|Winter 2013||Volume 4, Issue 4|
Greetings from the Newsletter Committee
Robin Reesal, MD, Newsletter Chair
Welcome to our Winter Newsletter, which focuses on the topics of child mental health and nicotine dependence.
We begin with a summary of this year's numerous events by Dr. Joanna Kowalik, the Society's President. The increased membership activity is a tribute to her leadership.
Dr. Jennifer Weller, a skilled researcher in Child Psychiatry, writes a practical and clinically relevant article on the utility of neuropsychological and psychological testing with children. Next, Dr. Bob Klaehn shares his years of experience and knowledge with an enlightening article on DSM-5 and eligibility for services from the Arizona Division of Developmental Disabilities. Dr. Joanna Kowalik's words in the Meet Fellow APS Members feature reveal that she is a high caliber psychiatrist who is committed to her family, the community, and her profession. Her success comes from years of hard work and dedication to others.
One of our residents, Dr. Mathew Goldenberg, displays his high-level of scholarship and initiative with his article on nicotine dependence and smoking cessation. His thoughts encourage an action oriented approach to this common problem.
There is a myriad of topics covered in the APA Assembly Report from Dr. Jay Bastani. Congratulations to him on having his action paper accepted by the APA assembly on establishing guidelines for interaction with caregivers. This document will be a useful tool and a topic for discussion at the next Kaffe Klatch in January 2014.
Throughout the Newsletter there is a host of informative sections. The areas covered include job opportunities, meeting announcements, APS executive committee news, disaster task force information, community options for smoking cessation, and APA resources.
Enjoy the Newsletter and tell a colleague about the APS.
On behalf of the Newsletter Committee, our Executive Director, and the APS Executive Committee, Happy Holidays!
2013 in Review and Highlights for 2014
By Joanna Kowalik, MD, MPH, President
Arizona Psychiatric Society
Dear Colleagues and Friends,
I hope you are doing well as we are entering this new holiday season for 2013.
This has been a very interesting, busy and productive year for the Arizona Psychiatric Society. I began my tenure as President of the APS after a very successful and well-attended APS Annual Meeting. We had excellent speakers, wonderful attendance, and after the meeting we received many constructive and enlightening comments. Through the year, we made every effort to incorporate these comments into practice.
Facing the constantly changing practice of psychiatry, in particular the release of a new DSM-5 in May 2013, we organized DSM-5 workshops to provide our mental health professionals but our members in particular, with a comprehensive and competitive educational option in our state. Those workshops were possible in part due to APA sponsorship, but most importantly our volunteer leaders. We are always grateful for those who are giving of their time and are committed to advancing our profession. Our gratitude goes to Drs. James McLoone and Ole Thienhaus for presenting "DSM 5: What you need to Know to Transition from DSM-IV". Those DSM 5 workshops in Phoenix, Tucson and Flagstaff were very well-attended and received. Rendering the feedback we received after those workshops, there is still an interest in additional workshops, and we have scheduled repeat offerings in Tucson (January 28, 2014) and Phoenix (February 8, 2014). See this Bulletin for more information on registering today.
We were pleased to offer a Fall Social event in each of Phoenix and Tucson to our members and even more delighted to see so many of you attending and participating. We are preparing another exciting social and educational event, sponsored together with PRMS, Inc., to be hosted in each of Tucson (January 29, 2014) and Phoenix (January 30, 2014), an interactive workshop on malpractice events called "What Would You Do If?" Save the dates, and stay tuned to learn more.
Thanks to Dr. Martin Kassell, APS members of all practice levels have been afforded the opportunity to come together and exchange experiences, viewpoints, and questions on psychiatric topics at the monthly Kaffe Klatch hosted at his home. This monthly opportunity for collegial connection continues in 2014 on the first Monday evening of the month.
The APS Education Committee is proud to announce that they have finalized the agenda and settings for the 2014 APS Annual Scientific Meeting. The theme for the incoming meeting is: "Changing the Practice and Perception of Psychiatry: Delivering Optimal Care in an Integrated Setting." Our special thanks to Dr. Ole Thienhaus for his exceptional speakers recommendations and active participation in planning the meeting and to the Arizona Chapter of Child and Adolescent Psychiatry for their collaboration. We are expecting very distinguished speakers who will focus on integrated care in the field of general and geriatric psychiatry, addiction, child psychiatry and other important fields. We are hoping all of our members will be able to join us at the event. The meeting will take place on Saturday, April 12, 2014, at the Wild Horse Pass Hotel, a beautiful establishment with great meeting facilities as well as endless possibilities for fun and adventures before or after the meeting. Please also plan to attend a Friday evening reception and social hosted by American Professional Agency, Inc. (which sponsorship is not reportable under the Sunshine Act).
APS and members of Executive Council recognize that our newsletter, website, programs, media communications, as well as other information outlets need constant enhancement to increase the visibility of our professional organization and provide more real-time information to you. Our special thanks to Dr. Robin Reesal for his meticulous job in preparing and publishing APS Newsletter. To assure more transparency, we are planning on visiting our residency training programs to introduce our new generation to our missions and values.
It is after Thanksgiving and the countdown to Christmas has begun. Wishing you a wonderful, healthy and joyful holiday season and a prosperous New Year 2014!
