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President's Message
Payam Sadr, MD, FAPA
President, Arizona Psychiatric Society
Thanks to the leadership of the Planning Committee, with contributions from members of the Executive Council on educational topics and sponsorship contacts, the Arizona Psychiatric Society Annual Meeting to be held on April 18, 2015 at Scottsdale Resort & Conference Center promises to be a great event-both for education and collegial exchange. Take a good look at the high caliber local and national speakers and the variety of topics. We hope to have covered something for every psychiatrist in the array of early prevention and the benefits of the same. I hope to see you at the Annual Meeting and at the hosted Social and Awards Reception on Friday evening before, also at the Scottsdale Resort & Conference Center. REGISTER TODAY!At the Annual Meeting, we will be electing the 2015-2016 slate of officers. It has been my pleasure to serve as your President this year, alongside these fellow officers who have agreed to step up into the next Executive Office position, and also with the benefit of the many Society members who make contributions on the Council in the wide assortment of Committees. I join the Society in sharing thanks and recognition for their valued contributions to the leadership of the Society and advocacy for mental health in our community. Special thanks go to Dr. Mona Amini, who accepted the nomination to serve as Secretary, and to our new Resident/Fellow Member Co Representatives Drs. Aris Mosley and Jesse Reinking, who will all be new Executive Officers. In this year, Dr. Roland Segal has made great leadership contributions as President-Elect and APA Deputy Representative, and it will be my honor to have him succeed me as President. Lastly, but most certainly not least, the Arizona Psychiatric Society has been represented at the national level in the most professional and engaged manner by Dr. Jay Bastani, who has served as the APA Assembly Representative for Arizona since 2011. Dr. Bastani has been known to call his act of service "paying back" to our psychiatric profession; in the last four years, he has done that and more--making valued contributions to the Area 7 Assembly and the Assembly in the review of paper and policies, active Committee work, including Nomination Committee efforts at the national level, and the mindful representation of the Society and timely reports back to our membership on all things Assembly related. In accepting the nomination to serve as the APA Assembly Representative beginning after the APA Annual Meeting, I will be striving to meet those high standards established by Dr. Bastani and counting on his sage counsel and support. Thanks to the continued support from American Professional Agency, Inc., the Society is able to make the Friday reception available without charge to attendees (with cash bar available), and we hope you enjoy the opportunity to celebrate the accomplishments of the best among us as we make the formal award presentations during this event. To help control costs and save the planet, the Society is asking you to go electronic on the presentation hand-outs for the Annual Meeting. This will allow you to access the most current versions of the presentation through the weblink provided. The Society will continue to make paper copies available, but is simply asking that you confirm to us your wish to have those copies made, so that unnecessary copy charges will not be incurred, and would appreciate a $5 contribution onsite at the meeting to help with those photocopy charges. In these current times of legislative unrest, and for over twenty years preceding, which have included times of prosperity in Arizona and austerity, both, the Society had and continues to have the benefit of the professional representation and hard work of its Lobbyist, Joseph Abate, Esq. I want to be sure to take a moment to thank Joe for his valued contributions in representing the Society and advocating (and helping instruct all of us on grass roots advocacy) for the psychiatric profession and the behavioral health community. It has been my pleasure to work alongside Joe, and the Society looks forward to its continued association with him. Speaking for myself and the leadership of the Society, we are always looking for your feedback on what represents the most value to you in your membership. What type of events would you like to see, with what focus (education, CME, social), on what topics, and in what locations? What topics are most important to you at the State and national level both in terms of advocacy? What content do you most appreciate in our Newsletters, and what other services might we strive to provide to our members? We will be asking for your input in a brief needs assessment immediately following the Annual Meeting and hope to hear back from all APS members. At any time, we welcome you to e-mail ( [email protected]) or call (602-347-6903) the administrative office to share your thoughts with us. And on that closing note, I wish to thank Teri personally and on behalf of the Society for her contributions. She tells me it is her job and her pleasure. Thank you for a wonderful year. I hope to see you at the Annual Meeting for the opportunity to celebrate together our profession and our peers.
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Our members really enjoyed the time together at the Health Care Reform and Risk Management Considerations Workshops held in Tucson on March 11 at Lodge on the Desert and in Phoenix on March 12 at Tomaso's. Special thanks to Drs. Edward Gentile and Carol Olson, Arizona Psychiatric Society members and Arizona delegates to the ACA Training hosted by the APA, for their presentations on practice implications of the ACA, and to Kristen Lambert, Esq. of Allied World, guest faculty presenting on the risk management considerations of the ACA and integrated care delivery models.
