Syllabus & Proceedings - #APAAM21 Finding Equity Through Mind & Brain - American Psychiatric Association
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Finding Equity Through Mind & Brain
Syllabus &
Proceedings
#APAAM21General Sessions well) and establish preventative care wherever
possible (stay well).
Saturday, May 01, 2021
Advancing Ethics and Equity in Psychiatry:
A New Narrative for Behavioral Health: Eliminating Perspectives From the Royal College of Psychiatrists
Defects and Promoting Value Chair: Saul Levin, M.D., M.P.A.
Chair: Patrick S. Runnels, M.D. Presenters: Adrian James, M.D., Gertrude
Presenters: Heather M. Wobbe, D.O., M.B.A., Jeanne Seneviratne, M.B.B.S., Wendy Katherine Burn, M.D.,
M. Lackamp, M.D. Kate Lovett, M.D., Paul Rees
EDUCATIONAL OBJECTIVES: EDUCATIONAL OBJECTIVES:
At the conclusion of this session, the participant At the conclusion of this session, the participant
should be able to: 1) Define defect-free behavioral should be able to: 1) Apply quality improvement
healthcare; 2) Define key leadership principles to strategies to improve clinical care.; 2) Provide
promote value in behavioral health; 3) Discuss and culturally competent care for diverse populations.;
debate process and outcome metrics opportunities; 3) Describe the utility of psychotherapeutic and
4) Identify Structural Metrics that need to be put pharmacological treatment options.; 4) Integrate
into place to capture value; 5) Consider barriers to knowledge of current psychiatry into discussions
taking a value-based approach to Behavioral Health. with patients.; 5) Identify barriers to care, including
health service delivery issues..
SUMMARY:
The past ten years has seen significant growth and SUMMARY:
evolution in value-based payment models, many In recent years, examples have occurred of
ushered in by initiatives contained in the Affordable psychiatrists and psychiatric bodies involving
Care Act (ACA) and expanded upon by subsequent themselves with local processes of reconciliation as
legislation and policy at the Federal and State well as in advocacy for the rights of mental health
level. Despite the accumulation of evidence and psychiatric care users. The RCPsych’s
supporting a growing number of quality measures, Professional Practice and Ethics Committee has
behavioral health care has lagged behind other developed a guide for psychiatrists, and the Royal
health disciplines both in utilizing system-wide College of Psychiatrists is also working with the UK
metrics to guide evidence-based care and in government to change mental health policies in
adequately distributing data to frontline clinicians order to improve the rights of mental health
for use in supporting quality improvement and patients. Presentations in this session will address
enhancing value. In order to improve value, systems psychiatrists’ and Psychiatry’s role and responsibility
should seek to eliminate defects in behavioral in the process of preventing and engaging with
healthcare. A defect framework should have three current, as well as remembering and reconciling
parts: creating and promoting a vision for defect- past, human rights abuses in mental health and in
free care, designing analytics to guide how care the community.
should be delivered, and then making defects that
impede expected outcomes visible and improving At the Interface of Science and Society: Integrating
them. To carry out these tasks, leadership Neuroscience Into Modern Psychiatry
must support culture change across the entire Chair: David Ross, M.D.
continuum of care to both break down silos and Presenters: Melissa Arbuckle, M.D., Ph.D., Joseph
enhance value. At the same time, frontline clinicians Cooper, M.D., Michael Travis, M.D., Ashley E. Walker,
must embrace the role of system engineer to M.D.
shepherd this process. An ideal system should work
to not only help people get better from acute illness, EDUCATIONAL OBJECTIVES:
but also manage chronic disease effectively (get At the conclusion of this session, the participant
should be able to: 1) Appreciate the relevance ofcutting-edge neuroscience to the future of Examine outcome measures of LT response that are
psychiatry; 2) Describe different approaches for relevant to patients with BD, remission rate,
integrating neuroscience education into classroom depression scores, functioning, sleep quality,
teaching, clinical settings, and for self-study; 3) chronotype, seasonality, functioning and polarity
Describe key neurobiological findings relating to a switch.; 3) Explore putative novel visual and neural
selected clinical topic. biomarkers of response to bright light therapy.; 4)
Discuss approaches in the management of
SUMMARY: antidepressant therapy in perinatal women, given
Psychiatry is in the midst of a paradigm shift. While the study findings on changes in antidepressant
the diseases we treat are increasingly understood in concentration across pregnancy and postpartum.; 5)
terms of the complex interactions between genetic Reflections on a rewarding career path in psychiatry:
and environmental factors and the development and pursuits in research, clinical care, education and the
regulation of neural circuitry, most psychiatrists have advocacy of women’s mental health..
relatively minimal knowledge of neuroscience. This
may be due to many factors, including the difficulty SUMMARY:
of keeping pace with a rapidly advancing field and a Patients with bipolar disorder (BD) often have major
relative dearth of accessible educational resources. depressive episodes and residual symptoms.