Visit the Job Board at www.azpsych.org
Check out the employ-ment and practice opportunities in this Newsletter and for the latest updates, visit the APS Job Board at www.azpsych.org
Scottsdale Area Adult and C&A Psychiatrist Opportunities
- Locum and permanent opportunities available
- 4-unit, 90-bed psychiatric center provides assessment/triage to patients
- Psychiatrists will be responsible only for their clinical preference or specialty unit
- Center admits approximately 15 patients per day
- Inpatient coverage needs Mon-Fri 8a-5p (weekend and part-time availability as well)
- Opportunities also available for consultative assessments
- Mid-level support includes nursing staff, social workers, therapists, and NPs
- Board certification and active Arizona license required
- Travel/lodging expenses reimbursement
- Medical malpractice insurance with tail coverage
- Credentialing assistance
Call 603-952-2590 or email email@example.com if interested. Please reference PSY23.
|DMG Psychiatrist Job Posting|
Desert Horizon Clinic
Desert Horizon is a Psychiatric Outpatient Clinic owned and operated by District Medical Group Inc. As a result of expansion, we have current vacancies for full-time Psychiatrists. The position, which will practice in collaboration with the physician/medical director, assumes clinical responsibility for tasks performed within a Psychiatrist's scope of practice.
Applicants must be Board Certified in Psychiatry or in the process of Board Certification and must be comfortable working as a part of a multidisciplinary team and using an electronic medical record.
DMG is a not-for-profit faculty practice plan owned and operated by physicians consisting of more than 350 providers who represent all the major medical and surgical specialties and sub specialties. DMG is the academic faculty practice plan for the University of Arizona College of Medicine (Phoenix) and is affiliated with the area's most comprehensive teaching hospital and medical center, Maricopa Medical Center.
DMG offers an outstanding work environment, competitive compensation plan/benefits package including relocation assistance, paid time off, CME allowance with paid time off and employer paid malpractice insurance.
For consideration, forward CV to DMG at firstname.lastname@example.org. EOE
|Part-Time Private Practice Opportunity|
Established outpatient psychiatric practice seeks part time psychiatrist, with possible advancement to full time. Referral sources well established. Scheduling, billing, and collections systems in place and fully functional. On-site nurse provides liaison between psychiatrist and clinical patients, and oversees medication refills. Forensic psychiatric opportunities available.
For questions, contact: Joel Parker, MD, 602-843-0035, email@example.com
|DSM-5 Workshops Offered Again in Tucson and Phoenix--By Popular Demand!|
|APS Members Receive a Discount on APA publications--Order your copy today at appi.org|
To afford our members an additional opportunity to attend the DSM-5 Workshops, we have scheduled two 2014 DSM-5 Workshops. If you were unable to attend before, don't mis your chance to register today to attend "DSM-5: What you Need to Know to Transition from DSM-IV," Jointly Sponsored by the American Psychiatric Association and the Arizona Psychiatric Society, offered at your choice of dates and times, in Tucson on Tuesday, January 28, 2014, from 12:45 p.m. to 5:00 p.m. (check-in beginning at 12:30 p.m.), and in Phoenix on Saturday, February 8, 2014, from 7:45 a.m. to 12:00 Noon (check-in beginning at 7:30 a.m.). The Arizona Psychiatric Society is pleased to offer this DSM-5 Workshop, with Dr. Ole Thienhaus (Tucson) and Dr. James McLoone (Phoenix) returning as Faculty. These APS members and educators represented APS as attendees to the invitation-only APA Annual Meeting Train-the-Trainer Session on DSM-5. The training materials used by Drs. Thienhaus and McLoone have been developed by Drs. Black, Kupfer and Regier. Dr. Black is the author of "Study Guide to DSM-5," and Drs. Kupfer and Regier are the editors of DSM-5.
Register today! APS Members attend for a low member rate of $30 for the workshop. Space is limited. For the full registration brochure, click here.
Direct registration link for the January 28, 2014 Tucson DSM-5 Workshop is at:
Direct registration link for the February 8, 2014 Phoenix DSM-5 Workshop is at:
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the Joint Sponsorship of the American Psychiatric Association (APA) and the Arizona Psychiatric Society. The APA is accredited by the ACCME to provide continuing medical education for physicians.
The American Psychiatric Association designates this live activity for a maximum of 4.0 AMA PRA Category 1 Credits ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
DSM-5 cover is reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright 2013). American Psychiatric Association.
Join us for the Winter Social "What Would You Do If?"
Tucson: January 29, 2014; Phoenix: January 30, 2014
| Sign-ups will be available soon for the Winter Social, in Tucson on January 29, 2014, and in Phoenix on January 30, 2014. The Winter Social will feature a member social time followed by dinner and interactive educational program, "What would You Do If..." Participants will pose their responses and analyze the same with respect to certain common, often distressing scenarios in psychiatric practice, including how to handle law enforcement demands to see patient records, high-profile cases, "Friend" requests from patients, and pharmacist reports of prescription alteration by patients, among others. Save the Dates! |
The Utility of Neuropsychological and Psychological Testing
|Jennifer Weller, Ph.D.|
Associate Research Director, Child Psychiatry
District Medical Group (DMG)/Maricopa Integrated Health System (MIHS)
Clinical Assistant Professor of Psychiatry, University of Arizona College of Medicine, Phoenix Campus
Neuropsychological and psychological evaluations can be valuable resources for the child/adolescent psychiatrist and the general psychiatrist. For psychiatrists constrained to brief patient visits, results of a comprehensive psychological evaluation can provide detailed information beyond the scope of what can be obtained during a typical appointment. Individuals of any age can be evaluated, but this article focuses primarily on psychological testing in youth. Questions addressed in this article include domains assessed by psychological evaluations, benefits of testing, when to refer youth for evaluations, ways to evaluate the quality of evaluations, and how to locate psychologists who provide assessments.
What domains of functioning are addressed by neuropsychological and psychological evaluations?
Neuropsychological evaluations are typically more thorough and informative than are psychological evaluations, require more time from the child and from collateral reporters, and assess cognitive functions as well as social and emotional functioning. Both types of evaluations are sought by psychiatrists, pediatricians, neurologists, and other medical professionals. These evaluations address questions ranging from differential diagnosis to which treatment approaches are most likely to be successful for the patient. Neuropsychological evaluations include assessment of constructs such as intellectual ability, academic achievement, specific learning disorders, cognitive functions (e.g., sustained attention, executive functioning, and memory), symptom frequency and intensity, temperament and/or personality features, social skills, and adaptive functioning. In contrast, psychological evaluations encompass some but not all of these areas; they do not usually extend to the assessment of cognitive functions beyond intelligence and achievement. Most evaluations include rating scales and forms that are completed by parents or caregivers, teachers, and/or the child or adolescent. Information from several reporters provides a multifaceted view of the individual being evaluated.