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Shaping Memories: Clay Therapy in Rwanda
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Giulia Nervo, MA Medical Anthropology
Viateur Munderere, Art Therapist
Contact the authors at: [email protected]
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| | Rise and Shine Rwanda: Rwanda's way to deal with mental health issues |
Rwanda is a country generally known for the tragic events of 1994, in which the genocide perpetrated against Tutsis devastated the whole country, with permanent effects regarding physical issues and psychological distress and trauma among the entire population. I still recall the dusty small bar in a Kigali neighborhood, where for the first time Viateur Munderere, a young Rwandan man now in his thirties, narrated his story and his experiences of the genocide and its aftermath. As many Rwandans, he suffered the loss of almost all his family, becoming an orphan when very young and finding himself alone and having to shift from one house to another seeking care and support - but most importantly a reason to live. He struggled to find a meaning to the tragedy that surrounded him, experiencing severe trauma and distress, telling me that "when you lose the precious value of family and the love for being alive, you get stuck. So the only way to talk or to help someone with trauma is to be able to open your heart and your wounds and talk about things you can't even find words to explain. I didn't find words to tell anybody how painful it was to see those who killed my family still alive today".
He worked at the genocide memorial site in Kigali for several years, but being close to his family's gra ve affected and burdened him, to a point he couldn't work anymore. As he narrates, the society and family surrounding him wasn't able to handle his suffering and deep pain: so his odyssey began, made of several admissions into the only psychiatric hospital in the country, Ndera CARAES, and ending up in a rehabilitation island in lake Kivu named Iwawa, where youths who are thought to affect society are sent, in order to learn the cultural ethic.
Unlike other expressions of suffering, in the case of the drama experienced by the mentally ill, the choice of the pathway to care is an intimate, private value. However, it relates not to the patient but to the family itself, which becomes an advocate of the choices relating to care policies to be undertaken, depending on the will to heal, as well as the stigma that indelibly marks the life of the mentally ill and affects the choice of the therapeutic knowledge one can rely on. The vulnerable individual is therefore inserted - trapped - in a world of violence and coercion, which begins in a personal and intimate family context.  His only comfort and peace of mind, and the only way he managed "to heal his broken heart", came when he encountered clay therapy thanks to Sophia College therapists from Australia who came to visit Rwanda. Clay therapy, a tool used in psychotherapy and art therapy, is a powerful means to deal with trauma or distress; as Sholt and Gavron affirm: "clay-work involves body expression through the physical work with clay, and mental processes through the act of modelling and through observing the product. Thus it allows integration of emotions, memories, and fantasies from different levels of consciousness. The potential intensity of clay-work in bringing up unconscious material, and amplifying the personal meaning of a symbol indicates the hazards that lie in premature disclosure, especially in treatment of traumatic issues". (Sholt & Gavron, 2006: 71). After his healing experience with the clay therapy, Viateur became an art therapist himself, affirming that "it helped me to know the shape of my pain, it made me realize that I needed to clean out my torture chamber and brake the chains of pain and sorrow, so I could live in harmony and peace, for a better future". He further explained the clay therapy process, which is characterized by the responsiveness to human feelings, the expressiveness of the inexpressible, the tangibility of the intangible, the knowingness of the unknowable, the visibility of the invisible and the apprehensibility of the inapprehensible (Sherwood, 2004).  To be specific, the whole therapeutic process could be divided into three main stages, with breathing and laughter yoga exercises to warm people up and make them discover what are the emotions and feelings that affect their body and mind. After the breathing exercise, while all in a circle, they close their eyes and they step into what is called the torture chamber, where their pain and sorrow reside; they visualize the shape and the location of it in the body, then they step out, they get the clay and start to model it. The second stage consists in what the subject wishes, and the patient suggests qualities that they need so that they may be protected either from fear, anger, grief and loss, or self-parenting, to create a harmony with good memories. After finding the qualities, they go back to the circle and they breathe in those qualities, and then they step into the torture chamber to see how it is with those qualities inside. They then shape it in clay once again, positioning the end product close to the previous one. The third step is the resourcing part, especially for grief and loss and self-parenting, which consists in creating harmony through a symbolic ritual in order to invite the qualities of those who have been lost to enter your life. Viateur, after his turbulent history, has decided to dedicate his time and share his knowledge of clay therapy with the Ndera Psychiatric Hospital inpatients together with inpatients of the psychotherapeutic centre Icyizere in Kigali on a weekly basis, because he reckons that "counselling is maybe not sufficient because the more you talk about it, the more your soul drowns with it, then it surrounds you and you can't even get out". We now work together, volunteering in both institutions, and both inpatients and medical staff are enthusiastic about the therapy. A young girl at Icyizere Centre stressed that she really appreciated the clay therapy "because I had the possibility to shape my present, but also to see my ideas for the future, and wishes and hopes for the future".  