October 2016, Vol. 7, Issue 3
In This Issue


From the Newsletter Editor-in-Chief

Mona Amini, MD, MBA

October 2016
Mona Amini, MD, MBA

Happy Autumn to my Psychiatric Colleagues!
As we enjoy the trickling in of cooler weather (and snow inevitably soon for our Northern counterparts!), I welcome you to our Fall APS Newsletter.  I am excited to share the focus of this season's newsletter:  Women's Health and Women in Psychiatry. From perinatal anxiety to a look into the life of our distinguished APS Past-President, Dr. Gretchen Alexander, the contributions of our writers this newsletter edition is commended. The diligence and hard work of our psychiatric community is truly evident within each edition of our newsletter, but special recognition should be conveyed to Dr. Carol Olson for her support in testifying before the AHCCCS Pharmacy and Therapeutics Committee to help subsequently approve an array of antipsychotic medications that no longer require prior authorization as of October 1st.
As Fall allows for better weather to bring people together, you will note numerous upcoming engagements, including the annual NAMI Walk on October 15th, the pharmacogenomics dinner on October 25th at The Gladly in Phoenix, and the October 29th free Integrated Care Training Conference made possible by the collaboration of the APA and APS, TCPi and Practice Innovation Institute  (with facilities and audio-visual support from University of Arizona College of Medicine, Phoenix, Flagstaff Medical Center, and Banner University Medicine Whole Health Clinic Tucson (the live training is in Phoenix, with Session 1 available by broadcast to Flagstaff and Tucson)).  In light of the Women's Health and Women in Psychiatry theme for Fall, we are excited to hold our second AZ Psychiatric Society Women's Group event on Thursday, November 17th, thanks to the sponsorship of Valley Hospital-Phoenix (a central Phoenix site is being confirmed as this goes to print).  I look forward to being in the company of my female psychiatric colleagues.

P.S.: Please share your feedback and follow us on Twitter @AZPsychSociety or on Facebook through the group page "AZ Psychiatric Society."

Sponsored by Valley Hospital-Phoenix

With thanks to sponsor, Valley Hospital-Phoenix, we are glad to announce the next networking event for Women in Psychiatry organized by the Arizona Psychiatric Society Women's Group, to be held on Thursday, November 17, 2016 from 6 to 8 pm (site TBD).  E-mail Teri to sign-up.  
Premium Corporate Sponsor 2016-2017

Gurjot Marwah, MD,
Arizona Psychiatric Society President

Dr. Gurjot Marwah, APS President, wearing traditional Indian dress, salwar kameez, spoke with Senator John McCain at a recent political event on the mutual interests in mental health reform, including preventing Veteran suicides in Arizona and how to decriminalize the mentally ill in jails and prisons in our state.
Fall is upon us, and I hope to see you at some of the upcoming events of the Society, including the pharmacogenomics corporate sponsored dinner event on Tuesday, October 25, 2016 at The Gladly, and the free live Integrated Care Training at University of Arizona College of Medicine, Phoenix on Saturday, October 29, 2016. 
To help develop relationships with both state and national legislators, Dr. Aaron Wilson, President-Elect, and I are looking for additional members interested in serving as Congressional Advocates. Congressional Advocates serve as "key contacts" for their members of Congress so that when important issues come up before the US Congress or the State Congress (committees/floor votes/need for legislation co-sponsors), the Society can quickly get its message/request to targeted members of Congress through direct, personal communication. Congressional Advocates can be key to an effective grassroots effort to improve mental health access to care, parity, and other legislation and regulation affecting the practice of psychiatry, specifically, and medicine, overall. If you can make this important contribution, please contact teri@azmed.org and specify the member(s) of Congress (US or Arizona) for whom you would like to serve as the Congressional Advocate (you may serve as Advocate for more than one member of Congress).

Your membership in the Society is an important step in advocating for our patients and our profession, and I thank you for being a member. Together we work to be a strong voice for mental health. Individually, I thank those of you who actively work to be ambassadors for psychiatry, membership in the Society, and improvements in the mental health system. The difference you make is greatly valued.

Corporate Sponsor 2016-2017


Saira S. Kalia, MD MBBS
Counselling and Psych Services
University of Arizona
Perinatal psychiatric disorders have long been a passion of mine.  While running the Perinatal Clinic, I kept running into mom telling me "but I'm not depressed," "isn't having a newborn supposed to be overwhelming," all while presenting with severe anxiety disorders. I wondered if anxiety disorders are under recognized due to the expectation of distress during this time. The continuum of anxiety symptoms seems more acceptable and easier to dismiss than depressive symptoms in the setting of pregnancy and postpartum. The crying mom is easier to identify than the very anxious nervous mom who maybe just overly worried. I also feel that the flag of "postpartum depression" is also part of the under recognition. The focus of the data and public education has been "postpartum depression." While it's a worthwhile cause, we risk reducing the entirety of the perinatal psychiatric disorders to postpartum depression.  Unfortunately, postpartum depression may not be the most prevalent perinatal psychiatric illness. In light of recent data, it appears that crown belongs to anxiety disorders.