What are the benefits of neuropsychological and psychological assessment?
Although most caregivers are comfortable describing children's behavior both generally and with specific details, this information is by nature subjective and therefore subject to bias. Many rating scales provide an opportunity to determine if the reporter is responding in an overly negative, positive, inconsistent, or odd manner to items. Psychological testing using standardized measures can elicit objective, reliable data about the child's current functioning that can be used to educate parents, teachers, and other important people in the child's life. Results of these evaluations may suggest areas for treatment that have not yet been addressed. If caregivers are reluctant to accept a diagnosis or to consider medication interventions, results of a psychological evaluation may reveal information on which to base important treatment decisions.
When should you refer a child or adolescent for psychological or neuropsychological testing?
Many clinical situations benefit from referrals for psychological or neuropsychological evaluations. When medication or other therapeutic interventions have not been successful, psychological testing may provide insight into factors intrinsic to the child, the family, the school situation, and the greater environment that contribute to persistent or severe symptomatology. If a child has comorbid medical issues that could affect neurological and/or emotional functioning, or when others observe an abrupt or worsening set of symptoms or behavioral changes, psychological testing may elucidate reasons for the appearance of these problems. Further, test results may serve as a baseline measure against which data from future evaluations can be compared (e.g., after treatment is initiated). Children with a history of trauma often benefit from psychological evaluations, particularly if disruptive behaviors are masking underlying psychopathology or unidentified triggers. Other scenarios in which a psychological evaluation may be helpful include following a head injury, during or after major life stressors, following psychiatric hospitalization, or when social or emotional difficulties interfere with daily functioning. Schools may conduct tests of intelligence and academic achievement, as well as obtain information from parents and teachers, but do not include neuropsychological assessment. Frequently, in-depth evaluation of the child is required beyond what a school psychologist can provide. Particular academic transitions (e.g., grade school to high school, high school to college) cause many children and adolescents to struggle, even if they have managed to succeed in earlier grades without much difficulty. When such challenges arise, neuropsychological testing can shed light on the specific factors that are making it harder for the individual to keep up with the workload. Case managers may contact psychiatrists to request a referral for a psychological or neuropsychological evaluation; in these situations, it is vital that the psychiatrist be as specific as possible about the questions to be answered by psychological testing.
How do I determine if an evaluation is of reasonable quality?
High quality psychological and neuropsychological evaluations are performed by psychologists who utilize test instruments that are standardized, valid, reliable, and age-appropriate. The age of the child determines the selection of appropriate test measures. Evaluations should address the referral questions, and reports of findings should include test scores and their interpretation. The well trained evaluator will use multiple measures to assess constructs, rather than relying on just one test instrument to assess an area of cognition, psychiatric symptoms, or general functioning. Test results should be tied to specific and realistic interventions for medical and behavioral health providers involved with the child. Results should be presented in a format that is easy to understand.
Where do I find a psychologist who specializes in testing and fits the needs of my practice?
Some psychologists specialize in child assessment, some specialize in assessment of the elderly, and others evaluate individuals across the lifespan. Similarly, certain psychologists have expertise in evaluating youth with specific needs, such as those with neurodevelopmental disorders. The Arizona Psychological Association (www.azpa.org) maintains a list of psychologists by geographic location who provide psychological and neuropsychological assessment. Many psychiatrists prefer to ask trusted colleagues who they use for psychological evaluations. Insurance companies are becoming increasingly specific about what types of neuropsychological and psychological assessment they will reimburse for; therefore, it may be necessary for families to pay for part or all of the evaluation out of pocket. If your patient must use insurance, the most helpful approach is to contact the insurance company directly for a list of covered psychologists who provide neuropsychological or psychological assessment.
For more information, the author can be reached at firstname.lastname@example.org.
DSM-5 and Eligibility for Services from the Arizona Division of Developmental Disabilities
|Bob Klaehn, M.D. |
Medical Director, Arizona Division of Developmental Disabilities
Faculty, Maricopa Integrated Health Systems Child Psychiatry Fellowship
Board Certified in Adult and Child and Adolescent Psychiatry
The introduction of the DSM-5 this year has brought significant changes to the diagnoses of Autism (now Autism Spectrum Disorder) and Intellectual Disability (aka Intellectual Developmental Disorder or the diagnosis formerly known as Mental Retardation). This article will briefly summarize these changes and how they will impact eligibility for services from Arizona's Division of Developmental Disabilities.
The most widely used definition for Intellectual Disability was been developed by the American Association on Intellectual and Developmental Disabilities (AAIDD - formerly known as the American Association on Mental Retardation). The 11th edition of the AAIDD's Definition Manual (1) was released in 2010 and continues to require measurement of both IQ and adaptive functioning in order to make the diagnosis. The AAIDD's definition assigns severity of the Intellectual Disability (i.e. whether it is Mild, Moderate, Severe or Profound) based on IQ scores. The new DSM-5 definition, in contrast, focuses on the extent of impairment in adaptive functioning in order to assign severity. The Arizona Division of Developmental Disabilities has chosen to continue to use the AAIDD definitions for eligibility purposes.
