Arizona Psychiatric Society Summer Newsletter
Dr. Matthew Goldenberg (Outgoing Co-RFM Rep) accepts the Howard E. Wulsin Excellence in Teaching Award on behalf of Dr. Andrea Waxman (Banner Phoenix) from Dr. Roland Segal (Incoming APS President) and Dr. Payam Sadr (Outgoing APS President)
Volume 6, Issue 2June 2015
In This Issue
Also visit our website for Additional Ads and Job Postings and past issues of the APS Newsletter
From the Newsletter Chair
Monica J. Taylor-Desir, MD, MPH, FAPA
June 2015


Welcome to the Conference Highlight issue of the APS Newsletter. Over the past couple of months we have had multiple opportunities to socialize, exchange experiences, and gather new knowledge. I attended the APA Annual Meeting in Toronto and began to reflect on how the APA has continually been a wealth of educational resources and support as I progressed in my profession. When I was a resident, the annual meeting provided multiple opportunities to socialize and enhance my knowledge of training and employment opportunities. While I was in my fellowship. the annual meetings provided opportunities to learn the latest on late-life depression to enhance my research and clinical practice. During my early career years, while working in Northern Arizona, I looked to the APA to help me prepare for my boards and to provide opportunities to meet and reconnect with colleagues from across the nation. The APA annual meetings also prepared me as I got ready to recertify, provided me with courses to polish up on child psychopharmacology knowledge and sessions to educate me on the DSM-V and the new billing codes. I am grateful to belong to an organization that meets the needs of psychiatrists across the span of their profession including: medical students, residents, early career psychiatrists, mid-practice professionals, and lifetime members. 

Our District Branch held our Annual Meeting on April 18, 2015. This issue of the Newsletter highlights some of the presentations on our theme of "Preventive Psychiatry: Benefits of Early Intervention." Dr. Breitborde highlights the work of the Early Psychosis Intervention Center (EPICENTER) at the University of Arizona, which provides evidence-based, phase specific specialized services for individuals early in the course of psychotic illness. We have also presented a question and answer session with Dr. Stuart Twemlow to clarify important points of his conference presentation, "Adolescents who Threaten Homicide and Other Violence in Schools and their Victims." Barry Morenz, MD, DFAPA of the University of Arizona was awarded the Career Achievement Award in Psychiatry. He is highlighted in our Meet Your Fellow APS Member column. Continuing with the theme of early intervention, the community organization highlighted in this issue is the Mental Health Guild which chose Mentally Ill Kids in Distress as the beneficiary of this year's annual fundraiser. 
Jehangir Bastani, MD, DLFAPA has served faithfully as our elected representative to the Area VII Council and the APA Assembly. He has submitted a report from the Assembly meeting at the APA. We are grateful for Dr. Bastani's service to the Arizona Psychiatric Society. Dr. Espinoza has submitted highlights from the International Society for ECT and Neurostimulation and the latest Arizona Medical Association proceedings where he serves as the Arizona Psychiatric Society Delegate. Each of us have committed to a lifetime of learning and we each achieve that in different ways, whether by reading journals, on-line CME, seminars, audio digest, or live conferences. We have highlighted many upcoming educational opportunities. Please take the time to meet with colleagues, make new connections, and network with providers from various disciplines.


Clockwise from seated left: Drs. Gurjot Marwah, Roland Segal, Matthew Goldenberg, Payam Sadr, Hamed Abbaszadegan, Vivek Prasad, Mona Amini, and Lauren Goldenberg at the Social and Awards Reception.


Dr. Sadr presenting Dr. Kassellwith Certificate of APA Recognition
President's Message

Payam Sadr, MD, FAPA
Arizona Psychiatric Society, President             

Writing this President's Message is my final official action in that capacity for the Society.  I write with feelings of sincere appreciation for all of the contributions made by the Executive Officers, Committee Members, contributing Society members, the APS Lobbyist, and the APS Executive Director.  It was a joy and an honor to celebrate many of these contributions at the APS Social and Awards Reception and to gather together for both excellence in education and the great chance to connect collegially at the APS Annual Meeting  in Scottsdale.  At the reception, I had the privilege of recognizing many of those outstanding achievements (including Dr. Martin Kassell's award by the APA Assembly Committee of Resident-Fellow Member Representatives of the 2015 RFM Assembly Mentor Award, Dr. Carol Olson and Dr. Edward Gentile for their advocacy efforts and their contributions in bringing health care education to our Society, and Dr. Jehangir (Jay) Bastani for four continuous years of service as the Arizona APA Assembly Representative).  The very best among us were also recognized, Dr. Andrea Waxman (Banner Phoenix) as the Howard E. Wulsin Excellence in Teaching Award; Dr. Barry Morenz (University of Arizona College of Medicine) as the Career Achievement in Psychiatry Award (see his inspiring profile and photos below); and Drs. Jasleen Chhatwal (UofA Main Campus), Krystal Chavez (UofA South Campus), Ryan Wilke (Banner Phoenix), and Alicia Cowdrey (MIHS) as Outstanding Resident Recognition Awards (nominated by their Programs for the distinction).  During the APS Annual Meeting, the APS Lobbyist Joseph F. Abate was recognized and presented with a President's Award for his over 20 years of service to the Society and efforts to support the improvement of mental health in the State of Arizona.  Thanks to the outstanding contributions by the Education Committee and the faculty and topics as part of the "Preventive Psychiatry: Benefits of Early Intervention," a high quality program was enjoyed by all.  Please be on the look-out for a Needs Assessment Survey to be used in deciding topics and speakers for the 2016 APS Annual Meeting, proposed to be on the theme of "Innovations in Psychiatry."  The next challenge awaits me, following in the amazing footsteps of Dr. Bastani, in service as the APA Assembly Representative.  The Society is capably moving forward under Dr. Roland Segal, whom I have admired the strong leadership skills in his previous executive officer positions, and I know will continue to build and improve upon the services and support provided by the Society.  
The Society thanks American Professional Agency, Inc., a 2015-2016 Premium Corporate Sponsor, and sponsor of the 2015 Social and Awards Reception
Dr. Olson, President's Distinguished Service Award Recipient, with Dr. Sadr
Photos from the APS Annual Meeting and Awards              