It's not really much of a surprise as anxiety disorders will affect one-third of the adult population at one point in their life.  Furthermore, women are approximately 1.5 times more like to suffer from anxiety disorders than men. That, combined with the peak age of onset for anxiety disorders in women being mid- to late-20s or the childbearing years sets the stage for perinatal anxiety disorders. The literature suggests prevalence rates of 9-22% in pregnant women to about 11-21% of postpartum women. In contrast, antenatal depression rates vary from 7% (major depression) to 16% minor depression. Half of all depressed patients also report symptoms meeting criteria for anxiety disorders. The cherry on top of our depressed anxious cake being that presence of both conditions yields an increased risk of symptom persistence and treatment resistance.

Even the most conservative translation of the data means one in ten moms is suffering from an anxiety disorder. This mom will be at a higher likelihood to get a comorbid depressive disorder and IF recognized they will be difficult to treat. This has serious implications for mom, baby, and health care costs. For the psychiatrist, this means the difference between evaluating and treating one patient or missing it and having the mom, baby, and family suffer.

The impact of maternal psychiatric illness on the child has been underscored in the data again and again with low birth weight and premature birth frequently touted as consequences; however, it goes much beyond the physical. It is also worth remembering that about 70% of the health care costs of perinatal psychiatric costs are due to the child.  

The child can suffer the impact through the neonatal period to adolescence and adulthood. The child can have physical, cognitive, and emotional sequelae. Physical outcomes include stillbirth, premature birth, low birth weight, low Apgar scores, smaller head circumference and major congenital anomalies as well as altered developmental trajectories. These children are noted to have a more difficult temperament, and an increased risk of emotional problems (especially anxiety and depression). They can have impaired cognitive development, and symptoms of attention deficit hyperactivity disorder and conduct disorder during childhood.  These children are also at increased risk of impulsivity and cognitive disorders at 14 and 15 years of age and at increased risk of developing depression in adolescence and adulthood.

For the mom these disorders have been associated with inadequate nutrition and weight gain, increased alcohol consumption, substance abuse, and smoking. Moreover, mothers with antenatal anxiety and depression are more likely to access perinatal services late, to attend antenatal appointments less frequently, and to fail to have regular scans. Moreover, a depressed mom is the highest risk factor for fathers to develop depression.

Despite the increasing data and established risks there is still a lack of screening and recognition in practice. The ACOG recommends that clinicians screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. This may not be enough to identify the majority of patients. Multiple evaluations during pregnancy can show differences in the rates of depression and anxiety. To this end, some studies (Bunevicius et al., 2009Lee et al., 2007Marchesi et al., 2009 and Yanikkerem et al., 2013) have shown that depressive episodes occur more frequently during the first and third trimester of pregnancy, compared with the second. The fact that many women present anxiety or depressive symptoms at one or two time points implies that only one screening is not enough during pregnancy.

It is worth remembering that these women often present with atypical symptoms of depression and unspecified somatic complaints such as fatigue, loss of energy, appetite and sleep changes, rather than depressed mood. It can be difficult to distinguish between "normal" pregnancy symptoms, and atypical somatic complaints, which may be related to depression or anxiety. This obviously makes it more complicated to diagnose depression and anxiety without a standardized assessment. For this reason, the most validated and widely used self-report screening tool for depression during the perinatal period, the Edinburgh Postnatal Depression Scale (EPDS), does not include questions about somatic complaints, fatigue, and changes in appetite.  

Thankfully, the Edinburgh Postnatal Depression Scale (EPDS) consistently identifies women with anxiety symptoms as well and EPDS scores seem to correlate with disorder type.  Women with no disorder have the lowest scores, followed by women with anxiety only, then by women with depression only.  Finally, women with a combination of depression and anxiety scored the highest of the four. It's important to note that the EPDS doesn't give us diagnostic accuracy; however, it does identify women with clinically significant symptoms who may benefit from treatment. PASS or Perinatal Anxiety Screening scale developed in Australia is another option for screening.  It screens for a range of anxiety symptoms during pregnancy and the postpartum period. It assesses for (1) acute anxiety and adjustment; (2) general worry and specific fears; (3) perfectionism, control and trauma; and (4) social anxiety. Due to its more specific range it may be a secondary tool to use to discern symptoms further. Distinguishing between perinatal depression and anxiety can guide us in treatment decisions and therapy referrals.