Based on the positive reactions we have had and we are continuing to have, we are planning on opening a centre, the KIZA CENTRE, whose mission will be to raise awareness of the social stigma that affects vulnerable individuals suffering from trauma and/or psychological distress, deriving both from their own families and the society at large. Its aim will also be to promote the effective reintegration of the beneficiaries in the community and the families and stimulate both towards participation in the reintegration process itself. In order to promote this reintegration of the beneficiaries, our desire is to support them through several therapeutic possibilities, such as clay therapy, art therapy and psychotherapy, together with training sessions and workshops, e.g. English lessons, music lessons, art and crafts: non-conventional therapeutic intervention together with workshops and training that could help the beneficiaries to gain more self-esteem together with skills in order to build their future and therefore free themselves from social and family stigma.
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Meet Fellow APS Member: Mona Amini MD
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Mo  na Amini MD, MBA Arizona Psychiatric Society
Early Career Psychiatrist
Nominee for APS Secretary 2015-2016
Mona Amini, MD, MBA is an adult psychiatrist specializing in acute care and consultation-liaison psychiatry. She provides care at numerous psychiatric facilities and hospitals in the greater Phoenix Metropolitan area as an independent consultant. Her clinical duties are diverse including inpatient psychiatry, consultation psychiatry at large tertiary care centers, as well as dual-diagnosis psychiatry at rehabilitation facilities. Dr. Amini utilizes her training to treat patients in a biopsychosocial approach, with the understanding that all factors play a notable role in disease processes.
Upon entering medical school at St. Matthew's University School of Medicine, she knew that a career in psychiatry was in store for her. Her decision was clinched after becoming intrigued by the much ignored connection of physical complaints with addictive and/or mood disruptions. During her residency, amongst her many clinical experiences, one of her favorites was psychosomatic medicine. After completion of residency at Banner Good Samaritan Medical Center in Phoenix where she was awarded House Officer of the Year by the University of Arizona College of Medicine- Phoenix and served as Chief Resident in her last year, Dr. Amini completed an ECT certification fellowship at Duke University. Graduating off-cycle due to maternity leave, she began as an attending physician working with the severely mentally ill population in outpatient community clinical practice. As she desired to become an independent consultant, Dr. Amini gradually built her current profession as a sole proprietor in acute care and consultation-liaison psychiatry.
She has been involved with the APA since medical school, and has served on the Executive Council as a member of the AZ Psychiatric Society since 2011. Dr. Amini has also obtained numerous appointments in hospital advisory committees, bioethics committee, and has been published in numerous "Ask the Expert" columns as an advisor for the Arizona Republic.
Dr. Amini enjoys time with her physician husband and toddler son. Her interests include photography, design, and consumer electronic advancements. She owes a debt of gratitude to one of the most important individuals in her life, her husband, for providing unconditional support throughout her career as a student and physician.
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Gabriel's Angels (Pet Therapy for At-Risk Children)
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| | Therapy Dog "Sadie" and Friend |
Kristi Wisdom, MSW Gabriel's Angels Individual Intervention Specialist
Gabriel's Angels is a non-profit organization dedicated to improving the lives of children through interactions with animals. Our mission is to deliver healing pet therapy to at-risk children, nurturing their emotional development and enhancing the quality of their lives forever. In 2015, Gabriel's Angels will celebrate 15 years of creating partnerships that have positively impacted Arizona's children.
Gabriel's Angels serves children from birth to 18 at no cost to our agency partners through the generosity of our donors. We cultivate partnerships with organizations that provide a variety of services to children. Our agency partners range from domestic violence shelters, homeless shelters, group homes, residential treatment centers, and outpatient clinics to Head Start classrooms and classrooms for children with emotional/behavioral challenges. All children are served equally without regard to gender, ethnicity, or income level.