Drs. Chhatwal and Chavez, Outstanding Resident Recognition Award Recipients
Dr. Ryan Wilke Outstanding Resident Recognition Award (Banner)

Dr. Alicia Cowdrey Outstanding Resident Recognition Award (MIHS)

Drs. Allen Kayser and Jason Curry

Drs. Eric Hegybeli and Urszula Kotlow

Tucson Practice Opportunity - Member Ad

Dr. Breitborde presenting at the APS Annual Meeting
Early Intervention in Action: The Early Psychosis Intervention Center 

Nicholas J. K. Breitborde, PhD

Departments of Psychiatry and Psychology

The University of Arizona

Department of Psychiatry and Behavioral Health

The Ohio State University


Psychotic disorders are debilitating illnesses that affected about 3.5 in 100 people [1].  Individuals who suffer from these illnesses typically experience a course of illness characterized by (i) repeated symptomatic relapses ; (ii) elevated rates of depression, anxiety, and cognitive decline [2-4];  chronic unemployment [5]; limited social support [6]; and a lifespan that is approximately 12-15 years shorter than individuals without psychosis [7].  Available evidence suggests that the response rates to treatment for schizophrenia has not improved significantly over the past decades despite an ever increasing armamentarium of evidence-based pharmacological and psychosocial interventions [8]. 


Yet, in the face of such daunting odds, there is growing optimism with regard to assisting individuals with psychotic disorders achieve symptomatic and functional recovery.  Accumulating evidence demonstrates that intervening early in the course of psychotic disorders may dramatically improve the course of these devastating illnesses [9].  More specifically, the available evidence-based pharmacological and psychosocial treatments for psychotic disorders appear to produce greater benefits when delivered early in the course of illness.  For example, available data suggest that up to 90% of individuals with first-episode psychosis will achieve symptomatic remission with antipsychotic medication alone-a figure that drops considerably as the illness progresses [10]. 


Recognizing the multiple domains of functioning that are deleteriously affected by psychotic disorders (e.g., perception, cognition, thought, vocational/educational functioning, social functioning, etc.), international health agencies have largely advocated for the provision of multi-component intervention packages for individuals with psychotic disorders.  Such multi-component intervention packages are a necessity in the treatment of psychotic disorders as no single intervention available to date-pharmacological or psychosocial-has been found to successfully address all of the needs of individuals with psychotic disorders.  Within the United States, the National Institute for Mental Health has recently advocated for the delivery of a specific multi-component treatment package for first-episode psychosis (Coordinated Specialty Care: CSC) comprised of case management, individual and/or group psychotherapy, supported employment and education, family support and education, and low dose antipsychotic medication [11].  Financial support for the dissemination of CSC throughout the United States was recently provided through the passing of the Consolidated Appropriations Acts of 2014 (H.R. 3547) which required all states to dedicate 5% of the funds received from Block Grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) to developing and expanding specialized services for individuals early in the course of a psychotic illness.


To address the need for specialized services in Arizona for individuals early in the course of psychotic illness, the Early Psychosis Intervention Center (EPICENTER) was established in 2010 at the University of Arizona.  EPICENTER provides a package of phase-specific, evidence-based interventions for individuals early the course of a psychotic illness.  To date, EPICENTER has served 110 youth and young adults with psychosis and their caregiving relatives.  Outcomes among these individuals differ dramatically from the usual course of psychotic disorders.  More specifically, within the first six months of treatment, EPICENTER participants experience, on average: (i) reductions in psychotic symptoms, anxiety, and depression; (ii) improved social functioning; (iii) increases in multiple domains of cognitive functioning; and (iv) decreases in use of illicit substances.  Cost-analyses suggest that for every dollar spent on EPICENTER care, almost three dollars are saved due to reduced rates of inpatient hospitalization and contact with the legal system among EPICENTER participants. 


Given the success of EPICENTER in promoting positive outcomes among individuals with first-episode psychosis, our staff have recently launched a collaboration with the Institute for Mental Health Research and Mercy Maricopa to open an EPICENTER in Maricopa County.  Although much work still needs to be completed before the opening of this new center, we remain committed to expanding our services so that individuals living throughout all of Arizona will have access to specialized care for first-episode psychosis.       



1.  Perälä, J., et al., Lifetime prevalence of psychotic and bipolar I disorders in a general population. Archives of General Psychiatry, 2007. 64(1): p. 19-28.

2.  Birchwood, M., et al., Cognitive approach to depression and suicidal thinking in psychosis. 1. Ontogeny of post-psychotic depression. British Journal of Psychiatry, 2000. 177: p. 516-21.

3.  Birchwood, M., et al., Social anxiety and the shame of psychosis: A study in first episode psychosis. Behaviour Research and Therapy, 2007. 45(5): p. 1025-37.

4.  Kahn, R.S. and R.S. Keefe, Schizophrenia is a cognitive illness: Time for a change in focus. JAMA Psychiatry, 2013. 70(10): p. 1107-1112.

5.  Marwaha, S. and S. Johnson, Schizophrenia and employment - a review. Social Psychiatry & Psychiatric Epidemiology, 2004. 39(5): p. 337-49.

6.  Bengtsson-Tops, A. and L. Hansson, Quantitative and qualitative aspects of the social network in schizophrenic patients living in the community. Relationship to sociodemographic characteristics and clinical factors and subjective quality of life. International Journal of Social Psychiatry, 2001. 47(3): p. 67-77.

7.  Crump, C., et al., Comorbidities and mortality in persons with schizophrenia: A Swedish national cohort study. American Journal of Psychiatry, 2014. 170: p. 324-333.

8.  Hegarty, J.D., et al., One hundred years of schizophrenia: A meta-analysis of the outcome literature. American Journal of Psychiatry, 1994. 151(10): p. 1409-1416.

9.  McGorry, P.D., Early intervention in psychosis: Obvious, effective, overdue. Journal of Nervous & Mental Disease, 2015. 203(5): p. 310.

10. Agid, O., et al., Antipsychotic response in first-episode schizophrenia: efficacy of high doses and switching. European Neuropsychopharmacology, 2013. 23(9): p. 1017-1022.

11. Heinssen, R.K., A.B. Goldstein, and S.T. Azrin, Evidence-based treatments for first episode psychosis: Components of coordinated specialty care  2014: National Institute of Mental Health.