Nonetheless, it is crucial that practicing clinicians Antimanic drugs improve depressive symptoms in
learn to embrace a modern neuroscience only one-third of patients. Antidepressant therapy
perspective. New research is already translating into pose risks for hypomania and rapid cycling. Given
a range of immediate clinical applications: from the limited options, developing new treatments for
improved diagnostic tests (e.g. via chromosomal bipolar depression is a high-priority concern. Bright
microarray testing for Autism Spectrum Disorders) to light therapy (LT) is a circadian based intervention
new medications (e.g. brexanolone for post-partum that can improve mood symptoms even in cases in
depression) and interventional approaches (e.g. which disruption in circadian rhythms is not the
deep brain stimulation for obsessive-compulsive primary cause. We conducted a dose-finding,
disorder). A neuroscience perspective can also offer preliminary safety and efficacy study of morning LT
insight into some of the most important in women with stable bipolar depression.
contemporary societal issues – such as the impact of Unexpectedly, morning LT induced hypomania in 3
police violence on communities of color and other of 4 patients. A careful literature review and
forms of structural racism. In this session we will consultation with experts informed our decision to
briefly review findings that highlight the importance adjust the protocol and implement LT at midday.
of integrating a neuroscience perspective into Three of 5 subsequent patients reported a full
modern clinical care. We will then offer an response and one responded fully after transitioning
individualized educational activity that illustrates a to morning light. Building on our findings, we
contemporary approach to online learning and conducted a 6-week placebo controlled RCT to
introduces a framework for ongoing engagement confirm the efficacy of adjunctive midday bright LT
with cutting-edge neuroscience. for bipolar depression. In the first part of the talk, I
will address 3 objectives: 1, Discuss the known and
Bright Light Therapy for Treatment of Bipolar novel clinical indications of bright LT particularly for
Disorder treatment of SAD, non-seasonal MDD, perinatal
Presenter: Dorothy Sit, M.D. depression and sleep/wake phase disorders. 2.
Examine outcome measures of LT response that are
EDUCATIONAL OBJECTIVES: relevant to patients with BD, remission rate,
At the conclusion of this session, the participant depression scores, functioning, sleep quality,
should be able to: 1) Discuss the known and novel chronotype, seasonality, functioning and mood
clinical indications of bright light therapy particularly polarity switch. 3. Explore putative novel visual and
for treatment of SAD, non-seasonal MDD, perinatal neural biomarkers of response to bright LT. The
depression and sleep/wake phase disorders.; 2) focus of my research encompasses studies of thephenomenology, pathophysiology and Then the central features of CBT methods for suicide
pharmacologic responses in women across the life risk will be demonstrated. Role-play demonstrations
cycle. I have contributed studies on changes in will illustrate key points. Particular attention will be
antidepressant concentrations across pregnancy. paid to development of the CBT elements of safety
These studies illustrated that the mean plasma planning in a depressed patient.
concentration-to-dose (C/D) ratios for sertraline,
fluoxetine (FLX) and Citalopram / escitalopram Dieting to Win, Be Thin, and Feel Comfortable in
(CIT/esCIT) decrease in the second and third My Own Skin: Disordered Eating in Athletes
trimesters, presumably from hepatic metabolism Chair: Ryley Paul Mancine
induction. In pregnant women treated with CIT, the Presenters: Samantha F. Kennedy, D.O., Shea D.