Our services are provided by volunteer Therapy Teams that are registered by a nationally recognized therapy animal organization. Currently we accept registered Therapy Teams from Pet Partners and Therapy Dogs, Inc. Each registered Therapy Team carries a minimum of $2 million dollars in liability coverage.
Gabriel's Angels has identified seven behaviors that are crucial to a child's healthy emotional development based on the research of Dr. Bruce Perry and other child development experts. We refer to these as the "Seven Core Behaviors" and provide training for our Therapy Teams explaining the behaviors and detailing activities to facilitate the development of these behaviors during their visits.
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| | Therapy Dog "Snickers" and Friend |
These seven core behaviors are:
1. Attachment (forming emotional bonds)
2. Affiliation (joining in activities, making friends, being part of a group)
3. Confidence (belief in oneself)
4. Empathy (recognize and appreciate what another person is feeling or experiencing)
5. Respect (for self and others)
6. Self-Regulation (control urges/emotions)
7. Tolerance (accept differences)
Gabriel's Angels offers its services through two distinct delivery systems. The first is our traditional model. This model is the heart and soul of our organization. We provide a Therapy Team to our partner agency to visit a designated group of children on a regular schedule, which is typically an hour visit two times per month. During these visits, a Therapy Team will use Animal Assisted Activities to interact with the children and to assist in developing the core behaviors.
The second model is the Individual Intervention Program ("IIP"). This program was designed for children that require more individualized attention and is delivered in conjunction with the child's mental health professional at the partner agency. IIP is a clinical intervention that employs Animal Assisted Therapy ("AAT").
Pet Partners defines AAT in its Standards of Practice for Animal-Assisted Activities and Therapy as "...a goal-directed intervention in which an animal that meets specific criteria is an integral part of the treatment process. AAT is directed and/or delivered by a health/human service professional with specialized expertise, and within the scope of practice of his/her profession. AAT is designed to promote improvement in human physical, social, emotional, and/or cognitive functioning [cognitive functioning refers to thinking and intellectual skills]. AAT is provided in a variety of settings and may be group or individual in nature. This process is documented and evaluated."
The clinician makes a referral to Gabriel's Angels, obtains parent/guardian consent to participate in IIP, and adds the intervention to the treatment plan or individual education plan. As Gabriel's Angels' Individual Intervention Specialist, I work with the clinician to highlight specific treatment goals for each child and then identify a Therapy Team to work with the child. The next step is to arrange a meeting between the agency clinician and the Therapy Team to further discuss the child's history and to set goals for the sessions.
After a Therapy Team has met with the clinician, the Team will attend the child's sessions. The clinician will always manage his/her sessions incorporating the Therapy Team during the therapeutic process as appropriate. Children referred to IIP have regularly scheduled, weekly sessions with their clinician and the Therapy Team for an average of 10-12 weeks. Gabriel's Angels also works with the clinician to obtain pre and post-test data.
Gabriel's Angels Individual Intervention Program is rooted in AAT theory, which is predicated on the instinctual connection between humans and animals. Working with an animal provides many physiological benefits that are well-researched including reduced heart rate and blood pressure, reduced anxiety, and increased feelings of safety, all of which may encourage a calm and productive therapeutic session.
If you are interested in learning how Gabriel's Angels Therapy Teams may be able to assist your organization, please contact Kristi Wisdom, MSW at [email protected] or 602.266.0875 ext.14. Website: www.gabrielsangels.org.
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INTENSIVE TREATMENT SYSTEMS OF ARIZONA SEEKS MEDICAL DIRECTOR
Pay is negotiable. Hours are flexible. Must be available for at least 24 hours per week part-time with option to increase to full-time. CLICK HERE for a detailed job description. CONTACT Teresa Riza, Human Resources Director, to apply (602-721-9683 or [email protected]).
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APS Lobbyist
CLICK HERE for the viewable or printable Legislative Report for the Fifty-Second Legislature, First Regular Session (2015), including those bill summaries with the most relevance to the practice of psychiatry that have been presented thus far. The bill summaries and histories are copyrighted by Arizona Capitol Reports, L.L.C.
The following is are excerpts from the full Legislative Report, highlighting bills of particular interest within that report. If you would like additional information, please contact the APS Lobbyist, Joe Abate, at 602-393-1700. If you are interested in being part of the Legislative Committee of APS, chaired by Dr. Carol Olson, please contact [email protected].