Dr. Stuart Twemlow with Dr. Urszula Kotlow
Question & Answer Session with Dr. Stuart Twemlow


Stuart W. Twemlow, MD, DLFAPA

Retired Professor of Psychiatry and Senior Psychiatrist, Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas; Visiting Professor, University College London (Health Sciences)

In support of the outreach from his presentation to the Arizona Psychiatric Society Annual Meeting on "Assessing Adolescents Who Threaten Homicide and Other Violence in Schools and Their Victims," Dr. Stuart Twemlow helps expand upon answers to some of the more frequently asked questions in the following Q&A with Dr. Twemlow, reprinted with permission granted by Dr. Twemlow from its first publication in Violence & Gender 2015:


(Question 1)
You have worked as a psychiatrist in the mental health field for over 40 years. What do you think are the most significant factors contributing to mass murder?

I have no doubt that contextual factors interact with individual genetic propensities to "explode"the bomb. More scientifically I have no doubt that a genetically programmed killer can live a satisfying life without killing if the social context gives him that opportunity. Much more research needs to be conducted into prevention and what creates peaceful, healthy, happy people. One such element we and others are looking at very closely is altruism. Altruism provides not only collaborative help but improves physical health through stimulation of the immune system. It is much easier for us to look for physical ways to identify, arrest and punish such potential killers, but we have to remind each other that punishing and executing killers does not help in the least to prevent further violence

(Question 2)

In your work at the Menninger Institute, did you see differences between males and females in terms of violence? Can you identify the top two or three reasons for these differences?

There are clearly differences in male and female violence in terms of prison populations, but such differences disappear for example in violence between male and female patients in mental hospitals, like Menninger. My likely unpopular view is that men and women are equally qualified for serious violence and that is clear in high schools where differences between male and female children in terms of overt physical and mental violence is much less obvious. Especially vicious relational violence is more common in early adolescent girls. At Menninger, and this is generally true since 75% of the population seeking psychiatric care, are women there are no significant differences..

In other contexts, the caretaker/mother is more likely to be viciously violent in protection of her children than a male caretaker, and might make a better frontline soldier as Israel has already found. Cultural roles modify these theoretical ideas immensely, as in the USA where male and female roles are rather strictly socially defined. I believe the military are trying to shift these rather rigid ideas.

(Question 3)
You have done extensive research and work in the area of bullying behavior in school, university, and workplace cultures. Are there indicators that a culture is "diseased" or broken and can therefore actually influence someone to act out violently?

Yes there is. We have relied too long on a notion that sexuality and aggression motivate us, unfortunately forgetting altruism. The evidence for altruism as a drive is very strong throughout the primate kingdom. Animals realize instinctively, that to survive we have to help each other as kin and for reciprocal reasons as well as fight and destroy each other only for food and protection, otherwise especially human beings, will create a non-living wasteland.

I am by nature optimistic, but in conversation with a prominent International diplomat yesterday he expressed his open fear that our global economy and political climate is rapidly and dangerously imploding.

(Question 4)

One area that is not typically discussed in violence causation is the role of parenting. Are these cases of mass murder influenced in part by how a parent raises a child? In your experience, what are the most important ways in which parenting styles contribute to subsequent acts of violence or can prevent this type of violence?

Very recently a Nobel Prize winning Economist and Sociologist Gary Becker was quoted as having made the following comment: "Children have the incentive to act altruistically toward each other as their parents want them to, even if the children are really egotistical" (NYT obituary B8 ,May 5, 2014). It astounds me that such issues are not more openly discussed. Even if we find a picture perfect profile of a psychopath complete with MRI's, genome printouts, and neuroplasticity data about his/her psychopathic brain. What help is it? A Psychopath register so the public knows who is dangerous in their neighborhood? Children spending a full school period each day with school security doing sweeps and all the discipline as has been reported in Bronx schools (John Devine: Maximum Security) being screened through metal detectors. Imagine this in affluent private schools as we slide down this distorted slippery slope!! That sort of work doesn't help the cause, which must in part be parent related, surely?


Dr. Twemlow
The three most important attributes of a parenting style that might lead to the creations of a dangerously violent adult are:

1. An upbringing where the child is constantly, 
and relentlessly afraid. Research has clearly demonstrated that such conditions not only interfere with how a child relates to peers, it interferes with brain development. High cortisol levels interfere with myelination of the Corpus Callosum and with growth of the Amygdala and Orbito-frontal cortex, areas of the brain relating to impulse control & recent memory. Note no physical abuse is needed to create these conditions.

2. A parent who models antisocial behavior. Mimicry is a learned behavior that lasts throughout life. Children learn a great deal by unconscious mimicry of parents and caregivers. Your child becomes what you are. If you are not functional for one reason or another, care from foster parents can be useful. Note men are great nurturers once they give up the rigidities of the social male role. I worked in a town where the best parent of the year was an ex Green Beret with 3 young female children and no wife!

3. Children grow up in a sea of legs. It is scary as are normal events like dreams. These events are ones children feel unsafe about. The feeling of being safe can only be conferred by a family, so the child can grow without worry about safety. A story: My two 10 &11 year old grandkids used to sleep with me so I could tell them scary stories. I snored loudly and they never complained. One day I asked them. They said yes you keep us awake with your snoring but it lets us know that you are there!! 

Meet Fellow APS Member:  Barry Morenz, MD, DFAPA, Career Achievement in Psychiatry Award Recipient 2015

Dr. Barry Morenz
Barry Morenz, MD,
Associate Professor of Clinical Psychiatry,
University of Arizona College of Medicine

Dawn broke gloriously over the Grand Canyon from our aerie below Yuma Point. I am supposed to receive the Career Achievement Award today, but it's also the last day I would be guiding an intrepid and enthusiastic group on a week-long backcountry route called the Jewels for the Sierra Club. Not able to be in two places at once, I'm thankful to Ole Thienhaus for accepting the award on my behalf. A particularly motivated and capable young woman on the backpack trip was in her 20's, similar in age to my daughters. How could she be so young and proficient? She is in love with the Canyon and we will train her to become one of our future wilderness guides. It seems that I was her age just yesterday; learning to guide groups in the wilderness and a psychiatry resident at the University of Arizona. Has over 30 years gone by in the blink of an eye? Time plays tricks on us. Reflecting on my experiences as a wilderness guide I realize that many of my efforts as a guide are not that different than what I do as a psychiatrist. In both roles I reassure, comfort, challenge, support, encourage, persuade and motivate.