Currently, the Division uses the DSM-IV (2) diagnostic criteria for Autism to determine eligibility. Statute and rule specifically exclude persons with Aspergers Disorder, Retts Disorder, Childhood Disintegrative Disorder and Pervasive Developmental Disorder, Not Otherwise Specified (PDD,NOS) from being eligible for DDD services. Our rules also require that the diagnosis be made by either a Psychiatrist, a Licensed Psychologist or a Developmental Pediatrician and their report document each of the DSM-IV diagnostic criteria for Autism that the individual meets. My advice to doctors has always been: when you are dictating or writing your report, have the DSM-IV criteria handy so that you can insure that the documentation the Division needs will be in the report!
In DSM-5 (3), the diagnosis of Autism Spectrum Disorder (ASD) replaces all of the DSM-IV Pervasive Developmental Disorders. The diagnostic criteria for Autism Spectrum Disorder requires that that there be evidence of "persistent deficits in social communication and social interaction across multiple contexts" in three areas:
* Social-emotional reciprocity
* Non-verbal communicative behaviors use for social interaction
* Developing, maintaining and understanding relationship
In addition, 2 out of 4 additional criteria in the area of "restricted repetitive patterns of behavior, interests or activities" must be present:
* Stereotyped or repetitive motor movements
* Insistence on sameness, inflexible adherence to routines
* Highly restricted, fixated interests that are abnormal in intensity and focus
* Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment
Many of these criteria will look familiar as they have been adapted from DSM-IV. However, there are two major changes for the DSM-5 diagnostic criteria for Autism Spectrum Disorder:
* Specific reference that the diagnostic criteria can either be present currently or are documented "by history"
* The "hyper- or hypo-reactivity to sensory input" criteria give a name to those "sensory issues" that are frequently a part of the presentation of persons with ASD.
The inclusion of the "reactivity to sensory input" criteria in DSM-5 also allows for their identification as a potential focus for treatment intervention, both with Occupational Therapy (focusing on Sensory Integration) and psychopharmacologic intervention (my clinical experience would indicate that Guanfacine may be of benefit in reducing hyper-reactivity to sensory input).
I have been asked many times since the introduction of the DSM-5 in May whether the Division of Developmental Disabilities intends to adopt the Autism Spectrum Disorder (ASD) criteria for eligibility purposes. The answer is yes, but implementation of that change will take time. Changing over from DSM-IV Autism criteria to DSM-5 ASD criteria will require changes to Arizona State Statutes and all statutory changes must be approved by the Legislature. It is difficult to predict when these changes will be put to a vote -- in the meantime, DDD will continue to use the DSM-IV criteria for Autism for eligibility for its services, so don't throw out your DSM-IV diagnostic manual yet! When the statutory changes have been approved, I will provide an announcement for the APS newletter. For any questions regarding eligibility requirement for DDD services, I can be reached at email@example.com.
1) Intellectual disability: definition, classification, and systems of supports (2010) Washington, DC: American Association on Intellectual and Developmental Disabilities.
2) American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association, 2000.
3) American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
|Meet Fellow APS Member and President: Joanna Kowalik, MD, MPH|
|Joanna Kowalik, MD, MPH
President, Arizona Psychiatric Society
Director of Medical Student Education in Psychiatry,
Maricopa Integrated Health System (MIHS)
Joanna Kowalik, MD, MPH, current President of Arizona Psychiatric Society, grew up in Poland and attended the Medical School at Jagiellonian University, one of the oldest universities in Europe. After graduation in 1994, she moved on to do a rotating Internship at the University Hospital in Krakow. She relocated to the United States in 1995. Challenged with the new country, new language and new healthcare environment, she decided to attend the University of Illinois in Chicago School of Public Health to learn more about the healthcare in the United States. She graduated with the degree of Master of Public Health in Health Policy and Administration in 2002.
In June 2003, Dr. Kowalik started her Psychiatry Residency at Maricopa Integrated Health System in Phoenix, Arizona. She chose the program to pursue her training at the institution serving the poor, underinsured, and those with severe mental illness. While pursuing her residency in psychiatry, she became interested in the developmental aspect of psychiatry which led her to choosing child and adolescent psychiatry as her future career path. She graduated from Child and Adolescent Psychiatry Fellowship at Maricopa Integrated Health in Phoenix in 2008.
Dr. Kowalik is board certified in both Psychiatry and Child and Adolescent Psychiatry. Upon her graduation, Dr. Kowalik joined the psychiatry and child psychiatry faculty at Maricopa Integrated Health System. She has worked in inpatient, outpatient setting, as well as a consulting psychiatrist at MIHS. Her clinical interests include psychosomatic medicine, especially in the area of child and adolescent psychiatry, but she also enjoys working with adult psychiatric patients. During those years in Consultation Liaison service, Dr. Kowalik worked hard to improve the clinical care for psychiatric patients in medical settings. She advocates for her patient regardless of their age, gender, culture, or socioeconomic status.
While very active in clinical practice, Dr. Kowalik is passionate about teaching and mentoring medical students, residents and child fellows. She is the Director of Medical Student Education in Psychiatry at MIHS. She has held the position since 2009 and has worked hard to improve the psychiatric experience for medical students from various universities. Dr. Kowalik also serves as outside Consultant for Arizona Medical Board.
Dr. Kowalik is married to Mark Harp, DO. They reside in North Central Phoenix. They share their home with two hyperactive, impulsive, furry friends, Sasha and Charlie. Those two friends are both rescue dogs who fill their home with joy and energy. Sasha, a Boxer mix, likes toys and Charlie, a German Shepard mix, loves toys and food, especially dog treats. All of them love hiking in the desert near North Mountain. Dr. Kowalik and her husband love traveling and their favorite destination is Hawaii. They love to swim, snorkel, and maybe one day will start diving as well.