H2645: LAB TESTING WITHOUT PHYSICIAN ORDER
A person is permitted to obtain any laboratory test without a physician's request or written authorization. For tests conducted not at the request or authorization of a physician, the test results must be reported to the person with a statement that it is the person's responsibility to arrange with a physician for consultation and interpretation of the test results. Does not require that a laboratory test be covered by a health insurance plan or product or by any AHCCCS program.
2/11 referred to House hel. At 3/19, awaiting Senate COW.
S1012: OSTEOPATHIC BOARD; LICENSURE; REGULATION
Various changes related to the Board of Osteopathic Examiners, including modifying the requirements for a person to qualify for a training permit to participate in a teaching hospital's accredited program, authorizing the Board to require applicants for various licenses to submit to a personal interview or health evaluation, authorizing the Board to issue pro bono registrations to allow a doctor of osteopathy to practice in Arizona for a total of 60 days each
calendar year and establishing requirements for pro bono registration. AS PASSED SENATE.
2/9 passed Senate 25-4; ready for House. At 3/19, passed House COW.
S1040: CHIROPRACTIC; LIMITED PHARMACOLOGY CERTIFICATION; REQS
Board of Chiropractic Examiners applicants who wish to be certified in pharmacology to prescribe prescription-strength dosages of ibuprofen, naproxen, methocarbomol and cyclobenzaphrine are required to submit to the Board documentation of successful completion of an unspecified number of hours (blank in original) of study in pharmacology at an accredited chiropractic college, documentation of successful completion of a rotation that includes an unspecified number of hours (blank in original) under the supervision of a licensed medical or osteopathic physician, a completed Board-prescribed application, and documentation of having passed a Board-approved pharmacology examination.
2/4 Senate hel-hu ser held. ArMA, AOMA, and other physician groups actively opposed this legislation and its failure to follow the Sunrise process. Bill is currently dead; could attempt to re-introduce as a striker amendment. At 3/19, no change in status.
S1092: AHCCCS; ANNUAL WAIVER SUBMITTALS
By March 30 of each year, the AHCCCS Director is required to apply to the Centers for Medicare and Medicaid Services for waivers or amendments to the current section 1115 waiver to allow Arizona to institute a work requirement for all "able-bodied" (defined) adults receiving AHCCCS services, place a lifetime limit of five years of benefits on able-bodied adults except in specified conditions, and develop and impose meaningful copayments to deter the nonemergency use of emergency departments and the use of ambulance services for nonemergency transportation or when it is not medically necessary. By April 1 of each year, the Director is required to submit a letter confirming the submission of the waiver requests to the Governor and the Legislature.
2/12 from Senate hel-hu ser with amend #4159. Same as HB2075. Signed by Governor.
S1149: AZ MEDICAL BOARD; FINGERPRINTING; DISCLOSURE
The profile of Arizona Medical Board licensees that is available to the public on an internet website is prohibited from containing any information received from the Federal Bureau of Investigation relating to a federal criminal records check. The requirement for Board licensees renewing a license for the first time on or after September 2, 2014 to submit a full set of fingerprints to the Board for the purpose of obtaining a state and federal criminal records check is eliminated, retroactive to September 2, 2014. Applies to all renewal applications that are currently under consideration by the Board. Makes a supplemental appropriation of $200,000 from the Arizona Medical Board Fund in FY2014-15 to the Board to refund fees collected by the Board to obtain criminal records checks for renewal applications. Emergency clause. AS PASSED SENATE.
2/12 substituted in House for identical H2521 and passed 58-0; ready for governor. Signed by Governor.
S1194: MEDICALLY UNDERSERVED AREAS; LOAN REPAYMENT
Expands the medical providers eligible to participate in the Primary Care Provider Loan
Repayment Program (Primary Care Provider Program) and the Rural Private Primary Care
Provider Loan Repayment Program (Rural Private Practice Program).
Went to Governor already; covers HB2495. Signed by Governor.
S1370: CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM
Various changes related to the Controlled Substances Prescription Monitoring Program, including repealing the statutory termination date of July 1, 2017 for the Program. A "medical practitioner regulatory board" (defined) is required to monthly notify the State Board of Pharmacy of any initial licensures for medical practitioners who intend to apply for registration under the federal Controlled Substances Act and licensure renewals for medical practitioners. On receipt of this information, the Board is required to register each practitioner, provide the practitioner access to the Program's central database tracking system and notify the practitioner of the registration and access. The list of persons the Board may release information from the Program to is expanded to include county medical examiners, forensic pathologists and medical death investigators who are involved with a death investigation. By July 1, 2016 and for two years following that date, the Board is required to report specified information about the Program tracking system to the Governor and the Legislature. Effective January 1, 2016.