Anxiety is an important and common factor affecting the wellbeing of moms and babies. Highlighting the issue, providing education, and other interventions can help improve outcomes and have an overarching impact on the physical and mental well-being of the family. This will allow for the family unit to thrive and improve the health of the community at large.
Corporate Sponsor 2016-2017

Gretchen B. Alexander, M.D.
Associate Clinical Professor of Psychiatry
University of Arizona College of Medicine-Phoenix
Associate Program Director
Maricopa Integrated Health System Psychiatry Residency Program
Unit Attending Psychiatrist
Maricopa Integrated Health System/District Medical Group
President, Arizona Medical Association, 2016-2017
President, Arizona Psychaitric Society, 2011-2012

Like many Arizona residents, I was not born here, but moved to Arizona for work. My husband and I relocated to the Phoenix area in 2003 with our three small children after living in Atlanta for five years; prior to that we had lived for eleven years in New York City, where I did my residency training in Psychiatry.  However, a large part of my childhood and adolescence was spent in rural Maine, on an old farm in a tiny town called Alton, which is north of Bangor.  My family lived in a rambling Victorian-era farmhouse that still had an outhouse attached to the barn, heated our home with wood that my father chopped himself and in the winter, cooked meals over an 1880's vintage wood stove that also heated the downstairs of our house.   We had fifty acres of land, some of which my father mowed on his tractor, probably mostly so he could have an excuse to drive a tractor since we didn't raise any crops. Our telephone service was a party line--two short rings meant the incoming call was for our family and we should pick up.  Other ring patterns signaled that the call was for another family-- you could pick up and listen in on somebody's else's conversation if you were bored but of course this was frowned upon. 

My brothers and I attended elementary school in a two-room schoolhouse down the road from our house until we got to seventh grade when we were bused to the relatively larger metropolis of Old Town for junior high.  My parents supplemented their income by owning rental properties which I spent my summer vacations painting.  As a senior in high school, I got a job at the McDonald's "in town;" in good weather this involved riding my bicycle about ten miles, part of it over a dirt road shortcut, to get to work. When it was snowy, my parents would graciously give me a ride, although I don't recall that happening very often.
 Most of Alton's residents were Mainers of many-generations standing, engaged in logging, working at the local paper mill, or operating small farms or businesses.  Many of our neighbors lived very modestly-- my best friend's bedroom was in an unfinished basement with dirt walls and floor.  My family was somewhat atypical for the community as my father was a professor at the University of Maine, and more importantly, we were "from away."  In spite of the fact that we drove around in a VW bug so elderly that we could see the road going by through a large hole in the floorboards, we were considered well-off by local standards and were regarded with suspicion by some. Nevertheless, we were an enthusiastic part of the Alton community.   My father was on the town council, my mother served as sexton (gravedigger) of the town cemetery for a number of years, and I recall many evenings spent at Junior Grange meetings and potluck dinners at the nineteenth-century Grange Hall, where we would do projects related to farming, and sometimes hear speakers from the University of Maine discuss their research and interesting trips they had taken.

In 1979 I left Maine to go to Bryn Mawr College, then medical school at the University of Pennsylvania.  In med school, I was attracted to psychiatry because I was fascinated by the idea that small changes in brain chemistry and structure could so profoundly affect mood and behavior, and also because all of my attendings in Psychiatry were nice, down-to earth people who treated their patients and medical students with respect, while not taking themselves excessively seriously.  Medical school was followed by residency training at Hillside-Long Island Jewish Medical Center in Glen Oaks, New York, after which I worked as an attending at LIJ, doing much the same work I do now, teaching and supervising residents on the inpatient service.

Although it has been many years since I lived in Maine, many of the values I absorbed there, such as hard work, fair treatment of others, independent thinking, respect for tradition and perseverance through challenges, still resonate strongly with me.

Since 2011 I have worked as an inpatient attending at Maricopa Medical Center in Phoenix, where I also serve as Associate Program Director for the Adult Psychiatry Residency Training Program.  The work I do at MIHS is very satisfying for a number of different reasons. 

The patients we work with are typically acutely ill, with conditions that respond relatively rapidly to psychiatric medications, so it is possible to quickly make a significant difference in the way a person is feeling. The appreciation that our patients and families often express for the care they have received is very rewarding.

Additionally, the public mental health system in Arizona is actually quite good and on discharge, our patients have access to critical services, including housing and case management, which patients in many states do not have.  It is impossible to overstate the impact that access to these resources has in the outcome of someone's mental illness, and our ability to provide hope to patients and their families through connecting them with services is an important and gratifying part of the work we do here.

Another very rewarding aspect of my work is the ability to spend time with my patients.  For a variety of reasons, the court-ordered evaluations we do need to be quite comprehensive, and so resources are allocated and the MIHS system is operated in a way that really gives us the tools we need to provide high-quality care.  Getting to know our patients as people, helping them with their problems, making accurate diagnoses and providing well-coordinated, effective treatment-I think many of us, as well as our patients, consider these to be the essential elements of good medical care.  All of these elements require time, and the gift of time with my patients, so that I can provide good care to them, is one for which I am deeply grateful.
1415 North First Street, Phoenix, Arizona  85004