I watched the first footsteps on the moon as a boy and dreamed that I would go to Mars or at least help send someone to Mars. My life ahead clearly lay in the realm of math and science, as so many young men of my generation. Electrical engineering was my undergraduate major but a particularly inspiring biology teacher helped shift my emphasis and I became fascinated by the intricate processes of life. Medicine was a natural outgrowth of this new interest in biology. Confronting human loss and tragedy at Indiana University Medical School was daunting for me at 21 years of age (and I was a young 21 years of age). Family practice was my planned career until my psychiatry clerkship. During the clerkship, the puzzling devastating dimensions to schizophrenia intrigued me, and kindled my commitment to a career in psychiatry. I landed in Tucson at the University of Arizona for my residency; a dynamic friendly environment surrounded by plenty of wilderness to satisfy my other passion.

An awakening is an apt word to describe my journey through residency. Those years were difficult but personally transformative in a positive way. The amount of human suffering from mental illness, which I witnessed frequently as a resident, was almost overwhelming and the needs were great. I quickly became aware that mental illness afflicted people in all strata of society. Helping in whatever small way I could became my goal. My many excellent supervisors and models while I was a resident, showed patients and their families support, empathy and a very humanistic understanding. Exceptional mentors and teachers guided me to greater understanding and I am indebted to them. A few of them include; Jack Marks, Hugh Estes, Steve Scheiber, Lisa Strober and Syd Arkowitz. Learning to develop long-term psychotherapeutic alliances with patients was the standard at that time and has been one of the more rewarding aspects of my career in psychiatry. Unfortunately, psychiatry is less committed to such long-term treatment today. There is much fragmentation of care in modern psychiatry and medicine in general. Too many providers and processes like insurance and electronic medical records invade the privacy and primacy of the therapeutic alliance with patients. Yet there is still a need for psychiatrists who want to pursue this type of long-term work with patients.

Forensic Psychiatry was an accidental sub-specialty for me. Because of a need (there were not many forensic psychiatrists around), I responded to requests for various types of evaluations by attorneys and courts. By attending American Academy of Psychiatry and the Law meetings and through experience, I slowly learned to be a forensic psychiatrist. My desk is piled high with challenging and fascinating forensic cases to review and I am thankful for those referrals. Many of the forensic consultations I have done, related to a horrific act of violence, committed by an individual in the throes of psychosis caused by schizophrenia. Playing a part in the process of seeking justice for these unfortunate men and women has been a very gratifying aspect of my career in psychiatry. And treating prisoners, many of whom have been forgotten by the world, has been very satisfying as well.

At the University of Arizona College of Medicine, Department of Psychiatry, Dr. Ole Thienhaus presents Dr. Barry Morenz with the 2015 Career Achievement in Psychiatry Award
Throughout my career I have enjoyed being a teacher of residents, psychology interns and medical students. In various roles as residency training director, supervisor, lecturer and my current role as Director of Medical Student Education in Psychiatry, I am appreciative that I have learned at least as much from my students as they have learned from me. My hope is that I have been able to contribute to the education of students and residents like the many educators that helped me increase my understanding in psychiatry and psychiatric patients.

Central to making life worthwhile has been my family including my wife of many years, a preventive medicine physician at the Student Health Center, and my wonderful daughters, the oldest is halfway through her psychiatry residency and the youngest is about to start medical school (both of whom are capable wilderness enthusiasts). I am grateful to them as they have been a source of great comfort and support. Some of my forensic cases have been extremely disturbing. The stress of this forensic work would not be bearable without the support of the many wonderful colleagues and assistants I have had the pleasure of working with over the years, and I wish there was space to mention all of them. I am especially grateful for the support of Drs. Racy, Herron, Kaempf and Misiaszek, in addition to my capable and loyal assistant, Julie Tary. Also, helping me keep my personal balance has been my other passion as a wilderness guide and conservationist, and the many people I have become friends with on backcountry trails.
The Society thanks PRMS for participation as a 2015-2016 Premium Corporate Sponsor.

Report from the Assembly of the APA - Toronto

Dr. Bastani receives a Presidential Distinguished Service Award for his valued contributions as Arizona APA Assembly Representative from 2011 to 2015
Jehangir J. Bastani, MD, DLFAPA
Arizona APA Assembly Representative

The Assembly of the American Psychiatric Association meeting precedes the Annual Scientific Meetings held at the Toronto Convention Center. The Assembly was called to order by Speaker Jenny Boyer MD and the usual housekeeping items were cleared such as quorum, prior minute's approval, recognition of members and guests. Flanked by several Representatives to the Assembly from the Canadian Psychiatric Association, Padraic Carr MD welcomed everyone to Canada for this year's APA Annual Meeting.

The floor was given to Debra Bolick MD (Rep. N.C) who spoke of a tragedy striking close to home (Chapel Hill, North Carolina). Dr. Bolick presented a moving story of Mohammed Abu-Salah, M.D., who, on the occasion of marriage of his daughter in January 2015, stated that, after immigrating to the USA, he was living the American Dream. One month later, the dream would be shattered when a neighbor came to his daughter's home, shot and killed her, her husband and Dr. Abu-Salah's other daughter allegedly over a parking space dispute. Suspicion was high that the killing was motivated by religious hate.

Saul Levin MD; CEO & Medical Director of the APA , announced the APA's new branding will be revealed at the Opening Session of the APA Annual Meeting. Dr. Levin assures us that the Benjamin Rush logo is not going away. A new consumer guide to DSM-5 debuted this month. Our membership continues to grow for the second year in a row. Efforts continue to attract interest among medical students through organizations such as PsychSign. Per the request of several Assembly members, the APA Staff Directory (Login required) is now available on the website. Also on the website, the site has been upgraded. Find a Psychiatrist will soon be operational on the APA website. All members who wish to participate are urged to complete their profiles online. APA has renewed its endorsement of APA, Inc. malpractice insurance carrier, which will offer several improvements in coverage, including removing the consent to settle clause, and increasing loss of income limits to insured during trial defense.