2/12 from Senate hel-hu ser with amend #4157. As of 3/19, sent to Governor.
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Call for ArMA House of Delegates
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The Arizona Medical Association is a strong partner to the Arizona Psychiatric Society and leads state-wide efforts on behalf of physicians from all specialties in support of needed legislation and/or in opposition to legislation or regulation that is against the interests of the medical profession and the communities it serves. You can help the Arizona Psychiatric Society have a voice in Arizona medicine! If you are a current member of the Arizona Medical Association, or if you are able to join without delay, you can volunteer to serve with Dr. Brian Espinoza as a delegate to the Arizona Medical Association House of Delegates, a two-day session held on May 29-30, 2015 at the ArMA Offices in Phoenix. Delegates from all specialties and all communities in Arizona gather together to caucus and adopt resolutions for presentation to the AMA, the State Legislature, or other regulatory agencies. Contact Teri ([email protected], 602-347-6903) if you are able to serve!
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Report from Area 7 Assembly
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 Roland Segal, MD, FAPA
President-Elect, Arizona Psychiatric Society
Deputy APA Assembly Representative
On February 28, 2015 and March 1, 2015, the Area 7 APA Meeting took place in Boise, Idaho. Area 7 representatives and deputy representatives from Arizona, Alaska, New Mexico, Colorado, Oregon, Utah, Hawaii, Idaho, Washington, Wyoming, Montana, Nevada and West Canada were joined by the current Speaker of the Assembly, Speaker-Elect of the Assembly, Recorder of the Assembly, and several candidates for these positions.
The American Psychiatric Association represents over 36,000 members. Federally APA is focusing on several bills and issues including advocacy for the Veteran Suicide Bill, Murphy Bill, new policy relating to Sustainable Growth Rate, and loan repayment programs for psychiatrist working in rural areas and for government agencies including the Veteran Affairs and Indian Health Services.
At the APA Assembly level there is significant movement in changing the structure of representation. The idea is to change titles of deputy-representatives to full titled representatives. The Arizona Psychiatric Society (APS) had 467 members and that currently entitles APS to one representative and one deputy-representative (the more members that are enrolled with a local state society, the more representation the state has). A deputy-representative does not have a vote at the APA Assembly. The proposed change will allow APS to have two votes (vs. one now). In relation to Area 7 as a whole, this is quite favorable, because approximately 9% of APA members live in Area 7. The proposed change will allow approximately 14% vote at the APA Assembly. Thus, Area 7 is supportive of this reorganization
Maintenance of Certification is a hot topic. The APA Board members (the President, President-Elect, and the Speaker of the Assembly) feel strongly that the first three parts (Professional Standing, Self-Assessment and Continued Medical Education, and Cognitive Expertise/Getting certified) is sufficient in assuring that psychiatrists are staying up to date. The APA Board members feel that there is no evidence that the PIP (Performance in Practice) improve psychiatrist's knowledge or quality of patient care. In fact, PIP is very time consuming with no return. The APA Board met with ABPN to have this discussion. During the APA 2015 meeting, the Assembly will take a vote, and Area 7 will vote against the PIP.*
Scope of Practice issues were also on the forefront of the Area 7 meeting. Dr. Charles Price, Chairman of APA Political Action Committee, motioned to ask the APA for additional recourses to assist individual states with legislative issues, and this was supported by Area 7 representatives. Matt Sturm, APA Deputy Director for Government Relations, indicated that his office is working on organizing data to help states with lobbying. The plan is to gather and organize data that can be used to argue pros and cons, and to provide alternative solutions to issues such as access and treatment in rural areas. The general direction appeared to be toward a "yes," with restrictions comparable to Illinois. Also the direction is to use anecdotes and vignettes as examples to legislators of medical cases that present as psychiatric cases.
Other topics that were discussed during the meeting include restraint of patients for unnecessary transport (i.e. hearings that could take place within the hospital) from a psychiatric hospital to a civil commitment hearing (done for convenience of the trier-of-fact). Also we discussed legalized marijuana issues, membership involvement and expansion.