Youth Friendly, Research-Based Center for Psychosis

The IMHR EPICENTER will open its doors in October to treat teenagers and young adults with early stage psychosis. Located between the Phoenix Art Museum and the Arizona School for the Arts in downtown Phoenix, this center will offer a new, innovative approach and setting to treat mental illnesses that have a devastating impact on young people and their families. Developed from world-wide research showing that early and comprehensive intervention can dramatically improve results over conventional treatment, this Center will be the first of its kind in the Greater Phoenix area to provide early psychosis intervention treatment in a community, youth friendly setting. The program is designed to prevent an escalation of symptoms and return participants to healthy, productive lives.    
"If not caught early, psychotic illness can take a terrible toll, cause lifelong problems and is the leading cause of disability worldwide. We believe that much of this can be prevented and that is why we founded Epicenter" said Nicholas Breitborde, PhD at Ohio State University (formerly University of Arizona) and founder of Epicenter. "At the IMHR EPICENTER we'll fill the gap in traditional treatments. Medication can be very good for reducing some of the symptoms of psychosis but the research clearly shows that it alone is not sufficient to help people recover and get back to work and school."
Lead by the Institute for Mental Health Research (IMHR) and with support from Mercy Care/Mercy Integrated Health, Blue Cross of Arizona, Jewish Family & Children's Service, Dignity Health of Arizona, Arizona Community Foundation. Sidney Baer Foundation and private donors this Center will provide a comprehensive approach to treatment. "IMHR EPICENTER will be different, a vibrant model that is research-based and crafted to provide early response and foster a sense of community without feeling like a sterile medical institution.  We are excited to be developing this innovative Center with Nicholas Breitborde, PhD one of our IMHR funded scientists, said Mike Meyer, Board Chair of the IMHR in Phoenix.
"We see kids and young adults with early psychosis in our emergency rooms every single day. It is a tragic situation for them and their families. We believe the Center can provide the rapid, much-needed treatment to keep these young adults healthy and out of the hospital and inpatient psychiatric units before it is too late to stabilize them," said Chuck Sowers, Chief Financial Officer for Dignity Health East Valley and Board Chair for IMHR EPICENTER.  Reliance on the hospital system as a band-aid is a costly approach to care and other first-episode psychosis program performance data indicate that for every one-dollar spent on Epicenter care nearly three dollars are saved.  
Many of the services to be provided by IMHR EPICENTER are proven interventions supported by results from elsewhere in the US, Europe and Australia.  CMS has recently recognized the power of these treatments and has provided support to states to encourage these programs. The State of Arizona and innovative health organizations such as Mercy Maricopa and Blue Cross have recognized their benefit. In year one, IMHR EPICENTER services will be targeted to 250 individuals ages 15-35 with treatment programs including cognitive behavioral therapy, an emphasis on family psychoeducation, social rehabilitation, substance use/abuse and vocational/educational services.  

Wednesday, October 25, 2016
6:00 pm check-in, 6:30 pm start
The Gladly, 2201 East Camelback Road
Phoenix, Arizona

APS Members and Non-Members alike are invited to attend Personalized Medicine for Neuropsychiatric Disorders, an Assurex Health/GeneSight Presentation, Clinical Applications of Psychiatric Pharmacogenomics, presented by Michael V. Genovese, MD, JD, Chief Medical Officer of Sierra Tucson, Acadia Healthcare.  Dinner is provided.  CLICK HERE for a flyer for the event, or CLICK ABOVE to register for the event.  Registration deadline is October 18, 2016.  

In the photograph below, APS Members and Non-Members enjoy the opportunity to connect over the Tucson dinner program at Fleming's Prime in September.  
Valley Hospital, 3550 East Pinchot, Phoenix, Arizona (http://valleyhospital-phoenix.com) is recruiting Psychiatrists for their Inpatient Unit and Adult Psychiatric Program. Position duties include; admission evaluations, daily care of assigned patients in the programs, treatment team leadership and interaction with clinical and other physician staff.
There is opportunity to work as an employed physician with salary and full benefits OR if preferred compensation can be structured as a fee for service independent contractor. Either way there is clinical and administrative support offered to physicians in what will be a patient-centered care and very collegial practice setting. There is also opportunity for program leadership for interested candidates.
CLICK HERE to apply today to join a great group of physicians at Valley Hospital. A private 122 bed free-standing psychiatric facility; Valley Hospital's Psychiatric Services offer a specialized level of care designed to meet the needs of patients who are experiencing various psychiatric and addiction disorders. For more information regarding the Job Duties, Benefits, and working at Valley Hospital, CLICK HERE. If you have questions or would like additional information, please contact Valley Hospital-Phoenix Human Resources at 602-952-3988.
CLICK HERE to Register to Walk or to Donate

October 15, 2016
17th Avenue and Jefferson

NAMI Valley Walk is held to increase awareness in Arizona about mental illness and its devastating effects, to bring Arizona's mental illness community together, and to raise dollars for NAMI's outstanding support and education programs.  If you have always wanted to show your support by walking, or if you want to support the great work that NAMI Arizona does for mental health in the community by donating, click the banner above to register or donate.  Information on the classes, support services, and outreach provided by NAMI Arizona is available at  http://namiaz.com.   
Joseph F.  Abate APS Lobbyist

Joseph F. Abate, Esq.
APS Lobbyist

A large number of Sunrise Applications were submitted for consideration before the September 2016 deadline.  The scope of practice considerations relate to the practice of medicine generally rather than specific to the specialty practice of psychiatry.  The Arizona Psychiatric Society Legislative Committee and Lobbyist will be working with the fellow physician specialty groups in promoting patient safety and proper standards of care affected by any of these proposals.  