Dr. Kowalik's interest in psychiatry began even before medical school but it wasn't until volunteering in clinical research while pursuing her Master of Public Health degree at University of Chicago in Illinois that she found her passion for helping those with mental illness. During those times she worked with people with developmental disabilities and elderly patients with dementia, some of the most vulnerable groups in psychiatry. Those experiences made her realize that reducing stigma surrounding mental health and prejudice directed towards people with mental illness are responsibilities of those who have the knowledge and opportunity to do it. Dr. Kowalik recognizes that her MPH in Health Policy and Administration combined with MD degree and training in psychiatry will give her the opportunity and possibly the power to do something about those heartbreaking issues.
For many years, physicians have been aware that psychiatric factors increase the risk of development and worsen outcomes of physical disorders. Furthermore, the high rate of psychiatric illness in various medical settings continues to be poorly recognized and managed. Practicing as Consultation Liaison Psychiatrist, Dr. Kowalik attempts to ensure that patients in medical-surgical settings receive the highest possible quality of care. Having clinical and administrative background, Dr. Kowalik understands that active participation in professional organizations and creating new guidelines and policies protecting the health of persons with psychiatric illness shall be an effort of every psychiatrist. She began working with Arizona Psychiatric Society in 2003 and became the Member-in-Training Representative. She shared her enthusiasm and beliefs with her colleagues and friends in her Psychiatry Residency program at MIHS. Under her leadership, the program joined the 100% Club of American Psychiatric Association. She continued on and currently serves as the President of APS.
Dr. Kowalik came to the United States with the curiosity to learn about a new language, culture, and country. She did not plan on her life and career so far away from her native Poland. She is thankful to all people she has met throughout those years. Her special recognitions go to the faculty and leadership of psychiatry and Child Psychiatry at MIHS, especially Drs. Carol Olson, Shayne Tomisato, and William James. She is also very grateful to Dr. James McLoone, for the guidance, leadership, and collaboration in the area of medical student education. She believes that every person you meet in your life brings a new experience and teaches you a little piece of their perspective on life. Those personal and professional experiences help us grow and develop emotionally to better serve those with psychiatric illness and prevent mental illness in those who are at risk.
|American Professional Agency, Inc. (Newsletter Advertisement)|
A Psychiatric Perspective on Nicotine Dependence and Smoking Cessation
|Matthew Goldenberg, DO |
Psychiatry Resident, PGY-III
Banner Good Samaritan Medical Center, Phoenix, Arizona
About one year ago, I began researching cigarette smoking and the impacts of nicotine dependence in preparation for my first Grand Rounds presentation at Banner Good Samaritan Medical Center where I am currently a third year Psychiatry Resident. My interest had long been with addiction psychiatry and I wanted to use that opportunity to research a topic that would be highly applicable to my patients. My goal was also to present useful data that my attendings, fellow residents and other members of our treatment team could use to improve patient care and treatment outcomes. Nicotine dependence (now included in the DSM-5 as Nicotine Use Disorder) and data related to smoking cessation became my area of focus. It is a highly topical area of medicine, as nicotine replacement therapy was provided by more psychiatric hospitals than any other treatment in both 2008 and 2011.(1)
There are three additionally important reasons that smoking cessation is such a critical topic and why I chose this area of research. First, despite knowing the risks and ongoing anti-smoking efforts, around 43.5 million American adults, or 21% of the population, continue to smoke cigarettes, according to data from the American Lung Association. In addition, individuals with psychiatric illness are about twice as likely to smoke cigarettes as the general population and consumed 45% of the total cigarettes smoked in the United States.(2)
Second, tobacco-related illness is now the leading cause of preventable and premature death in the U.S. and around the world. In 2008, the CDC reported that one in five deaths in the U.S. is attributable to tobacco and the average smoker will die at least 10 years earlier than non-smokers. As a benchmark, in the year 2000, the mortality rate of smoking-related illness surpassed the combined death total of HIV, illicit alcohol and drugs, suicide, murder and car accidents.(3)
Third, is the remarkable finding that health significantly improves after one quits smoking. In 2010, the U.S. Surgeon General reported that 10 years after quitting smoking the risk of developing lung cancer is cut in half. We also know that 15 years after quitting smoking the risk of coronary heart disease drops usually to that of a non-smoker.(4)
This data has motivated me, and should encourage all psychiatrists, to do more to help those at higher risk of smoking, including those with mental illness, lower socioeconomic status and co-morbid addictions. We must begin by making a commitment to screen all patients for smoking. In order to increase cessation rates and improve outcomes, we must also educate ourselves and our patients about smoking cessation treatment options and the perils of nicotine dependence. The next step is to formulate a treatment plan. The key is to collect a thorough history. Understanding what motivates your a patient to quit, if he or she has ever tried to quit before, and what aids have or have not worked in the past will help you determine the severity of you're a patient's nicotine dependence and choose between the various treatment options available.
My research has also yielded that our efforts can be highly effective. For example, in addition to pharmacotherapy, we can also offer group behavioral therapy and intensive physician advice which can all at least double quit and abstinence rates. Individual and telephone counseling can increase quit rates by 1.5 times and nursing and self-help interventions are better than none.5 Local and state agencies, including Arizona Smokers Help Line (ASH), can be helpful resources for outpatient follow-up.
Our patient population presents unique and inherent challenges; however, I believe we are up for this challenge. Patients with schizophrenia and/or mood and anxiety disorders will require more intensive interventions and possibly longer durations of treatment to achieve abstinence. We may also take heed that recorded quit rates of patients with psychiatric illness are similar to those of the general population, even though they smoke more cigarettes and smoke them more deeply.(6)
I have continued my research on smoking after presenting my initial findings and recently had the opportunity to share my research during Clinical Grand Rounds at Southwest Network. I have now focused on how smoking and smoking cessation specifically impact the quality of life of our patients. It has been an honor to work with Dr. Waguih Ishak and Dr. Itai Danovitch, of Cedars-Sinai Medical Center and David Geffen School of Medicine at UCLA, on an article we hope will be accepted for publication in the coming months. I will be presenting a poster of our critical review of the literature when the American Academy of Addiction Psychiatry comes to conference in Scottsdale, Arizona in December.
