Speaker of the Assembly, many colleagues and friends of the APA Assembly, Ms. Margaret Dewar and other dedicated APA staff.


Eliot Sorel, MD, Washington Psychiatric Society, Position Statement lead author Psychiatry & Primary Care Integration across the Lifespan

Recommended Sessions

Two symposia at the APA Annual Meeting today are central to the future course of mental health care and psychiatric medicine. In the morning, a panel of researchers from the U.S. and U.K. that have been leaders in effectiveness research will participate in a session on (PS02) Comparative Effectiveness of Psychotropic Drugs: What Can We Learn From Practical Clinical Trials? in which they will present the latest results of comparative effectiveness studies in various disease areas including schizophrenia, bipolar disorder and depression in adult and pediatric populations. These studies reflect the growing need for data on the relative effectiveness of marketed treatments.

The second symposium, (S43) Early Detection and Intervention in Schizophrenia: An Idea Whose Time Has Come, will focus on the strategy of early detection and intervention in psychotic disorders. This model of intervention and service delivery promises to revolutionize the treatment of psychotic disorders and lead to higher rates of recovery and better treatment outcomes. An international group of investigators will present their latest findings which are paving the way for this new intervention strategy.

Jeffrey A. Lieberman, M.D.
Chairman, Department of Psychiatry,
College of Physicians and Surgeons, Columbia University Director, New York State

New Research Poster: Email for Identifying Depressed College Students

Researchers at Massachusetts General Hospital in Boston found that email can be a good screening tool for identifying college students with depression. The study results were reported Monday, May 24, at the American Psychiatric Association Annual Meeting in New Orleans.

Researchers emailed a test survey that included some demographic information and common screening questions for depression – the Patient Health Questionnaire 9-Item, known as PHQ9. Out of 631 participants, 82 (or 14 percent) were screened positive for major depressive disorder. Those students were informed of the results and offered links to online information about depression and local treatment resources. The students identified were also sent a follow up survey eight weeks later and found only eight of about 40 students who responded to the follow up had used the resources provided.

Researchers concluded email is an effective and inexpensive way to screen college students for depression, but simply offering online information had limited effects on students’ help-seeking behavior. The research, part of the Young Investigators' Poster Session, was presented by Irene Shyu, B.A., of the Depression Clinical and Research Program at Massachusetts General Hospital.

Write for information about an online press briefing on this research and five other topics to be presented live from the APA Annual Meeting at 9 am CDT on Tuesday, May 25.

Sunday, May 23, 2010

Psychiatry & Primary Care Integration Across the Lifespan

Colleagues & Friends-Greetings from New Orleans !

The action paper Psychiatry & Primary Care Integration Across the Lifespan was unanimously approved by our APA Assembly, earlier today, Sunday May 23rd, 2010!

A new day/era dawns for American Psychiatry, rekindling our solid roots in the House of Medicine. Many thanks to all who have worked with us on it over a two year span, since May 2008 when our original action paper was endorsed by our APA Assembly. Many thanks to Anita Everett, Roger Peele, Michael Houston, Catherine May, Hind Benjelloun & Kayla Pope and to all our colleagues in the Washington Psychiatric Society, Area III Council and the Council on Children, Adolescents and their Families who embraced our vision and supported our mission.Now the challenging work of implementation begins, first with a symposium this afternoon on The Medical Home: Is There a Place for Psychiatry in it?

Eliot Sorel, M.D., Washington Psychiatric Society

Saturday, May 22, 2010

Greetings from New Orleans

The APA meeting is a high point of the psychiatric year. My husband Harold and I arrived just this afternoon and already we have run into thirty or forty good friends and colleagues. Alan Schatzberg, his program committee, and the APA staff have made great improvements in the organization and content of the program. As usual, I can't possibly get to all the sessions I would love to attend. All the same, we are going to find time to enjoy some New Orleans cooking. I could do without the hot and steamy weather, but indoors I still need my jackets for the predictable air conditioning. In my experience, the hotter it is outside, the colder they make it inside. For the next four days, I'll be busy from seven in the morning until eleven in the evening. I'll be exhausted, but it will be worth it. In fact, while I'm here, I'll be registering for next year's meeting. Harold loves Honolulu.