Paul Summergrad MD as APA President spoke about the accomplishments of the past year. He emphasized the importance of the Board of Trustees (BOT) in the vote to urge ABPN to lobby ABMS to revise MOC practice and review the evidence basis. The Assembly and BOT have been collaborating on the APA's Strategic Planning and Budgeting initiative and 4 priorities were identified: Advancing Psychiatry, Supporting Research, Education, and Delivery of Services. Dr. Summergrad shared an anecdote emphasizing that APA is the voice of psychiatry in this country. Also, the APA Position Statement on Torture "got it right" as evidenced by a recent NY Times article. Dr. Summergrad reminded us to subscribe to the highest principles of fidelity and ethics of our profession.

Frank Brown, MD, APA Treasurer: "This year's financial report is very positive". APA revenues are $5.3 million in the positive, investments have had a $4.2 million gain. Sales receipts from DSM 5 are doing well with CME and membership dues. Plans are to purchase a new headquarters in the Washington, D.C.

Renee Binder MD President-Elect of the APA (President from May 18, 2015) envisions a new slogan: "There is no Health Care without Mental Health Care". Important issues include how to improve access to MH care, decriminalization of persons with mental illness, and a culture of ethics. A BOT Telepsychiatry Workgroup has been formed to examine access to MH care for children, prisoners and among the immobile population. APA and the American Psychiatric Foundation (APF) are planning a marquee event for April 2016 featuring celebrities and VIPs to bring attention to the plight of those with SMI incarcerated in the criminal justice system. Our current code of ethics will be re-evaluated over the next year.

Action Papers (AP) are usually presented by Representatives to the Assembly (earlier cleared at the Area Council meetings) and by their approval after debate in the Assembly bring to the attention of the BOT the situation affecting and challenging the practice and the profession of psychiatry in the USA, truly a grassroot approach. The Assembly is the voice of the membership through its elected Representatives and each one has a potential input into the debate. There were 29 Action Papers initially presented at this Assembly and were of high calibre and appropriate to the events transpiring in our patients' and professional lives. Of those that were not withdrawn by their authors, a majority of them were debated and approved. The topics varied and significant AP passed were on location of civil commitment hearings, survivors of the Fort Hood incident, accesss to care, efficient electronic payment and EHR record access, Assisted Outpatient Treatment, promoting military competency among psychiatrists, changing ECP status to 8 years post residency, ED boarding of psych patients, mental health leave for college students, social media at Assembly, reconfiguring the health percentage of GDP and impact of environmental toxins on neurodevelopment and behavior. These will be forwarded to the Joint Reference Committee (JRC) for approval. Only after meeting approval by JRC (comprised of members from the Officers of the Assembly and the Board of Trustees) will it be forwarded to the Board of Trustees. Those that are not forwarded by JRC are refered to the author for further clarification or reworking or as case may be, referred to one or more of the APA Components for their opinion and recommendations.Thus the wishes of the Assembly (and members) are acknowledged.

A highlight of the Assembly was Lois Margaret Nora MD, JD, President and CEO of American Board of Medical Specialties (ABMS) invited by the Speaker of the Assembly. Dr. Nora began by paraphrasing the mission of the ABMS being "of the profession, by the profession, and for the patients that we all serve." In response to her previous solicitation, she received 87 constructive and critical comments from psychiatrists regarding MOC. She sees the ABMS mission to serve the public as well as the profession. This upholds the responsibilities of the profession, which allows society to grant the profession the privilege of self-governance. Fulfilling the public trust is one of the expectations of board certification. Unfortunately, evidence shows that skills decay over time since initial board certification. This problem is addressed by MOC. MOC has generated both positive and negative comments from participants. The exam helps focus on areas of continued learning. Others feel it constitutes an intrusion into physician practice, as well as a burden of time, cost, stress, and irrelevance for many physicians.

For 2015, Dr. Nora offered several upcoming changes and proposals to improve the MOC process: accepting CME participation, engaging diplomates in review of previous Board Exams, reducing burden and costs, and increasing relevance and meaningfulness of the exams. Innovations for future MOC exams will include making them modular - not as encompassing as the initial certification exams, and remote proctoring, which allows taking the exam from home. Dr. Nora made her argument for keeping MOC in place. She believes that MOC needs to be more relevant to practice. MOC is essential for quality improvement. And if MOC does not continue, someone else will step in with a solution that may be more problematic. She sees that MOC must also evolve to address more relevant issues. Citing a recent Rand Corporation study on growing physician dissatisfaction, Dr. Nora notes an upcoming module for MOC that addresses physician resilience and burnout.

She then opened the discussion for questions prepared and submitted by Assembly members and audited by Dr. Boyer. In addressing the issue of evidence basis, Dr. Nora noted that evidence does exist for MOC, suggesting that it does improve outcomes, but the question has not been well-studied. She dismissed an alternative to the ABMS model for MOC proposed by the National Board of Physicians and Surgeons as falling below the standards of many state medical licensing boards. In response to the question of why ABPN did nothing until there was a formal complaint by the APA Board of Trustees, she emphasized that dissension between specialty board and specialty society does not lead to productive outcomes. However, she believes that the ABPN and the APA should remain separate and distinct in their roles in MOC.

The other speaker invited by the Assembly was David Barde MD; Immediate Past Chair, AMA Board of Trustee who talked of the interaction and contribution of Psychiatry through the APA members of AMA and Delegates to the AMA. He encouraged the APA members to join the AMA and the State Medical Societies.

The Assembly Reorganization Plan was revealed and will be in effect with the Fall Assembly meeting. Our District Branch will have 2 Representatives to the Assembly from now onwards restoring the cut of 5 years ago. The next Area VII meeting of the Representatives and Deputy Representative (latter now elevated to Representative) will be in Portland Oregon August 8-9, 2015. Becoming Representative, the former Deputy Representative now can vote in the Assembly on issues such as Position Statements, Action Papers etc. that may come up for vote.

The final work of the Assembly was election of Daniel Anza MD as the new Speaker-Elect and Theresa Miskimen MD as Recorder of the Assembly. Glenn Martin MD will become the Speaker of the Assembly. The next APA Assembly will meet in Washington DC over the Thanksgiving weekend.