Each unique opportunity to engage and collaborate with colleagues on the very critical topics of nicotine dependence and smoking cessation has reinforced the importance of this area of field. I have concluded that doing nothing is more harmful than screening, educating and formulating a specialized smoking cessation treatment plan. I encourage everyone to take action as smoking continues to devastate the health and quality of life of our patients.
1. Ortiz G, Schacht L, Lane GM. Smoking cessation care in state-operated or state-supported psychiatric hospitals: from policy to practice. Psychiatr Serv. 2013 Jul 1;64(7):666-71.
2. Karen Lasser, MD; J. Wesley Boyd, MD, PhD; Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD; Danny McCormick, MD, MPH; David H. Bor, MD. Smoking and Mental Illness: A Population-Based Prevalence Study. JAMA. 2000;284(20):2606-2610.
3. Ali H. Mokdad, PhD; James S. Marks, MD, MPH; Donna F. Stroup, PhD, MSc; Julie L. Gerberding, MD, MPH. Actual Causes of Death in the United States, 2000. JAMA. 2004;291(10):1238-1245
4. Tobacco Control: Reversal of Risk After Quitting Smoking. IARC Handbooks of Cancer Prevention, Vol. 11. 2007. p 11
5. Lemmens V, Oenema A, Knut IK, Brug J. Effectiveness of smoking cessation interventions among adults: a systematic review of reviews. Eur J Cancer Prev. 2008 Nov;17(6):535-44.
6. El-Guebaly N, Cathcart J, Currie S, Brown D, Gloster S. Smoking cessation approaches for persons with mental illness or addictive disorders. Psychiatr Serv. 2002 Sep;53(9):1166-70.
|ASHLine - FREE Quit Tobacco Service in Arizona|
- The Arizona Smokers' Helpline, a FREE quit tobacco service.
- A program that began in 1995 and has received state tobacco tax funding since 1996.
- Supportive of the U.S. Public Health Service Guidelines which recommend quitlines as effective, evidence-based treatment for tobacco users.
Benefits to your clients:
- Quit-tobacco coaching over the telephone in English and Spanish, self-help materials, and interactive web-based quit programs.
- Coaching support in developing tobacco free lifestyles to meet individual needs.
- Medication assistance program.
Benefits to your practice:
- ASHLine technical assistance can be brought on site to implement the Ask, Advice, Refer model.
- Electronic feedback related to the enrollment status of the clients referred.
- Monthly program updates and client education materials at no cost.
HOW TO GET STARTED:
Follow the U.S. Public Health Service Guidelines and . . .
- ASK - about tobacco use at every visit.
- ADVISE - all tobacco users to quit.
- REFER - to evidence-based treatment programs, like ASHLine.
To start making referrals and set-up a WebQuit account, call 1-800-55-66-222 x 208 or visit www.ashline.org.
|PRMS Psychiatrists' Program (Newsletter Advertisement)|
|Nominating Committee Slate for 2014 Executive Officers|
The following members have been nominated as Executive Officers for 2014-2015, and will be presented for vote at the 2014 Annual Scientific Meeting:
Payam Sadr, MD - moves from President-Elect to President
Roland Segal, MD - President-Elect and Deputy Representative
Gurjot Marwah, MD - Vice President
Aaron Wilson, MD - Treasurer
Monica Taylor-Desir, MD - Secretary
Jasleen Chhatwal, MD and Matthew Goldenberg, DO - Co Members-in-Training Representatives
The term of Jay Bastani, MD, as Assembly Representative, continues through the conclusion of the APA Annual Meeting in 2015, as it is a two-year term.
Terms of office for the Arizona positions begin at the close of the Annual APA Meeting (May 2014) and end at the close of the 2013 Annual APA Meeting (May 2015).
The term of the APA Assembly Representative is for two years. Jehangir B. Bastani, MD, DLFAPA, automatically continues for an additional year as APA Assembly Representative, having been elected in 2013, and his tenure ends at the close of the 2015 Annual APA Meeting (May 2015). The term of the APA Deputy Representative is for one year.
The Society thanks each of these members for their leadership, and also thanks the members of the Nominating Committee for their service (Drs. Carol Olson, Gretchen Alexander, Elizabeth Kohlhepp, and Jack Potts).
Highlights from the APA Assembly Meeting (November 8-10, 2013)
|Jehangir (Jay) B. Bastani, MD, DLFAPA, Arizona APA Assembly Representative
Highlights from the Fall APA Assembly Meeting (November 8-10, 2013) are as follows:
- Saul Levin, APA Medical Director, gave his first Report before the Assembly. He wants his office easily accessible to membership concerns. He has been in his post for the past month.
- The Treasurer Report was a pleasant one showing there was a surplus of $25 million before factoring the DSM 5 revenues. The Annual meeting revenue exceeded projection by $1.8 million. Other savings are not filling vacancies as well as budget tightening. They have to recoup the expense of DSM-5 and do not see any problems as sales have been brisk. Item of interest: psychiatrist salary are 4th lowest nationwide averaging $218,000/- annually.
- Former Representative Patrick Kennedy gave an impressive speech that was taped for our APA membership on mental illness/substance use disorder and parity that is now the law. He used his late uncle, President Kennedy's Race for the Moon theme and spoke of psychiatrist as being astronauts. Another analogy given was the old AIDS theme of Secret= Death pertaining to non-treatment of mental illness that has to be widely published to prevent the fatalities from this illness. He shared his own experience of his asthma being treated with high cortisone but his family illness of MI being ignored. He shared a small item re: National Institute of Childhood Diseases being the brainchild of his aunt Eunice Shriver as his aunt Rosemary had Down's syndrome and a linkage to Alzheimer's disease came from NICD. He ended on "I am trying to bring political science to the field of Neuroscience."