The election season is am important time to stay connected and involved. The APS Lobbyist, Joe Abate, is available to assist you in a visit to the Capitol. Developing a personal relationship with the legislative representatives from your voting district is an important part of grassroots advocacy for psychiatry.

If you would like any additional information, please contact the APS Lobbyist, Joe Abate, at 602-380-8337.  If you are interested in being a part of the Legislative Committee of APS, chaired by Dr. Roland Segal, please contact teri@azmed.org

Denver, Colorado, August 2016

Payam Sadr, MD, FAPA
Aaron R. Wilson, MD
Arizona Assembly Representatives

Dr. Payam Sadr and Dr. Aaron Wilson attended the Area 7 Meeting in Denver, Colorado on August 5-7, 2016.  The Colorado Psychiatric Society began the weekend by hosting a reception for CPS members to welcome APA Area 7 Representatives.  The reception was sponsored by American Professional Agency, Inc.  The Area 7 Representatives greatly enjoyed the chance to meet so many of the local psychiatrists.  

Each District Branch from Area 7 presented a report of their current operational, membership, and financial status, legislative concerns, events, and issues relating to mental health in their areas.  The meeting included comments from the APA Regional Field Director, Tim Miller. He discussed, among other things, scope issues as well as molding the job to better fit the priorities of the APA.  Dr. Charles Price gave a report on the APAPAC and the Federal Advocacy Coordinator program. Of note, the Area VII Council is a leader in the percentage of members contributing to the APAPAC. 

May Assembly follow-up included discussion of the following:
14.A APA endorsement of Position Statement in AGLP on Discrimination against LGBT Citizens Based on Arguments of Religious Liberty- Speaker-Elect brought this to the July BoT, where a statement in support was approved.

7.B.3 Assembly Election of Officers - postponed until Nov 2016. Dr Zarling provided a summary of the Areas that have produced the last 12 Speakers. Area 1 - 2 Speakers, Area 2 - 3 Speakers, Area 3 - 0 Speakers, Area 4 - 2 Speakers, Area 5 - 3 Speakers, Area 6 - 1 Speaker, Area 7 - 1 Speaker. Dr. Anzia provided the most recent numbers on the members in each Area that corresponds to voting strength: Area 1 - 4,059, Area 2 - 4,296, Area 3 - 3,976, Area 4 - 4,866, Area 5 - 6,874, Area 6 - 2,957, Area 7 - 3,012.

12.Q Develop an APA Resource Document on Use of Patient Targeted Social Media Searches - JRC referred to Ethics, Council on Psychiatry and the Law, Office of Communications - reports due Oct. 2016.

12.T Protecting Senior Psychiatrists from Mandatory Competency Testing - JRC referred to APA administration to clarify AMA position and report to JRC when the position becomes available.

12.U Psychiatrist Involvement in Euthanasia of Non-terminally Ill - JRC referred to Council on Psychiatry and the Law.

12.Y Develop APA Resource Document Regarding Ethical Tensions Faced by Psychiatric Third Party Utilization Managers - JRC referred yo Ethics Committee and Council on Healthcare Systems and Financing.

12.DD Allow Deputies to Vote - AEC voted to have Procedures Committee draft language for the Assembly to consider.

Area 7 finances were reviewed. Several ideas to control spending were discussed as well as increasing revenue. 

Reviewed issues with Action Papers. Deadline for submission is September 19th.

Upcoming meeting dates and locations for 2016-2017 were agreed upon:
Assembly November 4-6, 2016, Omni Shoreham, Washington DC
Area VII Council meeting March 4-5, 2017 Monaco Salt Lake City, UT
Assembly May 19-21, 2017, San Diego, CA
Area VII Council meeting August 5-6, 2017, Vancouver, BC, CA

Dr. Payam Sadr and Dr. Aaron Wilson will be in attendance at the November Assembly.  In the week preceding the Assembly, an Ethics Workshop will be held.  Dr. Jehangir Bastani and Executive Director Teri Harnisch will attend the Ethics Workshop for the Society.  

Dr. Carol K. Olson of the Arizona Psychiatric Society was one of the more than dozen physicians, behavioral health advocate agency representatives, family caregivers, and others to testify before the AHCCCS Pharmacy & Therapeutics Committee (Committee) at its August 16, 2016 hearing for the purpose of reviewing and prescription drugs and related authorizations for AHCCCS Medicaid, which listing included several groupings of psychopharmacological drugs. The Society sincerely thanks: the Committee for the courtesies extended for allowing this testimony; the other participating physicians, representatives, advocates, patients, and caregivers providing the same; and especially Dr. Olson for her strong testimony on behalf of the Society in advocating for appropriate access to care for Arizona patients. 
After consideration of all testimony and offered statements, the Committee approved fourteen oral antipsychotics along with three long lasting antipsychotic injectables to the statewide drug list without requiring prior authorization effective October 1st. The atypical antipsychotics listing includes: Risperidone tablet, Quetiapine tablet, Risperidone solution, Risperidone ODT, Ziprasidone capsule, Saphris, Olanzapine ODT, Latuda, Clozapine tablet, Clozapine ODT, Abilify tablet, Risperdal Consta, Aristada, Abilify Maintena, Invega Sustenna, and Invega Trinza.  