On a personal note, this will be my final report. I have enjoyed the past four elected years as your Representative to the Area VII Council and the Assembly. I hope my reports have helped you understand the working of the Area Council and the APA Assembly. I thank you for your trust.
ArMA Logo
Report from 2015 ArMA House of Delegates

Brian Espinoza, MD
Arizona Psychiatric Society Delegate 2014-2016

The Annual Meeting of the House of Delegates of the Arizona Medical Association (ArMA) was held Friday, May 29, and Saturday, May 30, 2015. We should all be proud of Dr. Gretchen Alexander, Past President of the Arizona Psychiatric Society (APS), who was elected as President-Elect of the Arizona Medical Association. Dr. Alexander was present and available for discussion on a resolution on gun-control and the mentally ill which was adopted without debate or contention.

Dr. Houshang Semino and I served as APS delegates. We were advised beforehand not to expect any contested topics at this meeting. Reference Committees on Friday afternoon and caucuses prior to the Saturday morning session of the House which elected ArMA Board members and acted on submitted resolutions progressed smoothly.

Items of note in my opinion are the following:

* A resolution was adopted to allow the sale of the ArMA office building;

* Multiple resolutions were submitted by a young Pima County physician regarding the issues of Maintenance of Certification, the lack of Medicaid Reimbursement for Non-Face-To-Face Patient Care activities, and the fallout from Healthcare Organization Consolidation. Many delegates agreed with the physician's concerns, but the resolutions, as submitted, lacked sufficient detail to be adopted as ArMA policy. The sponsoring physician was encouraged to refine them and resubmit them to the next meeting of the ArMA House. Several physician delegates offered to advise and assist in the redrafting and resubmittal.

In my view, if any of you new career physicians have an issue that you feel strongly about, get involved in the political process. APS and ArMA will support you.

I was complimented by our Caucus Leader on how well Psychiatry has been represented the past few years and that any input we could contribute is welcomed. I was also advised that we should prepare for another sunrise proposal by the Arizona Psychological Association to allow Psychologist Prescribing of Psychotropics.
Independent psychiatrist is looking for another psychiatrist (ideally an adult psychiatrist) who is interesting in sharing a three to four offices setting, as well as common resources, i.e. receptionist, billing, office administration.  If you are interested, please contact Adriana Boiangiu, MD at 973-902 5563.
5% AHCCCS Provider Cut Withdrawn

APS Lobbyist Joseph F. Abate, Esq. receives a Distinguished Service Award
Joseph F. Abate, Esq.
APS Lobbyist

A summary of the Health Care Legislation relevant to psychiatry that was signed by the Governor in the Fifty-Second Legislature, First Regular Session (2015), is available to view and/or print by CLICKING HERE.

Although the current make-up of the legislature has fewer moderates, the Republican membership has a good managerial relationship with Governor Ducey. As has been the case for the last few years, as Arizona struggles to catch up with the national economic recovery pace, the largest efforts focused on budget issues. As an update to the budget passed during the Session, on June 5, 2015, AHCCCS announced that the five percent provider cut scheduled for October 1, 2015 is no longer necessary, stating: 
"Based on the data and information provided through these public comments, along with lower than forecasted utilization and other available funding, AHCCCS has, working with the Governor's Office, determined that no provider rate reductions are required at this time." Visit for the entire statement. 
If you would like any additional information regarding the legislative session, please contact the APS Lobbyist, Joe Abate, at 602-393-1700. If you are interested in being a part of the Legislative Committee of APS, chaired by Dr. Carol Olson, please contact
Reporting from APA Annual Meeting - Toronto
Celebrating with Our Newest Distinguished Fellow

It was a pleasure to attend the Convocation of Fellows at the APA Annual Meeting and take a moment afterwards to catch up with these Arizona members, celebrating their achievement with their family members.  If you are interested in more information about Fellowship, please visit  If you would like more information about the Distinguished Fellow process, please contact

Dr. Emerson Bueno celebrated his Distinguished Fellow honor with his wife.

Dr. Taylor-Desir celebrated the distinction of Fellowship with her parents.

Sponsorship Thank You from Mental Health Guild;
Celebrating MIKID and May Mental Health Awareness

The Mental Health Guild would like to thank the Arizona Psychiatric Society for your support of the Guild's recent fundraiser, "SATURDAY NIGHT - Live on the Green Carpet" as well as last year's fundraiser celebrating the 50th & 60th birthdays of the Mental Health Guild (MHG) and the Mental Health America of Arizona (MHA). Events are always held during May to raise the awareness of Mental Health Month. The Honorable A. J. "Skip" Hall, Vice Mayor of Surprise, Arizona, and father of MIKID staff member Michelle Springer, read the Governor's proclamation that May is Mental Health Month in Arizona.

A beautiful Marilyn Monroe and a vibrating Elvis Presley greeted over 150 people as they arrived on the "green carpet" on Saturday, May 2, 2015, at the Starfire Golf Club in Scottsdale. A free wine tasting, 50/50 raffle and live music were provided during a pre-dinner silent auction of over 70 items. An important goal of the event was to make the community more aware of MIKID (Mentally Ill Kids in Distress) and raise funds to support the important work they do to help Arizona's children and families who have a mental illness.

An amazing young man, Eric Gilbertson, who was diagnosed with schizophrenia at age 13 did not let his mental illness interfere with his determination to help mentally ill children. At age 17 Eric made a plea on their behalf for financial help to the Arizona State Legislature. For the first time money was obtained for children's mental health.

Eric lived a life full of dignity and courage in accordance with his faith. Unfortunately, his life ended on September 2, 2005 due to complications of a liver disease caused by psychotropic medications while waiting for a liver transplant.

While dealing with the enormous difficulties of Eric's illness, his parents, Warren and Sue Gilbertson, in 1987 founded MIKID (Mentally Ill Kids In Distress), an organization dedicated to assist parents/caregivers in seeking appropriate mental health care for their children. The demand for MIKID services has increased, particularly in Maricopa County. That's why the MHG Executive Board was proud to announce MIKID was selected as the primary beneficiary of this year's fundraiser.

Former MIKID board members and dedicated advocates for mental health, Steve Carter and Sam Engram were honored in memoriam for their contribution to improving Arizona's mental health system. Steve and Sam's families were present to receive recognition and honors on their loved one's behalf presented by MIKID President Ilene Dode and board member Ted Williams.