- Reimbursement code is evolving and Dr. Ron Burd is planning on being in Phoenix in January 2014. He did give the analogy of MD visit + X-Ray where there are no 2 copays for psych office visits, patients being charged twice for 99203 + 90836. Web-site www.FairHealth.org has information re: Office Fees. It is patient focused.
- APA Board of Trustee HealthCare Reform Strategic Action Workgroup findings was presented by Howard Goldman MD. Focus on 3 areas of Integrated Care, Public Sector and Quality and Performance measures.
- APA Marketing Director Suzanne Shetty (firstname.lastname@example.org) presented about the website, newsletters including print version, email blast to be in constant contact with membership, starting a Blog, Facebook, Tweets (latter is more casual) and the DB Executive Directors to whom she had earlier spoken of these ideas.
- There was a public dialogue between the President-Elect of the APA, Dr. Paul Summergrad and the Speaker-Elect, Dr. Jenny Boyer of the APA Assembly setting out their plans and recent accomplishments. Dr. Carolyn Rabinowitz spoke of the APA delegates to the AMA who is increasingly being listened to in the AMA by chairing and serving on significant committees.
- Action Papers were once again presented on timely topics and the new electronic voting did allow time for a healthy discussion of Papers by the presenters and the reviewers before the Assembly. Some of these papers dealt with pressing issues such as the APA Workforce Initiative due to Obama Care (ACA) creating need for increased personnel and APA work with AMA to foster residency and medical school recruitment and training. It recommends further education and implementation of models of care compatible with ACA and its promise of expansion of access to psychiatric care. Other papers successfully passed were Nomenclature change from 'Member in Training' to 'Resident Fellow', CPT where data shall be collected on members experience with CPT Code-set, Establishment of incentives to encourage voting, VA Loan Forgiveness program, study of parity utilizing United Kingdom's Model, APA Referendum on voting procedures and Establishing Guidelines for interacting with Care Givers (your Representative was one of the active co-authors).
- Pertaining to the last Action Paper on Establishing Guidelines for Interacting with Caregivers, there are no guidelines for the psychiatrist and yet we realize the essential role that family members and other informal caregivers serve in the patients' lives. Other medical societies such as Society of Internal Medicine, American Academy of Academic Neurology have formally adopted ethical guidelines. Currently there are no guidelines of resource documents to help psychiatrists interact with care-givers of patients with psychiatric illness. The Action Paper was passed by the Assembly and forwarded to the Board of Trustees to direct a Work-Group which working with relevant APA Councils will:
(1) identify barriers to communication with caregivers of mentally ill persons,
(2) investigate clinical, ethical and legal problems unique to such communication; and
(3) develop resource documents to advocate and assist psychiatrist in their interaction with the caregivers.
The different Area Councils met three times between general body meetings to review Action Papers. During the last meeting they were canvassed by the below three Candidates for President-Elect and the successful candidate will become the President of APA in May 2015.
Rene Binder MD discussed her candidacy for President-Elect, emphasizing her awareness of area 7 concerns, and priorities of psychiatric access and payment in health reform efforts, retaining nearly members in the APA, and reasonable MOC standards.
James Nininger MD in announcing his reason for running for President-Elect were his ideas of a financially sound and membership responsive APA, and concerns regarding Scope of Practice, medical records privacy with the ACA regulations and strong liaisons with allied medical societies.
Dr. Mark Rappaport announced his candidacy for President-Elect discussing his priorities of operationalizing and implementing psychiatric parity, partnering with the ABPN to shape MOC criteria, increase membership, and create tools to permanently enhance communication and alignment within the APA.
|Disaster Psychiatry Task Force Underway!|
Thanks to those who volunteered to serve on the Disaster Psychiatry Task Force. At the invitation of Dr. Bastani, Dr. Aaron Wilson has agreed to Chair the Committee for the Arizona District Branch, and has begun by contacting local emergency response coordinators. With that information in hand, the first Task Force meetings will be scheduled. If you are interested in contributing to this important and timely effort, either by serving on the Task Force, or by indicating an interest in serving as a responder, please contact Teri (602-347-6903, email@example.com).
|Kaffe Klatch - Network, Socialize, Connect - First Mondays|
| Kaffe Klatch, the member discussion group gatherings open to all experience levels and interests in psychiatry, will continue in 2014, and are moving to the first Mondays of the month. The first Kaffe Klatch for the new year will be Monday, January 6, 2014, at 7:00 p.m., and will be hosted at the home of Dr. Martin Kassell. Dr. Bastani will lead the discussion on the topic of his recent collaborative on the Action Paper from the November Assembly on establishing guidelines for interacting with caregivers. For address information, please contact Teri (firstname.lastname@example.org), Dr. Kassell (email@example.com), Dr. Koster (firstname.lastname@example.org), or Dr. Goldenberg (email@example.com). Come out and connect--enjoy a pleasant social evening sharing experiences, interesting or unusual cases, and experiences.
|Educational Opportunities: Banner Grand Rounds, Women's Mental Health 2014|
|Banner Grand Rounds are on haitus for the month of December, but will resume on January 10, 2014, "Gender Dysphoria," Sasha Hamdami, MD, PGY-2 Psychiatry Resident, Banner, Medical Education Amphitheatre; no Grand Rounds on January 17, 2014; January 24, 2014, "Coming to Our Senses: Implications of Embodiment for the Pathogenesis and Treatment of Major Depression," Charles Raison, MD, University of Arizona COM (Medical Education Classroom C); and January 31, 2014, "Obesity and Serious Mental Illness," Alena Petty, DO, PGY-4 Psychiatry Resident, Banner, Medical Education Classroom C. Banner Grand Rounds are held from 12:00 Noon to 1:00 pm on the scheduled Fridays and in the educational space above, at Banner Good Samaritan Hospital, 1111 East McDowell Road, Phoenix, Arizona. For additional information regarding Banner Grand Rounds, CLICK HERE to view the flyer or visit the Arizona Psychiatric Society Education webpage. |
The Women's Mental Health Symposium provides high quality continuing education. Keynote speaker Charles Raison, MD, Associate Professor of Psychiatry and Integrative Mental Health at the University of Arizona, will present, "Coming to Our Senses: Rethinking Depression in Women and Children." His visionary work focuses on harnessing scientific understanding of the mind and body to enable us to enjoy happiness and health. He is the mental health expert for CNNhealth, works with the Dalai Lama on Cognitive-Based Compassion Therapy, and studies novel interventions for mental health.