Nada Stotland, M.D., MPH
APA President 2008-9

Nada L. Stotland, M.D., MPH, received a lei after registering for the 2011 APA Annual Meeting in Hawaii.

In New Orleans, the first 2,000 registrants for the APA meeting in Hawaii are presented with a lei. In addition to the garland of flowers, anyone who registers for the Hawaii meeting during the meeting in New Orleans gets to register at 2010 rates. The discounted Hawaii registration will close after the New Orleans meeting. 

Assembly Urges Restoration of State Funding

By Laurence H. Miller, M.D.
Assembly Representative, Arkansas
Chair, Assembly Committee on Public and Community Psychiatry
Member, Council on Healthcare Systems and Financing

The Assembly placed Action Paper 12.D, “Restoring State Department of Mental Health Funding,” on the consent calendar. The consent calendar is a mechanism used by many legislative bodies, including the APA Assembly, to save time by approving several actions at once. Placement on the consent calendar does not imply that an issue is not of prime interest or importance, but rather that it is perceived to be non-controversial, routine for information (perhaps to another component) or an administrative matter.

This Action Paper, authored by Stephen McLeod-Bryant, M.D., and Rahn Bailey, M.D., both of whom are Representatives of the Caucus of Black Psychiatrists. Dr. McLeod-Bryan, lead author, is from South Carolina where he previously served as medical director for the Department of Mental Health.

His Action Paper states:

“Whereas South Carolina has experienced a $6 million reduction in legislative appropriations for its Department of Mental Health while overall state appropriations have increased $777 million over the past decade…

“Whereas, this loss of funding has resulted in removal of inpatient psychiatric beds, closure of outpatient mental health clinics and layoffs of clinical mental health professionals exacerbating patient lengths of stay in emergency rooms, reducing access to evidenced-based psychosocial treatments and making more onerous the caseloads of psychiatrists treating the most persistently, seriously psychiatrically ill….

“Be it resolved that the Council of Healthcare Systems and Financing, in concert with the Assembly Committee of Public and Community Psychiatry, recommend a successful strategy, including consideration of legal action, to restore appropriate legislative funding of state department mental health budgets.”

This is a significant Action Paper since it is a crucial time for all state mental health authorities regarding budget cuts due to the downturn in the economy. The impact on patient care has been devastating with closure of many programs and layoffs of staff leaving many of the most seriously psychiatrically ill patients without the services needed to maintain recovery.

The APA, the professional organization for over 37,000 psychiatrists, is dedicated to improving patient care and, as such, has embraced this issue directly. All sectors of the APA will collaborate in developing a workplan. This will include the Council of Healthcare Systems and Financing, the Assembly Committee of Public and Community Psychiatry and the Transformational Leadership in Psychiatry program. We will also reach out to the American Association of Community Psychiatrists and the Medical Directors Council of the National Association of State Mental Health Program Directors (NASMHPD) in our efforts to develop strategies to protect the needs of our patients.

The Council of Healthcare Systems and Financing and the Assembly Committee of Public and Community Psychiatry have already developed a toolkit for state mental health associations to use in addressing the budget issues locally. All district branches have received this toolkit and many have begun to use it in addressing the impact of budget reductions.

District Branch presidents-elect will receive a brief presentation on these issues and the toolkit during their orientation session at the APA Annual Meeting to encourage newly elected DB leadership to embrace the work so far the APA leadership.

Content Tracks, New Schedule for APA's 'Crown Jewel'

This APA meeting in New Orleans has a number of firsts. A number of the core elements of this year’s APA Annual Meeting started on Saturday prior to the opening session. The meeting adjourns Wednesday evening. This schedule creates a tightly packed five-day immersion into psychiatry.

Specific content tracks represent another new development. Two important tracks are the track engaging the National Institute for Drug Abuse and a number of presentations on the evolving development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. This track offers members an opportunity to learn about DSM5 and to provide input into its development.

As Mel Sabshin might have said, it's a great start to APA’s Crown Jewel—the Annual Meeting.