Another highlight of the event was Patsy J. Kelly, who was crowned Queen of the Night and honored for her 43 years of service to the Mental Health Guild. Patsy was recognized for her tenacity and her strong, vibrant, and outspoken advocacy for the issues that she holds dear.

Because of the great support received by the AZ Psychiatric Society & others for this event, MHG was able to present to MIKID a check for $20,000. In addition to APS, 30 organizations contributed to the event's financial success including Champion sponsors Mercy Maricopa Integrated Care (MMIC) and Community Partnership of Southern Arizona (CPSA) and Supporter sponsors Cenpatico Integrated Care, Johnson & Johnson, Health Choice Integrated Care and the Arizona Behavioral Health Corporation.

The Mental Health Guild collaborates and supports programs to improve the lives of individuals impacted by mental illness. MHG is a private, not-for-profit 501C(3) organization, 100% volunteer run and has provided education, advocacy and support services to Arizona for over 51 years. In addition to raising funds for mental health programs, MHG sponsors Peer Support Groups for adults in Maricopa County as well as a Homeless Outreach program for those with a mental illness. Please consider becoming a member & joining our MHG team of volunteers.

Peer Support - call Andy (480) 994-4407 or
Homeless Outreach - call Marlin Fried at (480) 206-7434
To get involved or learn more about the Mental Health Guild, contact:
Cheryl Collier, President Board of Directors of MHG at
Report from ISEN International Society for ECT and Neurostimulation 2015 Annual Meeting

Brian Espinoza MD
Interventional Psychiatry
ECT & IV Ketamine for Depression

This is an Annual Meeting which I attend regularly to keep up to date on ECT and developing Neuromodulation Therapies.

Below are some items of interest:

Ketamine added to ECT Anesthesia to promote an antidepresive response:
6 published studies were presented showing no improvement in outcome.
A 7th yet to be published study was presented and came to the same conclusion.
Ketamine in Anesthetic doses led to higher rates of confusion, disorientation , and

The leading ECT experts showed enthusiasm for IV Ketamine as an alternative for
patients with treatment resistant depression (TRD) that did not respond to ECT. ( I have patients that did not respond to ECT, and, with Maintenance IV Ketamine, have consist-ently maintained PHQ scores at 5 or below).

rTMS (repetetive Transcranial Magnetic Stimulation)
This modality continues to be refined with targeted magnetic stimulation, and some
preliminary data suggests that particular neurotransmitter clusters may be the new
area of explorations of this modality. On a local basis, some insurance companies will approve this treatment after a lengthy appeal process.

MST (Magnetic Seizure Therapy)
As the magnetic fields in this treatment modality are not shunted by non-brain tissue as
they are in ECT, it appears that Memory Circuits are less affected than by ECT.
This results in less memory loss, but, the effectiveness of this modality is comparable to
only Unilateral ECT.
This modality will not come to the U.S. until there is a large head-to-head comparison
study vs. ECT which is highly unlikely for some time now given the burden of the FDA,
and the small pockets of device manufacturers. The Canadians are further along in this development due to the above.

DBS (Deep Brain Stimulation)
This treatment modality remains available for Medicare patients on an HDE
(Humanitarian Device Exemption) for Treatment Refractory OCD.
As reported from the 2014 ISEN meeting, trials in TRD were unyielding.
I suspect at $90,000 per implantation, this modality will not come to usage for TRD.

tDCS (Transcranial Direct Current Stimulation)
(This is not the same as the Fisher Wallace Stimulator or other devices on the market.
The Fisher Wallace device is a CES (Cranial Electrical Stimulator). It is not FDA
approved. It is FDA "exempt" due to its low (below1 milliamp) output.)
tDCS requires everyday treatment for at least 3 weeks to produce results.
It appears to have it's effect by priming membrane potentials and synaptic alterations.
Preliminary trials show effectiveness for mild to moderate depression, and,
enhancement of cognition.

Study Devices cost approximately $5000. Copy-cat devices, costing as low as $500,
have been tested with an amp-meter and were found to be inconsistent with amperage

Self-administered tDCS is considered "dangerous" by experts. One risk is manic
induction in Bipolar patients, and, we do not know the long term outcome of this different mechanism of action. The Australians are leading the way in this research due to factors mentioned above.


* Ketamine as part of ECT Anesthesia does not work

* International ECT experts recognize that IV Ketamine for depression deserves recognition and further comparison studies

* rTMS remains an effective option for mild to moderate cases of depression

* MST will not likely be approved for the treatment of depression for several years, if at all

* DBS will not likely be shown to be effective for depression

* tDCS looks promising for mild to moderate Depression, but U.S. trials, and FDA approval is many years away


In the closeout workshop, all International Experts agreed that the more "focalized" a neuromodulation modality becomes, leading to reduced cognitive impairment, the lower the chance of effectiveness.

More to come from the International Society of ECT & Neurostimulation Meeting in Atlanta, GA, May 2016.

Please contact me with any questions;
Announcing a New Option for Treating Schizophrenia (Sponsored Content)              

The Society thanks Janssen Pharmaceuticals, Inc. for participation as a 2015-2016 Premium Corporate Sponsor.
APA Updates:  Opt-In to Find-A-Psychiatrist; Final 2015 Dues Deadline June 30; Applying for Fellowship

Opt-In Today for Find-A-Psychiatrist            

Dr. Saul Levin, CEO and Medical Director of the APA, recently invited all APA/APS members to opt-in to the "Find a Psychiatrist" searchable database, a new benefit for both members that are accepting new patients and individuals seeking mental health services and a tool aimed to assist access to care in our communities. The opt-in link (you will be asked to log-in as an APA member) will take you to an easy to complete online form, or you can also click here to see the functionality of the new resource.

The APA will be tracking opt-ins and will deploy the new resource when there is participation throughout the country. Your participation is key to bringing this tool to fruition! If you have any questions or need help, please contact APA Customer Service at or 1-888-35-PSYCH or 1-888-357-7924.

Final 2015 Dues Payment Deadline is June 30th
Protect your membership benefits and continuity of membership, sign-in to renew today or call 703-907-7322
for assistance.