A series of diverse breakout lectures follows. Dr. Raison kicks off a new track this
year, "Integrating a Pediatric Focus." This optional track covers mental health concerns of children, focused on adolescent girls, and integrative medicine options. Visit www.wmh.arizona.edu for updates.
|Save the Date--Annual Scientific Meeting - April 12, 2014|
| Save the Date for the Arizona Psychiatric Society Annual Spring Meeting on Saturday, April 12, 2014, with the theme "Changing the Practice and Perception of Psychiatry: Delivering Opitmal Care in an Integrated Setting." The tentative speaker agenda includes: "Alzheimer's Prevention: Pipedream or Possibility?," Pierre Tariot, MD; "Integrated Mental Health Care: Closing the Gap Between What We Know and What We Do," Anna Ratzliff, MD, PhD; "Mood Dysregulation in Children: What's Bipolar and What's Not," Steven R. Pliszka, MD; Legislative Update -Joseph F. Abate, Esq., APS Lobbyist; "Update from State of Arizona Division of Health Services - Behavioral Health Services." Steven Dingle, MS, MD; "Diagnostic Principles in Psychopharmacology" - Pedro L. Delgado, MD; "Pathopsychology of Alcohol Withdrawal: Novel Treatments Beyond Benzodiazepines." Josť R. Maldonado, MD, FAPM, FACFE; and "Palliative Care and Psychiatry: Providing Supportive Care to the Palliative Patient" - Karen Weihs, MD. Final details are being set for the Friday, April 11, 2014 social reception. Both the Annual Meeting and Friday Social Reception will be hosted at Wild Horse Pass Hotel & Casino. Wild Horse Pass is easy to access, located just off the I-10 at Wild Horse Pass Boulevard, and offers many opportunities for relaxation, dining, and shopping nearby. Discounted room rates will be available to Annual Meeting attendees. Plan ahead to come out and enjoy a relaxing weekend! |
|Maricopa County RBHA Contract Stay Lifted|
|In a recent Department of Administration decision, the DOA affirmed the November 19 recommendation of an Administrative Law Judge rejecting a protest filed by Magellan to the State of Arizona's decision to award the contract for behavioral health services in Maricopa County to Mercy Maricopa. With the DOA decision, Mercy Maricopa stated it "will be able to devote all our attention and resources" to launching a new model for behavioral health in Maricopa County in 2014. Magellan of Arizona has announced its intent to appeal the decision in Maricopa County Superior Court, and has further stated "Magellan continues to provide services to its members in Central Arizona without disruption." |
|APA Resources for You: Parity, PSA, CMS Reminder, HIPAA Compliance Manual|
MENTAL HEALTH PARITY: FINAL RULE
A significant step has been taken to the goal of undoing barriers to care for people with mental illness in the issuance of the Final Rule for the Mental Health Parity Act. See comments from APA President Jeffrey Lieberman, MD, and look for further analysis from the APA at www.psychiatry.org.
In many circumstances, the final law requires equal insurance coverage of medical/surgical services and mental health services.
HEALTHY MINDS MINUTE WITH FORMER CONGRESSMAN PATRICK KENNEDY
Former Congressman Patrick Kennedy extends his support to the advancement of mental health through a series of PSAs intended to raise awareness. The second in the series focuses on supporting military veterans and their families. http://www.psychiatry.org/mental-health/
HIPAA PRIVACY RULE MANUAL AND RESOURCES FREE BENEFIT TO APA MEMBERS
In October, APA released its updated HIPAA Privacy Rule Manual, a Guide for Psychiatric Practices. The manual includes step-by-step instructions, checklists, template forms, and patient notices, FAQs, a thorough explanation of the regulations, and cross-references to useful APA developed materials on issues including treatment of psychotherapy notes and "minimum necessary" disclosure standards. The manual is offered as a FREE benefit to only APA members. The manual, as well as other HIPAA resources, can be found at: http://www.psychiatry.org/hipaa/
CMS FILING REQUIRED BY DECEMBER 31ST TO AVOID 1.5% DEDUCTION ON MEDICARE CLAIMS
The APA Office of Healthcare Systems and Finance reminds you that to avoid having a 1.5% deduction on all your Medicare claims for 2015, all you need to do is file ONE claim with Medicare before December 31, 2013 that includes a G-code indicating a PQRS measure. For additional information, visit the APA ALERT at http://www.psychiatry.org/practice/managing-a-practice/medicare.
The Newsletter banner photo is a tree-lined view of the sky on a rare, snowy day in Arizona. If you have a seasonal Arizona landscape photo you would like to submit for the Newsletter banner, or if your e-mail or mailing address have recently changed, please contact Teri Harnisch (firstname.lastname@example.org, or 602-347-6903) to update the same.
If you are interested in contributing an article to the Newsletter or have a topic that you would like addressed, please contact us. The Spring Newsletter theme will incorporate the practice of psychiatry in the Native American community.
Have a wonderful holiday season! We hope to see you at one of the many upcoming Society events and hope you will plan now to attend the 2014 Annual Scientific Meeting!
APS Newsletter Committee: Robin Reesal, MD, Chair; Elizabeth Kohlhepp, MD, DFAPA; and Gretchen Alexander, MD.