parent drug and metabolite decreased between 20 Repins
weeks gestation and delivery and returned to
baseline at 12 weeks postpartum. The significant EDUCATIONAL OBJECTIVES:
negative relationship between depression scores At the conclusion of this session, the participant
and dose-corrected S-FLX (P=0.008) and chiral should be able to: 1) Understand the signs and
parent drug concentrations (S-FLX + R-FLX; P= 0.021) symptoms of disordered eating, including those of
suggest a need for increased dosing as which may be most concerning.; 2) Recognize the
concentrations diminish in the 2nd half of epidemiology of disordered eating behaviors in
pregnancy. These findings have shaped recent athletes, and subsequently be able to identify
changes in clinical practice and informed the patients who are at the highest risk.; 3) Identify
development of advanced pharmacokinetic studies methods which can be utilized within the community
of antidepressants in pregnancy. Objective 4. Discuss to recognize and potentially reduce disordered
approaches in the management of antidepressant eating behavior.; 4) Describe the developing
therapy in perinatal women, given our study research from Michigan State University – the
findings. Objective 5. Reflections on a career path in Disordered Eating Screen for Athletes (DESA-6) – and
psychiatry: pursuits in research, clinical care, know how it can be used to identify disordered
education and the advocacy of women’s mental eating quickly.; 5) Exercise intervening and providing
health. nutritional counseling to simulated clinical case
patients, which can then be implemented into a
Cognitive-Behavior Therapy for Reducing Suicide physicians’ practice..
Risk
Chair: Donna Sudak, M.D. SUMMARY:
Presenters: Jesse H. Wright, M.D., Judith Beck, Ph.D. Disordered eating (DE), a subclinical spectrum of
eating disorders, has a dramatically increased
EDUCATIONAL OBJECTIVES: prevalence in athletes. It has been linked to stress
At the conclusion of this session, the participant fracture, menstrual cycle dysfunction, and mood
should be able to: 1) Assess and modify disturbances and is a major component of both the
hopelessness and suicidal thinking with CBT Female Athlete Triad and Relative Energy Deficiency
principles; 2) Describe research that supports CBT in Sport (RED-S) syndrome. DE may progress to a
for reducing suicide risk; 3) 3. Implement CBT- clinical eating disorder (ED), which has one of the
oriented safety plans with at-risk patients. highest mortality rates of all mental illnesses. An
extremely large number of athletes are at risk for the
SUMMARY: development of DE, including adolescents, young
CBT approaches to the suicidal patient have been adults, college athletes, and professionals.
proven to reduce rates of future attempts. Active Individuals participating in lean-type sports may be
and collaborative work to reduce hopelessness and at an even higher risk. Though many athletes
specific anti-suicide plans are important features of develop disordered eating in an attempt to increase
this approach to patients. This workshop will briefly performance within their sport, in reality DE is linked
review research on CBT for treating suicidal patients. with decreased athletic achievement. DE issubsequently associated with a prolonged return-to- the current expansion of TA and training through
play duration. Luckily, there are methods to which numerous initiatives..
DE can be identified and strategies which have been
shown to be protective against the development of SUMMARY:
DE. For example, coaches have the opportunity to Educating and supporting the mental health
encourage protective behaviors (such as motivation workforce is a challenge that has only increased as
or enthusiasm) rather than focusing on shape or the workforce shrinks and new methods are
weight. Nutritional counseling for athletes has also required by the “new normal.” SAMHSA supports
shown to be effective in halting the progression from initiatives that provide ongoing, free support of the
DE to ED. If mental health professionals and general workforce that can be useful to junior and senior
physicians were able to provide actionable changes, clinicians. The Centers work to accelerate the
such as nutritional counseling and small adoption and implementation of evidence-based
environmental modifications, individuals with DE practices in mental health services across our nation;
would potentially have a lower risk of progressing to foster regional and national alliances among
deadly EDs. Additionally, recent research from our culturally diverse practitioners, researchers, policy
lab at Michigan State University has been directed at makers, family members, and consumers of mental
developing the Disordered Eating Screen for Athletes health services; and ensure the availability and
(DESA-6), which would serve as a much more rapid, delivery of publicly available, free of charge, training
easy, and cheap way of identifying DE. In adolescent and technical assistance to the mental health field.
populations, the DESA-6 has shown an area under This session will provide an overview of the
the ROC curve (AUC) of 0.892, a sensitivity of resources available and highlight two Centers: The
92.00%, and a specificity of 85.96% with a sample Mental Health Technology Transfer Centers and SMI
size of 308 initial participants. During our session, we Adviser.
will provide participants with an audio-visual
infographic regarding the demographics and Empathy, Therapeutic Rapport, and Military
epidemiology of DE, provide sample cases of Service: How Our Personal Journey Into Psychiatry
individuals struggling with DE behaviors, and engage Impacts Our Practice
in small group sessions where we encourage teams Chair: Jerry Trotter, M.D.
to come up with “next steps” regarding nutritional Presenters: Hamid R. Tavakoli, M.D., Eric Luehrs,
counseling and DE intervention. M.D., Johnathan Heller, M.D., Matthew McGirr, M.D.