To receive pharmacy related updates from AHCCCS, you may sign-up for the Pharmacy Updates ListServ

Private Practice Opportunity (Phoenix)

Established outpatient psychiatric practice seeks full-time or part-time psychiatrist. Referral resources well established; scheduling, billing, and collection systems are in place and fully functional.  On-site nurse provides liaison between psychiatrist and clinical patients, and oversees medication refills.  
For questions, contact:  Joel Parker, MD, 602-843-0035, or  joelparker@icloud.com.  

Private Practice Opportunity (Tucson)

Take over patient care and office space of retiring psychiatrist in Tucson Medical Park, by Tucson Medical Center in East Tucson.  Join over-head sharing arrangement for all office services, with established providers: Psychiatrists - Dennis C. Westin, M.D. and Adriana Boiangiu M.D.; Psychologist - Wayne Satten Psy.D.; and Therapist - Julie Westin MSC, LPC.  For more information call 520-795-0309.  

Each month APA makes available a free CME course exclusive to members only through its Learning Center. October's selection is "Childhood Precursors of Borderline Personality Disorder: Why are Childhood Precursors Important?" CLICK HERE for more information.

As part of the Transforming Clinical Practice Initiative (TCPI), APA will offer training to psychiatrists to support practice transformation through nationwide, collaborative, and peer-based learning networks. 
Free training is available to psychiatrists through online modules 
and live training (see Arizona live training information below).  
CME credit is also offered. Content is similar for both training sessions so you may choose to participate in one or the other based on your learning preferences and availability.  
Online Modules - CLICK HERE to get started! There are two parts to the training containing seven modules in all. It is recommended that participants complete both parts 1 and 2.  For a flyer to share with peers, whether member or non-member, CLICK HERE.


CLICK HERE for the full Flyer.  

Session 1 and 2 Live in Phoenix:  University of Arizona College of Medicine, Phoenix (6.0 hours CME)  
REGISTER FOR THE PHOENIX SESSION AT http://aps-integratedcare2016.eventbrite.com 

Session 1 (Only) (3.5 hours CME) available by video broadcast to:

Tucson:  Banner University Medicine Whole Health Clinic
REGISTER FOR THE TUCSON SESSION AT http://aps-tucson-integratedcare.eventbrite.com 

Flagstaff:  Flagstaff Medical Center, McGee Auditorium
REGISTER FOR THE FLAGSTAFF SESSION AT http://aps-flagstaff-integratedcare.eventbrite.com 


The  Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changes the way psychiatrists and other physicians working with Medicare patients will be paid. Some reporting requirements begin as early as January 1, 2017.  The APA has submitted comments to CMS requesting relief from some of the requirements of MACRA as relate to the practice of psychiatry.

MACRA permanently repealed the Medicare SGR formula and set in motion entirely new programs for quality reporting and new payment models. Over 23,000 psychiatrists currently see Medicare patients. These new MACRA programs are also widely expected to have a ripple effect and spur similar efforts by many other payers.  CLICK HERE to access more information about MACRA, the APA free member webinar slides from June 2016, and other important updates.  

Banner Grand Rounds for the Department of Psychiatry Banner-University Medical Center Phoenix have resumed for the year.  For the October Grand Rounds schedule, including presentations on Newer Drugs of Abuse, Collaborative Care: Transforming the Delivery of Healthcare, and The Role of Benzodiazepines in the Treatment of Psychiatric Disorders, CLICK HERE.  Grand Rounds are held in the Medical Education Amphitheatre at Banner UMC Phoenix from 12:00 Noon to 1:00 pm on the scheduled Fridays of the month.  

Southwest Psychoanalytic Society New Biennial Series:  The Enduring Legacy of Psychoanalysis:  Research and Clinical Practice Presented by Professor Alexander Lemma, "Minding the Body: Body Modification, Technology and Sexuality; Transsexual Identity," Saturday, January 14, 2017, 9:00 am to 3:00 pm, at Hacienda Del Sol Guest Ranch Resort, Tucson, Arizona.  CLICK HERE for the flyer; visit http://www.swpsychoanalytic.org for additional information.  

MIHS Aiming for the 100% Club
APS President and Past Presidents Drs. Gurjot Marwah, Tariq Ghafoor, and Michael Brennan, and APS Life Member and RFM Mentor, Dr. Martin Kassell, enjoyed an opportunity to discuss with Maricopa Integrated Health Systems (MIHS) Residents the importance of membership in the APA/APS both now and as they look forward to their early career years.  The MIHS Program is shooting for a three-peat in the APA 100% Club, having attained Silver Status in 2014 and Bronze Status in 2015.  

The APA has provided additional benefits to Resident-Fellow Members beginning with the 2016-2017 membership year.  More information on those benefits will be provided at upcoming residency visits to both the Banner-UMC Phoenix and the University of Arizona College of Medicine Tucson Psychiatric Residency Programs.  