*On March 17, 2015, the APA reported that APA President Paul Summergrad, M.D., and CEO and Medical Director Saul Levin, M.D., M.P.A., have recommended to the American Board of Psychiatry and Neurology (ABPN) that Part 4 of the Maintenance of Certification (MOC) Program be eliminated. Part 4 is the "Improvement in Medical Practice" section, also known as Performance in Practice, or PIP. For the full text of the Psychiatric News Alert, CLICK HERE. |
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Report from Advances in Neurological Therapeutics 2014
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 Advances in Neurological Therapeutics 2014, Cleveland ClinicLas Vegas, Nevada
Brian Espinoza, MD
Interventional Psychiatry
I attended this annual Neurology Conference which is a very nicely put together one-day summary of some of the advances being made by our colleagues in Neurology.
There was even a presentation on the Treatment of Mood Disorders in Neurological Diseases.
Please read on:
Multiple Sclerosis & Neurological Repair: There are currently 11 FDA approved drugs that reduce nerve cell inflammation during Multiple Sclerosis. However Cortical Remyelination, that is, the regeneration of the the cells that lay down protective insulation to damaged nerve cells from MS has been shown to occur into the 8th decade of life. So a new target for MS treatment will likely be "remyelinating therapies" that promote this process, in addition to the current target of "inflammation".
Parkinson's Disease in 2014: More than just tremors and dopamine: Besides the classic motor symptoms, there are Nonmotor Symptoms (NMS) such as psychiatric, autonomic, sensory, and sleep issues as part of Parkinson's Disease (PD). These include depression, anxiety, apathy, fatigue, impaired memory, dementia, psychosis, drops in blood pressure when standing up, sexual dysfunction, constipation, nausea, drooling, excessive sweating, and REM sleep disorders.
Some interesting observations:
- Constipation is the most frequent NMS (>60% of PD) and can occur years before PD is diagnosed.
- PD patients have the highest rates of depression by age for any disease (50%).
- Fatigue is the top cause for medical disability insurance claims in PD.
- PD patients are at a 5 times greater risk of developing dementia.
Some points on treatments:
- Rivastigmine (Exelon) is FDA approved for Parkinson's Dementia.
- Clozapine (Clozaril), an antipsychotic developed in Psychiatry, remains the Gold Standard in treating PD psychosis.
- I posed the question about using ECT (Electroconvulsive Therapy) in PD. The speaker concurred that ECT is highly effective for Motor and several Nonmotor Symptoms of PD, and was concerned about its relative lack of availability.
Updates in Deep Brain Stimulation (DBS):
The Neurosurgical implantation of electrodes into certain areas deep in the brain is an established treatment for Parkinson's Disease, Essential Tremors and other Movement Disorders.
Some DBS innovations include:
- Frameless DBS: Instead of the ominous steel frames that are used to keep the patient's head fixed down and motionless (the patient is awake during surgery), a much smaller frame, much like a cap, is computer designed, manufactured by 3D printing, and affixed to the patient's head, and much less cumbersome than Frame Based DBS.
- IMRIS (Intraoperative MRI Suite): This allows immediate visualization of the electrode placement and greater anatomical precision.
Future Directions in DBS:
- Shaped field stimulation: This is through the use of Biomedical Engineering, altering the electrical field to better target the abnormality of the disease. In Psychiatry, we are studying this for Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS).
- Closed loop DBS: Here, the electrodes sense changes in neurotransmitter levels and provide stimulation only when needed.
Updates in Cognitive Assessments: One of the highlights of this section was referencing the recent study suggesting that the video game, Portal 2, improved Cognitive Testing scores more than the brain training program, Lumosity.
The Role of New Medications in the Treatment of Mood Disorders in Neurological Diseases: Besides the currently available Psychiatric Medications here are some developing horizons:
- Dextromethorphan/quinidine (NueDexta), currently approved for Pseudobulbar Affect (extreme emotional instability) is being studied for agitation in Alzheimer's disease and disinhibition in other neurologic disease.
- Pimavanserin, appears to be effective in Parkinson's Disease psychosis. What is interesting about this antipsychotic is that it works exclusively in the Serotonin regions, without any effect on the Dopamine areas like all previous antipsychotics. It may prove useful in psychosis associated with other dementias, and even Bipolar mania.
- Several antidepressants are in in Study Trials for apathy, insomnia, and agitation associated with Dementia.
Advances in Stroke Management: It was not too long ago that not much could be done to prevent or treat Strokes.