Educating and Supporting the Mental Health EDUCATIONAL OBJECTIVES:
Workforce At the conclusion of this session, the participant
Chairs: Anita Everett, M.D., Humberto Carvalho, should be able to: 1) Appreciate how physician
M.P.H. experiences impact therapeutic rapport; 2) Apply
Presenters: Tristan Gorrindo, M.D., Amy Cohen, psychological principles to engaging with special
Ph.D., Heather Gotham, Ph.D. populations, such as veterans; 3) Gain insight into
the impact prior combat exposure has on mental
EDUCATIONAL OBJECTIVES: health engagement; 4) Appreciate the role previous
At the conclusion of this session, the participant military service may play in developing a therapeutic
should be able to: 1) Explore the framework of alliance; 5) Develop and incorporate military-specific
SAMHSA’s current TA and training initiatives, their knowledge to enhance patient buy-in to treatment
areas of focus, what they can provide to whom, how of patients with military history, effecting improved
they work synergistically, and the organizations that treatment compliance and quality outcomes..
lead them.; 2) Identify resources within these
initiatives which can assist clinicians in the SUMMARY:
implementation of evidence-based practices.; 3) Meet the patient where they are. A common refrain
Understand the difference between the current in the discussion of therapeutic interventions,
approach and SAMHSA’s previous TA approach and especially in mental health, which takes on specialsignificance in the treatment of patients with participants will be afforded an opportunity to speak military service history. Psychiatrists, psychologists, with wartime veterans who later became mental and allied providers may perceive their lack of health professionals to explore specific topics in military experience as creating a barrier to providing greater detail. The speaker session will include optimal patient-centered care. Patients report military psychiatry senior residents with prior baseline assumptions that their providers will combat experience and the lead consult-liaison neither understand, nor value their military psychiatrist from one of the military’s largest experiences. At the nexus of these assumptions, teaching hospitals. building a therapeutic alliance can be difficult and patients may choose not to follow-up despite Enhancing Use of the DSM-5 Outline for Cultural recommendations for evidence-based care. A Formulation: Linking Social Determinants of Mental hallmark of successful mental health delivery is Health to Structural Competency Through V Codes closing this gap and establishing genuine, intimate Chair: Francis G. Lu, M.D. communication, underscored by empathy both Presenters: Helena Hansen, M.D., Ph.D., Lise Van offered by the provider and recognized by the Susteren, M.D., Merrill Rotter, M.D. patient. While a core feature of evidence-based treatment for most psychiatric morbidity includes EDUCATIONAL OBJECTIVES: highly standardized, templated psychotherapy, we At the conclusion of this session, the participant must always ask if previous research results are should be able to: 1) Understand the use of the generalizable to our treatment population. In DSM-5 Outline for Cultural Formulation as a method treating military-affiliated patients including their of scanning for social determinants of mental health family members, the ability to personally relate to (Part C).; 2) Understand the use of the DSM-5 wartime and deployment experiences based on Outline for Cultural Formulation as a method of military service prior to becoming a physician linking social determinants of mental health to V provides an inherent sub-cultural keystone to the codes (Part E).; 3) Understand the use of the DSM-5 therapeutic alliance, providing emotional validation Outline for Cultural Formulation as a method of through knowledge and experience. The intensity of using V codes as part of the diagnosis to activate the military camaraderie assumed by many patients structural competency methods in the treatment implies a seemingly automatic assumption of plan (Part E).; 4) Understand how a system of care meeting the goals of each of Kohut’s three identified (New York State Office of Mental Health) has begun self-object needs; the prior-military physician in to influence use of the social determinants of mental speaking with a veteran assumes the role of an health to improve diagnosis and treatment idealized veteran, one who offers kinship while planning.. representing a role model, having become a physician as our patients perceive it in spite of, SUMMARY: though perhaps actually because of the challenges of Clinicians are increasingly called upon to incorporate military service. Rather than avoiding the unknowns social determinants of health/mental health in their of military-related patient scenarios, participants in formulation and treatment planning to prevent this session will learn to more confidently address misdiagnosis and mistreatment so as to provide this subset of patients through a presentation of optimal clinical care (Holmes, 2020). This attention is cases highlighting challenges and accommodating also driven by fiscal and public health priorities as techniques utilized. Participants will further gain well as considerations of health equity and social improved understanding of their colleagues with justice. This general session equips clinicians to military experience, in part to dispel common enhance their use of the DSM-5 Outline for Cultural misconceptions. Additionally, participants will have Formulation by linking social determinants of mental the opportunity to reflect on their own experiences health to structural competency in the treatment within a framework of refreshing their motivations plan by greater use of V codes that can be part of for practice and better understanding their approach the medical record. First straw polling will be used at to patient care. After case highlights and discussion, the start of the session to assess participants’
knowledge of these concepts. Second, a didactic Chair: Ramotse Saunders, M.D.
