DSM-5 Task Force Chair David Kupfer, M.D. Provides Updates

Study Looks at PTSD Risk Factors

National Guard troops who had some symptoms of posttraumatic stress disorder but not enough to receive a diagnosis before deployment were more vulnerable to PTSD when exposed to combat trauma than other troops, according to a new study released at the American Psychiatric Association Annual Meeting. Researchers found pre-deployment depression and alcohol dependence were not associated with an increased risk for PTSD.

The longitudinal study was scheduled for presentation Tuesday at the 164th American Psychiatric Association Annual Meeting, which is in Honolulu May 14-18.

Researchers from the University of Medicine and Dentistry, New Jersey, surveyed National Guard Members before and after deployment and compared pre-deployment and post-deployment data for 922 Guard members. The researchers looked at symptoms like intrusive memories, hyperarousal, and avoidance of stimuli associated with a trauma as well as for symptoms of depression and alcohol dependence.

When any of the PTSD symptoms were present prior to deployment, Guard members were at higher risk for a new onset of PTSD after exposure to combat trauma. Guard members screening positive for two out of three components prior to deployment had higher risk than those screen positive for one.

Despite the fact that depression and alcohol dependence frequently found with PTSD, neither was a risk factor in the study.

Women-Focused Sessions at 2011 APA Annual Meeting

Maternal Mental Health and Menopause Myths Addressed Next Month

Research has shown that nearly twice as many women as men are affected by a depressive or anxiety disorder. Sessions and workshops at the 2011 APA Annual Meeting in Honolulu will explore transitions in a woman’s reproductive life cycle linked to mood disorders and uncover ways to optimize overall mental well-being.

Sexuality and aging is one of several topics featured at the American Psychiatric Association’s 2011 Annual Meeting, when presenters examine moods, memory, and menopause. Related sessions look to debunk popular gender myths and identify effective treatments for depression, insomnia, and hot flashes. The APA’s 164th Annual Meeting, the world’s largest psychiatric meeting, will run Saturday, May 14, to Wednesday, May 18, 2011 in Honolulu at the Hawaii Convention Center.

Improving the mental health care of pregnant women and new mothers is another focus. Not always recognized as a mental health concern for women, posttraumatic stress disorder (PTSD) is acknowledged by some as an issue new moms can face following a traumatic birth. The presidential symposium on translating neuroscience for advancing PTSD prevention, which is scheduled for Monday, May 16, will include a presentation on treating maternal PTSD. Another Annual Meeting session on optimizing maternal care will present research on treating pregnant women with bipolar disorder.

Reproductive concerns will also be addressed in a series of sessions examining the psychiatric effects of infertility, abortion, miscarriage, and genetics on women’s mental health. Gisele Apter, M.D., Ph.D. will chair a presentation on how to identify and manage antenatal maternal mental health dilemmas. Presentations on prenatal and newborn genetic screening will highlight the ethical and legal challenges surrounding psychiatric and behavioral genetics.

Several sessions focus on women’s mental health and cancer diagnosis, including new research on the psychological impact of cancer diagnosed during pregnancy. David Spiegel, M.D. will lead a presentation on how a woman’s mood can predict her survival rate with metastatic breast cancer. Additional studies showing the link between the mental attitudes of breast cancer patients and their cellular immunity will be discussed.

Online advanced registration for journalists is open. Review the guidelines for press participation in the meeting.

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.

Reference:
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.

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.

MindGames Competition Challenges Psychiatric Resident Teams

Residents from three universities will compete and show off their knowledge of psychiatry in the live MindGames competition at the APA 2010 Annual Meeting.

MindGames is APA’s national residency team competition. It's a fun  educational activity that challenges the residents on patient care and medical knowledge. Over 90 psychiatry residency programs participated in the preliminary round for a chance to compete in the finals and take home the national trophy. Dr. Glen Gabbard, renowned psychiatrist and educator, will be the host.

The competition is Sunday, May 23, from 6 p.m. to 7 p.m. in Rooms 343-345 of the Morial Convention Center in New Orleans.