Sidney Weissman, M.D.
Consultant and Former Chair, APA Program Committee

Aloha to Psychiatry

Aloha means the American Psychiatric Association is coming to Hawaii soon. The first 2,000 attendees in New Orleans to register for the 2011 meeting in Hawaii will receive leis, arranged by APA Assembly past-President Jeffrey Akaka, M.D. Dr. Akaka has been working since 1998 to bring the APA meeting to his home state of Hawaii. The association received a special message from Hawaii's U.S. Sen. Daniel K. Akaka, who is Dr. Akaka's uncle. In a letter to the APA Assembly, Sen. Akaka recognized the integral role psychiatrists play in the health care delivery system. "We share a committment to improving the quality and accessibility of mental health care," the senator said.

Daily Bulletin from New Orleans

The Daily Bulletin, the American Psychiatric Association's annual meeting newspaper, is available online. The Bulletin is published each day of the annual meeting. It includes news from the meeting, feature articles on researchers and the city, and changes to the program schedule. Read the Saturday/Sunday issue.

The Evolving Face of Psychiatry: Demons, Molecules, and Genes

By Barton J. Blinder, M.D, PhD
This year’s APA meeting, with its presentations of cutting-edge science and discussions about the many aspects of psychiatry has inspired me to reflect on the history of our field. For the past few years, I have had the pleasure and opportunity of teaching the history of psychiatry to our residents at the University of California-Irvine. The long historical struggle to change attitudes toward mental illness, from contempt, superstition and stigma to compassion, understanding and a true medical approach, has been hard-won and littered with pitfalls. The greatest deterrents to progress have come from theories of mental illness that failed to include the complexities of human development, the multiplicity of biopyschosocial factors, and the heterogeneous forces of culture and various spiritual traditions. As knowledge of mental illness progressed from the terror of supposed demon possession to the belief in a theory of bodily humors to the absurdity of mesmerism and phrenology and, in recent years, the parent-bashing of “refrigerator” mothers, we have often endured long periods of stagnation.

The era of asylums and state hospitals has given way to community-based psychiatry, which has been characterized by great accomplishments as well as continued challenges and disappointments. Advances in neuropharmacology have lessened the suffering from psychosis, mood disorders, anxiety, and cognitive impairments. Yet pharmaceutical treatments, for all their usefulness, have not eliminated the need to continue to address the mind and life of each patient in a comprehensive and truly effective manner. The need to integrate the autobiographical complexity of each patient, their adversities and strengths and their biological and genetic vulnerabilities into a meaningful diagnosis and treatment plan must continue to be a hallmark of our specialty.

Doing away with the mind-brain controversy and integrating psychotherapy with pharmacotherapy should be an important future goal. LeDoux (2002) has stated this eloquently, writing, “nature and nurture speak the same language--they both ultimately achieve their mental and behavioral effect by shaping the systematic organization of the brain. The particular pattern of synaptic connection in an individual’s brain and the information encoded by these connections are the keys to who the person is.” Achieving psychotherapeutic goals (gaining insight, experiencing emotional modulation and enjoying decreased conflict in interpersonal relations) depends on some degree of modification to the perceptions, memory, and emotions that work throughout and enduringly in the brain.

The rapidly progressing field of brain imaging studies may help define attentional and memory processes that are significant in human relationships. Brain imaging may also have important implications for the development of a science-based and rational psychotherapy. Combined medications and psychotherapy may drive change by promoting consolidation of the individual and combined effects on the underlying biology. Both negative stressors and positive changes in behavior can cause alterations in gene expression, which may produce structural changes in the brain. Brain imaging studies in the future may aid in diagnosing chronic states of conflict and may advance the practice of psychotherapy.

Even though we still have major challenges to overcome, our specialty has a very bright future. This means there is all the more reason to overcome the problems of access to care, the integration of psychiatry within the medical field, and adequate recognition and funding of our critical and effective care of patients.

Dr. Blinder is clinical professor from the Department of Psychiatry at University of California-Irvine.

LeDoux JE. The self: clues from the brain. Ann N Y Acad Sci. 2003;1001:295-304.

Blinder BJ. Psychodynamic Neurobiology. In: Beitman B, Blinder B, Thase M, Riba M, Safer D, eds. Integrating Psychotherapy andPharmacotherapy. New York, NY: Norton; 2003:161-180.