lecture will outline how these major concepts can be Presenters: Tobias Marton, M.D., Ph.D., Robert
synergistically linked through the DSM-5 Outline for Estrada, M.D., Richard A. Bermudes, M.D.
Cultural Formulation. Brief case presentations
involving two social determinants of mental health— EDUCATIONAL OBJECTIVES:
discrimination (Hansen, 2018) and climate change At the conclusion of this session, the participant
(Dumont, 2020)—will illustrate the value of routinely should be able to: 1) Describe the evidence
assessing for social determinants of mental health as supporting transcranial magnetic stimulation in the
part of the use of DSM-5 Outline for Cultural treatment of major depressive disorder; 2) Describe
Formulation to include appropriate V codes so that the evidence supporting electroconvulsive therapy in
structural competency (Hansen, 2018) can be the treatment of major depressive disorder; 3)
activated as part of the treatment plan. Finally, a Describe the evidence supporting ketamine in the
brief didactic lecture will present how the New York treatment of major depressive disorder; 4) Appraise
State Office of Mental Health, one of the most patient-selection criteria, and propose timing of a
complex in the country, has begun to influence particular interventional approach; 5) Discuss access
policy and program at the statewide and local level limitations to interventional psychiatry treatments.
to address social determinants for both individual
clients and the community-at-large (Rotter, 2020). SUMMARY:
Panel discussion with the participants will address A sizeable proportion of patients with major
questions and comments. The DSM-5 Outline for depressive disorder do not achieve an adequate
Cultural Formulation provides clinicians with a response with pharmacotherapy. For the Treatment-
clinical tool for assessing information about cultural resistant depression population, a number of FDA-
features of an individual’s mental health problems approved/cleared alternatives now exist, including
and how it relates to a social and cultural context Electroconvulsive therapy (ECT), Transcranial
and history. Part C entitled “Psychosocial stressors Magnetic Stimulation (TMS), and Ketamine-based
and cultural features of vulnerability and resilience” treatments. As a result, These options engender
asks the clinician to “Identify key stressors and clinical dilemmas: While consensus guidelines exist
supports in the individual’s social environment which should ideally be a next-step treatment, and
(which may include both local and distant events)…” in which patient? Can they be combined? Are there
which include the social determinants of mental predictive phenotypes? What about clinically-
health. Part E entitled “Overall cultural assessment” available biomarkers? Are there age and gender
asks the clinician to “Summarize the implications of considerations? What about response, efficacy and
the components of the cultural formulation… for durability? There is also the access dilemma: Which
diagnosis and other clinically relevant issues or of these treatments can my patient afford? This
problems” that are the V codesdescribed in DSM-5 presentation will begin with concise overviews of
as “other conditions and problems that may be a these modalities, putative mechanisms of action,
focus of clinical attention.” Relevant to the social and their clinical indications. Short didactics will be
determinant of mental health of discrimination is used to provide a high-yield review of key
“V62.4 Target of (Perceived) Adverse Discrimination publications relevant to each modality. Case
or Persecution” and for climate change, “V62.89 examples will highlight clinical phenotypes and
Other Problem Related to Psychosocial treatment ‘red flags’. With each of these modalities,
Circumstances.” Through increased use of these V there is a compromise between beneficial effects
codes, the social determinants of mental health will and tolerability. A proposed interventional
be included in the diagnosis so they can be treatment algorithm (decision tree) will be
addressed in the treatment plan through structural presented. Combination therapy will be discussed.