Poster Presentation Invitation to APS Integrated Care Training Event
At the conclusion of the live Integrated Care Training on October 29, 2016, Resident Fellow Members are invited to present posters for scholarship prizes.  CLICK HERE for the Poster Guidelines.  Abstracts should be submitted before October 22, 2016 for consideration.  Contact teri@azmed.org with any additional questions. 

Visit the submission link at:  https://www.surveymonkey.com/r/APSFallPosters2016 and provide the requested authorship information and submit your abstract of 3000 characters or less (including spaces).  Please review the APS Resident-Fellow Member Poster Guidelines for complete information regarding participation and prizes.
We welcome Resident-Fellow Members to present their best work from recent meetings or preview new work.  The submission deadline is midnight on October 22, 2016.  Posters will be juried at the conclusion of the Integrated Care Training.  The posters are welcome to be put up for the full day for viewing by the meeting attendees.  Presenters are required to have the poster on display by 2:30 pm and to be available from 3:00 pm to 4:00 pm to present to the judges.  Each presenter will receive a Certificate of Recognition.  A prize award of $250, $150, and $100 will be awarded to the first, second, and third place poster presenters, respectively. 

Kaffe Klatch Continues (First Tuesday of the Month):  Tuesday, November 1, 2016 at 7 pm
Hosted at the home of Dr. Martin Kassell, 5613 East Lewis, Scottsdale, Arizona, 
at Kaffe Klatch, Residents, Early Career, General, Fellows, and Life Psychiatrists Gather for coffee, wine, treats, and the exchange of ideas.  
Members and Non-Members of Arizona Psychiatric Society are welcome!  No need to feel alone in the practice of psychiatry-connect with your peers at Kaffe Klatch!
CLICK HERE for a flyer to share with your peers.  Hope you can be there.

June 11, 2016
Las Vegas, Nevada

Brian Espinoza MD
Interventional Psychiatry
APS Continuing Medical Education Liaison

ISEN continues to grow and had the largest turn out ever this year.  The morning was spent with presentations on the topic of preventing relapse after an initial series of ECT or TMS (Maintaining Remission Following ECT for Depression: Psychopharmacological Approaches, Ultra Brief Pulse Right Unilateral ECT, Maintenance ECT for Patients with Clozaril-Resistant Schizophrenia, Long-Term Outcomes with TMS Therapy, and THM).  These are a series of conferences that are attended in order to help appreciate the overlap between Psychiatry and Neurology.   I attended the June 11th session at the Lou Ruvo Center for Brian Health in Las Vegas. CLICK HERE for the full report, including interesting points from presentations on:  Breakthroughs in Neurocognitive Dysfunction in White Matter Disease, Multiple Sclerosis (MS); Vascular White Matter Disease; CADASIL: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy; Dementia with Psychotic Symptoms; Differentiating Movement Disorders with Cognitive Dysfunction; Chronic Traumatic Encephalopathy: Hot Topic or Hot Mess; The Professional Fighter Brain Health Study; MRI in Dementia; and PET in Dementia.  

There are currently a dozen trials looking at neuroimaging, biomarkers, and treatment of Alzheimer's Disease underway at the Cleveland Clinic Lou Ruvo Center for Brain Health.

If I provide additional insights to any of the above, please contact me at BrianEspinozaMD@gmail.com.

September 2016
Robin T. Reesal MD, Psychiatrist in Liberia

In the next few paragraphs, I briefly explore how social media is woven into the fabric of today's society and how it effects mental health. 

What is social media? 

One way to find out is to do a Google search, "what is social media?" The top three answers on August 18, 2016 are as follows. "Computer based tools that allow people, companies and other organizations to create, share, or exchange information, career interests, ideas, and pictures/videos in virtual communities and networks." https://en.wikipedia.org/wiki/Social_media 
"Social media is a phrase that we throw around a lot these days, often to describe what we post on sites and apps like Facebook, Twitter, Instagram, Snapchat and others....The term is used so vaguely that it can basically be used to describe almost any website on the internet today." http://webtrends.about.com/od/web20/a/social-media.htm - by Daniel Nations
"A term used to describe a variety of Web-based platforms, applications and technologies that enable people to socially interact with one another online. Some examples of social media sites and applications include Facebook, YouTube, Del.ici.us, Twitter, Digg, Blogs and other sites that have content based on user participation and user-generated content." http://www.webopedia.com/TERM/S/social_media.html - by Vangie Beal 

In my view, social media is a form of real time on line communication that disseminates mostly non-erasable information. 
Person to person verbal communication vs Internet communication 

Verbal and internet communication involve an exchange of auditory and/or visual ideas between individuals or groups. Both can be sensory by touching a person or screen. 
Internet communication reaches people quickly. It's original content remains the same after pushing the send key. A verbal conversation changes with person-to-person transmission. Our memories of conversations, unless recorded, fades. By contrast, Internet communications are difficult to eliminate.
Many may recall the famous quote from Christopher Marlowe's Dr. Faustus about Helen of Troy, "Was this the face that launched a thousand ships? ..." Written Greek mythology is quoted today. The written words of the bible are quoted today. Social media postings are long lasting but not usually as profound.
Once sent, it is hard to recover a social media message. Reverting to "That is not what I meant..." is often not an option. There is a precise recording. It is tough to undo a cc'd name after sending a message.
Ironically, low technology communication offers more privacy. A hand written delivered note is more confidential than one written on a computer and delivered by email. A "private" email conversation can become public, as experienced by a presidential candidate. 