Fortunately, that has changed with intriguing advancements:
- IV t-PA (Tissue Plasiminogen Activator; i.e. "clot buster") is an effective treatment for a stroke, and the motto is "Time is Brain!", as it is estimated the we lose 1.9 million brain cells, 14 billion brain connections, and 3 weeks of life every minute that a stroke is taking place. The Germans, and now, The Cleveland Clinic has a Mobile Stroke Treatment Unit, essentially a "Stroke Ambulance" that has a CT scanner, and can initiate treatment at the scene via Telemedicine.
I thought that it was interesting that the Stroke Ambulance pays for itself after treating 8 patients, as it reduces time spent in the hospital recovering.
- In patients with atrial fibrillation, the new anticoagulant agent, apixaban (Eliquis) was more effective than the old standby Coumadin (Warfarin) in preventing stroke, caused less bleeding, and lower mortality rates.
- Proper management of Hypertension, and aggressive treatment of High Cholesterol have been shown to reduce the risk of stroke, guideline recommendations on this have been recently published.
Psychiatry and Neurology are both sciences of The Brain, and it is important to keep updated on what is happening in the field of Neurology. I hope this was informative you.
Next report: The Nevada Psychiatric Association 20th Annual Psychopharmacology Update, February 11-15th, the nation's largest Psychopharmacology Conference.
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APS Annual Meeting; Local CME; PCSS
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REGISTER TODAY for the Arizona Psychiatric Society Annual Meeting, Saturday, April 18, 2015, at Scottsdale Resort & Conference Center, 7700 East McCormick Parkway, Scottsdale, 85258 ( meeting brochure attached for additional details). On the theme of "Preventive Psychiatry: Benefits of Early Intervention," the agenda includes timely presentations by national and local experts, Early Interventions for Psychotic Disorders (Dr. Breitborde), Wellness in Psychiatry - The Neuroscience Driven New Treatment Paradigm for Optimum Outcomes (Dr. Jain), Assessing Adolescents Who Threaten Violence in Schools (Dr. Twemlow), Adverse Childhood Events and Their Relationship to Adult Well-Being, Disease, and Social Malfunction (Dr. Felitti), and Treating Mood Disorders During Childbearing: Are We Asking the Right Questions? (Dr. Wisner), as well as a Panel on the Role of the Psychiatrist in Integrated Care and Early Intervention (Dr. Olson, Moderator), for a maximum of 8.0 AMA PRA Category 1 Credits™. FREE to APS Members. Please also share this invitation with your peers! Members of AACAP and ArMA attend for a greatly reduced rate. You can register online at: https://aps-annual-041815.eventbrite.com or by faxing or e-mailing the completed form to Teri (602-242-6283, [email protected]).
Also plan to attend the Friday Social and Awards Reception, 6:30 to 8:30 pm at the Scottsdale Resort & Conference Center, with Polynesian cuisine hosted by American Professional Agency, Inc. and cash bar available. RSVP on your registration form or contact Teri to update your registration. PRESENTS SOMATIC EXPERIENCING: EXPANDING THE PSYCHODYNAMIC DIALOGUE
David Levit, PhD, ABPP, April 25, 2015, 9:00 am to 4:00 pm, Hacienda del Sol, Tucson, Arizona (for the Registration Brochure, CLICK HERE). Banner Grand Rounds Sponsored by the Department of Psychiatry at Banner Good Samaritan - University Medical Center Phoenix
are held from 12:00 Noon to 1:00 pm on the scheduled Fridays in the Medical Education Amphitheatre at Banner Good Samaritan Medical Center, 1111 East McDowell Road, Phoenix, Arizona. In April, no Grand Rounds are scheduled for April 3 or April 10, 2015. Presenting April 17, 2015, Buffy T. Wooten, PhD, Dialetical Behavior Therapy: An Overview of the Intervention; April 24, 2015, Matthew Goldenberg, DO, Grief: Helping Patients Get Through "The Worst Day of Their Life." CLICK HERE to view the April 2015 flyer for CME and other information.
ARIZONA GERIATRICS SOCIETY
8th Annual Spring Geriatric Mental Health & Aging Conference
"BUILDING BRIDGES and EMBRACING HUMANITY"
Friday, April 24, 2015
Community Partnership of Southern Arizona, Tucson, AZ
"Thoughts of aging gracefully have been replaced by efforts to age successfully." This conference is one of the premiere annual continuing educational events in geriatrics in Arizona and will address the continuing educational needs of geriatric professionals in all disciplines. For more information and to register, visit http://ags.memberclicks.net/2015-spring-conference or call the AzGS office at 602-265-0211.
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