competency methods. The faculty will then present data as well as
experience-based vignettes on access and access
Equity and Building an Interventional Treatment challenges across treatment systems including
Decision Tree university-based, VA-based, private sector and publicsector. Models of public/private partnership will be EDUCATIONAL OBJECTIVES:
explored. The effects of equity issues on the At the conclusion of this session, the participant
treatment algorithm will be discussed. This will should be able to: 1) At the end of this session,
include multifactorial contributors to disparate participants will be able to describe the roles and
access to care, system-of-care barriers, and patient- functions of the APA Ethics Committee.; 2) At the
related concerns. Our faculty bring considerable end of this session, participants will understand how
experience in all of the aforementioned modalities to identify and address the ethical issues raised by
and work in the aforementioned clinical contexts. participant case presentations and questions.; 3) At
Additionally there is expertise in clinical, research the end of this session, participants will gain
ethics, and neuroethics. At the conclusion of the appreciation of central ethical topics of importance
session, practitioners will have increased insight into to practicing psychiatrists..
the appropriateness of a particular interventional
approach. Attendees will acquire tools with which SUMMARY:
they can make evidence-based interventional This workshop will be entirely devoted to the APA
treatment choices for TRD. They will also be Ethics Committee members’ taking questions from
conversant with regard to access challenges, and the audience on ethics dilemmas they have
oriented toward potential workarounds. encountered, participated in, or read about.
Audience interaction will be encouraged, and
Equity, Ethics, and Future Directions in ensuing discussions will be mutually driven by
Telepsychiatry audience members and Ethics Committee members.
Chair: Avrim B. Fishkind, M.D. All questions related to ethics in psychiatric practice
Presenters: Avrim B. Fishkind, M.D., Gonzalo J. Perez- will be welcomed. Possible topics might include
Garcia, M.D. boundary issues, conflicts of interest, confidentiality,
child and adolescent problems, dual agency conflicts,
EDUCATIONAL OBJECTIVES: acceptance of gifts, emergency situations, trainee
At the conclusion of this session, the participant issues, impaired colleagues, and forensic matters.
should be able to: 1) Recognize inequities in the Questions may not relate to any pending ethics
delivery of telepsychiatry; 2) Define ethical complaints.
challenges in telepsychiatry; 3) Identify future areas
of expansion in the use of technology in psychiatry. Ethnopsychopharmacology
Chair: William Bradford Lawson, M.D., Ph.D.
SUMMARY: Presenters: Daniel Y. Cho, M.D., Rahn K. Bailey, M.D.
This session will provide an overview of three topics
in telepsychiatry in the changing landscape of the EDUCATIONAL OBJECTIVES:
Covid Pandemic and growing acceptance of At the conclusion of this session, the participant
telepsychiatry as the norm. As clinicians seek should be able to: 1) Recognizing the biologic and
to more quickly offer remote visits, it is imperative social determinants in ethnopsychopharmacology; 2)
that they be aware of the issues of equity, ethics and Understanding there are ethnic differences in
technological advancement in the field. psychopharmacologic drug metabolism; 3) Realizing
Telepsychiatry continues to offer great opportunity that special care must be taken with side effect
for psychiatry to expand it's importance throughout profiles when different ethnic groups are
integrative care and geographical territory. considered; 4) Acknowledging the disparity in
minority groups in relation to, access to care, and
Ethical Dilemmas in Psychiatric Practice stigma involved in seeking care and
Chair: Rebecca Brendel, M.D., J.D. psychopharmacologic treatment.