With a verbal misunderstanding one can say, "I thought I heard or I meant to say..." It is up to the two people in the room to decide what was said and what was meant." Once a conversation, visual or verbal occurs on social media many can join in. Participants make their own judgment about the content and judge the discussants accordingly. Public participation in daily living is more common with social media. People post selfies and life experiences for family, friends and others. 

With real time transmission, it is hard to stop a picture you did not want taken. A quick picture or video from a smart phone can change a person's life for better or for worse, whether intended or not. Employers search social media for data on potential employees and their already hired employees. Customer, colleagues, family and friends are affected by postings. Friendships and jobs can be lost over a posting from years past. A person can create a false image of themselves with Internet know how. 

Instant action

Social media offers instant global access. The use of mobile phones has quickly exposed police actions, civil unrest and war scenes. Sports figures, entertainers and politicians are using social media to send their thoughts around the world. Groups with a cause can send their message rapidly to millions of people. Lives can be saved with social media. Social media has been used for police work and medical emergencies. Health companies are growing rapidly using social media to the benefit of their patients. Online education with interactive chats are standard now. 
Social media and mental health 

Some are addicted to the Internet and social media. They neglect "real life" for an "alternate reality". They have friends both places. The BBC recently interviewed a therapist who explained a rise in erectile dysfunction among young men due to watching too much pornography http://www.bbc.co.uk/newsbeat/article/37058019/easy-access-to-online-porn-is-damaging-mens-health-says-nhs-therapist.
Antisocial personality disorders make up one percent of the population Social media provides a forum to misuse and manipulate others. They can set up fake websites to steal money. They can present themselves on dating sites and they can lure others into danger. Theft and resale of personal information is a publicized crime. 
About ten years ago, I was involved in study about patients sharing mental health information to a computer and a health professional. The data showed comfort either way. As far back as 1997, Dr. Ken Kobak and others published an article in Psychiatric Services showing the validity and acceptability of diagnostic psychiatric interviewing using a computer. Small and large companies track, buy and sell personal information. Given this reality, it is difficult for a mentally unwell person to appreciate the ramifications of partaking in social media. 

Poor impulse control can lead to problems with social media. The manic patient can go on an online spending spree or access sites with high sexual content. They can express unacceptable thoughts in public forums. When under the influence of a substance, a person can reveal information they regret. When angry a patient can misuse websites to harm others or themselves. An actively psychotic person with paranoid delusions can be swayed into damaging actions on a social media site. 

Clearly social media can help distressed people and provide valuable knowledge. However, there are minimal safeguards validating the information reviewed. 
Teens and social media 

Teenage brain development is uneven. The parts involved in strong emotions develop faster than parts controlling emotions. This imbalance leaves teens vulnerable to making regrettable online postings. http://www.nimh.nih.gov/health/publications/the-teen-brain-still-under-construction/index.shtml

Online bullying is a problem associated with teen suicides. Sadly, unlike bullying in a schoolyard, Internet bullying is rapidly shared and remains online for years. When severely humiliated in this medium, there is a sense that "everyone knows". Most teens live in a social media world for hours daily. A teen can feel they cannot escape their shame. Decreased impulse control and social isolation increases a teen's vulnerability to destructive acts against themselves or others. 

Final words

Social media is now an ingrained pattern of behavior among users. By definition, it is part of human personality. Social media is changing how we live, think, behave and feel. Reality is becoming relative term. 

This link is an example of the power of social media - the injured Aleppo, Syrian boy post airstrike.


Please note the links provided are for information purposes only and do not represent an endorsement of the site or its content.

Saturday, May 6, 2017
Marriott at The Buttes Tempe
2000 West Westcourt Way

APS Members, we will open early registration soon so you can save your spot for the Arizona Psychiatric Society 2017 Annual Meeting on Saturday, May 6, 2017, at The Marriott at The Buttes, 2000 West Westcourt Way, Tempe, Arizona.  The Planning Committee is excited to report that this meeting will feature keynote presentations on Dialectical Behavior Therapy from Melanie Harned, Phd, ABPP of the Linehan Institute, Behavioral Tech Research.  

Dr. Harned currently works as a Research Scientist in the Department of Psychology at the University of Washington and is the Research Director of Dr. Linehan's clinic. Since 2005, she has been Co-Investigator with Dr. Linehan on her NIMH- and NIDA-funded research as well as Principal Investigator on her own NIMH-funded research focused on the development and evaluation of a protocol to treat PTSD during DBT. 

Dr. Harned also currently works as the Director of Research and Development for Behavioral Tech, LLC as well as the Director of Behavioral Tech Research Inc. In these positions she develops and evaluates methods of disseminating and implementing evidence-based treatments into clinical practice. Dr. Harned has published numerous journal articles and book chapters and she regularly lectures and leads trainings both nationally and internationally.