Fellow definition Take the Next Step in Your Career and Apply for Fellowship Status in the APA

Fellow status is an honor that reflects your dedication to the work of the APA and signifies your allegiance to the psychiatric profession.  VISIT THE APA for more information on the guidelines and criteria for eligibility, and to download the Fellowship Application.  Fellowship Applications are due on or before September 1st each year.  Confirmed Fellows are recognized in the Convocation of Fellows at the next following APA Annual Meeting.  

Education and Events--Something for Everyone!    
2015 Arizona Society of Addiction Medicine Annual Conference
Discounted rate available for Arizona Psychiatric Society Members!
Saturday, November 21, 2015, 8AM - 4 PM
Black Canyon Conference Center

This program provide a great opportunity for networking with others in the field and learning the latest approaches to treatment. Register early for a discounted rate of $75 for AZ Psychiatric Society and AzSAM Members, $35 for Students/Residents. After November 1, 2015, rates will increase by $20 so register now. A limited number of scholarships are available for students and residents. For more information visit:  This program has applied for CME and CEUs.

AzSAM will provide an extended program focusing on key aspects of the Addiction field.
Topics will highlight:
- New and Emerging Drugs of Abuse
- Medical Marijuana
- Evaluation and Treatment of Substance Use Disorders in Veterans
- Pregnancy and Addiction and much more.

Space is Limited--Legal Competency & Restoration Conference (Closes July 3, 2015)

Legal Comp Training AZState of Arizona Supreme Court Legal Competency and Restoration Conference, August 4-6, 2015, at Camelback Inn and Conference Center, Scottsdale, is designed for licensed Arizona physicians with forensic experience who seek to become court-approved evaluators in criminal and juvenile cases.  The 2015 Conference will feature Dr. Jennifer Skeem, UC Berkley, as the Keynote speaker.  Advanced tracks will be offered for those who have attended the conference in the past and address topics of juvenile competency, interplay of substance abuse, and mental health, and sexually violent predators.  For more information, view the conference brochure.  Registration is limited to 150 and closes July 3, 2015.  Register today.  

If you missed the recent Behavioral Health in Rural Arizona: Looking Toward the Future presentation on June 18, which was available live and by telecast, moderated by Robert Fleet, Director of Medical Management Health Choice Integrated Care, with Speakers: Tom Betlach, Director AHCCCS and Paul Galdys, Assistant Director, ADHS; Shawn Nau, COO Health Choice Integrated Care; Melinda Vasquez, Chief Officer of Cultural and Community Affairs Cenpatico; and Christi Lundee, Chief Innovation Officer, Mercy Maricopa Integrated Care, it is available for streaming viewing from Arizona Telemedicine by clicking above. Great speakers and timely information!

Join the Hope Conference, a state-wide conference for professionals, survivors, and advocates, in creating a brighter community for those at risk in or schools, workplaces and communities.  It is an opportunity to inspire new dialogues, create new partnerships and mobilize resources in our fight to reduce suicide in Arizona.

Keynote speakers include:
- Thomas Joiner, Ph.D. - The Robert O. Lawton Distinguished Professor in the Department of Psychology at Florida State University
- Michelle Linn-Gust, Ph.D. - Past-President of the American Association of Suicidology

Topics will highlight Suicide in the Military, Peer Support Groups, Youth and Suicide, the National Strategy for Post Vention, Suicide in Native American populations, and more. The conference also includes a pre-conference with a ASIST / SafeTalk Regional Network Trainer Update and a SafeTalk Training workshop.

Early Registration is $119 1-Day, $199 2-Day, rates increase $20 after September 12. There is a separate fee for the Pre-Conference. For more information visit

SAVE THE DATE:  2nd Biennial Perinatal Mental Health Conference,
Translational Research in Perinatal Mental Health: Laboratory to Bedside to Community Practice, November 4-6, 2015, Northwestern University - Chicago
Chaired by APS Annual Meeting featured speaker, Katherine L. Wisner, MD, MS, the 2nd Biennial Perinatal Mental Health Conference is designed to support the conversation among investigators across the translational continuum, scaffolding efforts to move findings from the academic settings into real-world clinical practice--a public health priority.  For more details and to register, CLICK HERE.  

SAVE THE DATE--Eli W. Lane Memorial Master Workshop
The Impact of Affect and Trauma On Development: Implications for Treatment
Presented by: Paul C. Holinger, MD, MPH
Saturday, November 7, 2015 9:00 am-4:00 pm
Registration from 8:30 am to 9:00 am
at Hacienda del Sol Guest Ranch Resort, Tucson
CLICK HERE for Save the Date Flyer. 
Plan Ahead to Attend The 2016 Update on Psychiatry--Save the Date for this Educational Gem of the Desert!!
2016 Update on Psychiatry: Highlighting Integrated Care
Conference date: Feb 15-18, 2016, Tucson, AZ
Presented by:  The University of Arizona College of Medicine, Department of Psychiatry

In collaboration with: Arizona Psychiatric Society, a District Branch of the American Psychiatric Association; Arizona Nurses Association; and Arizona Psychological Association.  Visit for additional information as the same becomes available on location, accreditation, full course schedule and list of invited speakers, and registration.  
Concluding with Thoughts on Psychiatry and Hope and Thanks to Advancing RFMs              
The Society has had the valued contributions over the last few years from Matthew Goldenberg, DO, outgoing Co-Resident-Fellow Member Representative, a fourth year resident at Banner Phoenix, advancing on to a Fellowship in Addiction Psychiatry at UCLA-Kern.  We take a moment and share with you a Residents' Forum article authored by Dr. Goldenberg and printed in the October 2014 Psychiatric News, Psychiatry and Hope: Thoughts After Robin Williams' Death.  The Society sincerely thanks Dr. Goldenberg, and fellow Resident-Fellow Members who served as officers or Committee members on the Executive Council in 2014-2015, now advancing on to fellowship or general practice, Dr. Felicitas Koster (MIHS) and Dr. Jasleen Chhatwal (UofA Main), and wish them well in the next steps on their career path.  Their professional caring and advocacy gives us all hope for psychiatry's future.
Newsletter and Website Advertisements - Benefit of Membership               

As a member benefit, Arizona Psychiatric Society members are permitted one free Newsletter advertisement per year, and 50% discount on Newsletter advertisements thereafter, and website advertisements at 50% of the published rate.  Visit to view current advertisements.  Contact Teri (, 602-347-6903) with any questions or to place an advertisement.