Blinder BJ. The Autobiographical Self: Who We Know and Who We Are. Psychiatric Annals 37:4. April 2007: 276-284.

Wednesday, May 19, 2010

Interactive DSM Session: Impact of Diagnostic Labels

An interactive workshop focusing on the impact of psychiatric terminology and diagnostic labels on patient care will be among eight sessions at the APA Annual Meeting related to the development of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders. Data collected in this session will inform decision-making in the DSM process. Other DSM-related sessions at the New Orleans meeting will include symposia on substance use disorders and developmental and intellectual disabilities and a three-part series of updates for DSM Work Group chairs.

Thursday, May 13, 2010

New Orleans is Ready for the APA

New Orleans is Ready for the APA by Dr. Ed Foulks from American Psychiatric Association.
The APA Annual Meeting is coming to New Orleans. Dr. Ed Foulks, an APA member and New Orleans native, talks about the city and assures attendees that the oil spill in the Gulf of Mexico will not affect their stay. The meeting will be May 22-26, 2010, in New Orleans. On-site registration begins May 21 at the Morial Convention Center.

Thursday, May 6, 2010

Preparing for Natural Disasters Addressed at Meeting

Preparing for and responding to natural disasters, including lessons learned from Hurricane Katrina, will be the focus of several sessions at the 2010 Annual Meeting in New Orleans, the city devastated by flooding that followed Katrina in 2005.

New Orleans psychiatrist Edward Foulks, M.D., Ph.D., says New Orleans residents had different reactions to Katrina. “Many people have major scars from Katrina and its aftermath. People with preexisting schizophrenia, bipolar disorder, or depression often developed PTSD. Some could not take [the hardships] and presented a clinical challenge to the system, but many people came out of the experience with a new role in life. It brought out the best in them.”

Disaster sessions at the annual meeting include a workshop on reorganizing the New Orleans health delivery system chaired by Elmore Rigamer, M.D., a workshop on disaster preparedness and rebuilding chaired by Erich Conrad, M.D., and a symposium on lessons learned from Katrina featuring Ronald C. Kessler, Ph.D., Kenneth Thompson, M.D., Anthony Speier, Ph.D., Howard J. Osofsky, M.D., and Joy D. Osofsky, Ph.D.

Learn more.

Wednesday, May 5, 2010

Advance Press Registration Closes May 14

Advanced online press registration for the APA Annual Meeting in New Orleans will close on May 14. Register now to ensure a spot. Press registration will be available on site in the APA News Room, room 211, at the Morial Convention Center starting at 11 a.m. on Saturday, May 22.  Press registration is limited to full-time working journalists who are covering the meeting for a news organization. Credentials and other evidence of status may be requested. Visit the APA Annual Meeting Online Press Room for details.

Carrie Fisher to Address APA Convocation

Carrie Fisher, who may be best known for her role as Princess Leia in “Star Wars,” for which she gained international recognition at the age of 19, will speak on Monday, May 24 at the Convocation during the American Psychiatric Association Annual Meeting in New Orleans.

Fisher has struggled with bipolar disorder, drug and alcohol addiction. She has written about her triumphs and travails in the autobiographical and semi-autobiographical best-selling novels Postcards from the Edge, Surrender the Pink, Wishful Drinking, and The Best Awful There Is. Fisher also wrote the screen play for the movie Postcards from the Edge, which starred Meryl Streep and Shirley MacLaine. She has recently completed a major run of her autobiographical one-woman play based on her novel Wishful Drinking.

Tuesday, May 4, 2010

DSM-5 Draft Criteria Featured in Sessions

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders will be featured in 12 sessions at the APA Annual Meeting. Updates will be provided by each of the workgroups developing DSM-5 through a series of three symposia. An interactive session will solicit opinions from attendees on a number of key questions on proposed criteria questions, terminology and diagnostic lables. Proposed inclusion of dimensional assessments in DSM-5 will be presented at a scientific and clinical report session, including an APA paper presented by lead author William E. Narrow, M.D., M.P.H., Task Force research director. See the press release for a listing of DSM-5 events.