Presenters: Charles Dike, Daniel J. Anzia, M.D., Tia
Patricia Powell, M.D., Philip Candilis, M.D., Richard P. SUMMARY:
Martinez, M.D. In this presentation, we will discuss the factors in
which ethnicity plays a role in psychiatricpharmacological treatment. It is important to be At the conclusion of this session, the participant
aware of these points as they affect patient should be able to: 1) 1. Summarize the state of the
outcomes for these specific groups. Today we will be early psychosis field in terms of effective
focusing on the biological considerations, as they interventions/services promoting long-term
relate to the pharmacokinetics and recovery.; 2) 2. Describe new models of digital
pharmacodynamics of various medications. interventions designed to be linked to clinical
Furthermore, the panel will touch upon the cultural services.; 3) 3. Identify the pitfalls of existing online
and social factors that contribute to varied clinical mental health interventions..
outcomes of ethnic populations. The audience will
be informed of the mechanisms that underlie SUMMARY:
dissimilar reactions in different racial groups. For Sustained social and vocational recovery are the
instance, there are Ethnic differences in allele ultimate goals of first episode psychosis (FEP)
expression of subsets of cytochrome P450. This services and the most valued outcome by young
encompasses enzyme inhibition, induction, genetic people and their families. Yet, follow-up studies have
polymorphism or duplication in coding regions of indicated that treatment benefits of early psychosis
these enzymes; both psychotropic and non- services are not sustained and therefore functional
psychotropic medications may be metabolized at and social recovery is often not fully realised. The
different rates in different ethnicities. Speakers will recognition of these limitations has brought about a
explore the different comorbidities that are seen in renewed focus on treatment approaches focused on
certain minority populations including African improving long-term recovery from early psychosis.
Americans, Hispanic Americans and Asian Along with studies evaluating psychosocial
Americans. These predispositions must be taken into interventions focused on preventing relapse and
consideration when choosing the optimum fostering social and vocational recovery, three
antipsychotic to administer to minority groups. The recent clinical trials have evaluated the effects of
speaker will then consider cultural-economic extending the duration of specialist support, with
differences in relation to how mental health and mixed findings. Recent psychological models have
psychopharmacology is viewed. It has been shown proposed self-efficacy, intrinsic motivation and
that different ethnic groups in the United states positive emotions as important targets to promote
have varying attitudes towards seeking psychiatric social functioning in psychosis. Strengths- and
care and starting psychopharmacologic treatment. In mindfulness-based interventions have been put
this session we will also highlight the misconceptions forward as key interventions, with preliminary
and stigma maintained by various minority studies supporting their potential to improve social
populations. The panel will speak on access to care functioning in psychosis. Similarly, self-
and how that contributes to African Americans and determination theory posits that interventions
Hispanics having longer courses and greater addressing the basic psychological needs of
disabilities as a result of their mental illness. We will competence, autonomy and relatedness will
numerate the current practices that are employed, increase engagement and improve overall
and how we can continue to rectify some functioning. A promising and potentially cost-
disadvantages that different ethnic populations face effective alternative to extending the duration of
in regard to psychopharmacologic treatment. specialist FEP services is to provide lower intensity,
maintenance treatment following the initial 2 years
Harnessing Digital Technology to Bring About Long- of specialist support. Online, mobile and social
Term Recovery in First Episode Psychosis media-based interventions provide a novel avenue
Chair: Mario Alvarez-Jimenez, Ph.D. to offer young people lower intensity, effective,
Discussants: Tristan Gorrindo, M.D., John Torous, sustainable and scalable support beyond discharge
M.D. from specialist FEP services. Drawing on our previous
interventions in preventing relapse and improving
EDUCATIONAL OBJECTIVES: vocational attainment in FEP, combined with novel
approaches to social recovery (strengths andmindfulness-based approaches) and the principles of pseudonym Dr. Henry Anonymous, disguised in a
self-determination theory, our team developed a mask and using a voice modulator. His riveting
world-first digital intervention (Horyzons) designed testimony started a process that resulted in member
to foster long-term recovery in FEP. Horyzons blends approved DSM change. The lecture is a history of
evidence-based models of social functioning, relapse one of the most remarkable chapters in psychiatric
prevention and vocational recovery in a wrap- and American civil rights history
around social media therapeutic environment
supported by peer workers as well as clinical and Ketamine for Depression: Is the Hype Holding Up?
vocational professionals. The effectiveness of Mechanisms and Evidence
Horyzons has been examined via a single-blind Presenter: Richard C. Shelton, M.D.
randomised controlled trial (RCT) designed to test
whether treatment with both Horyzons and EDUCATIONAL OBJECTIVES:
treatment as usual (TAU) for 18 months was more At the conclusion of this session, the participant
effective than TAU alone. Horyzons was effective in should be able to: 1) Have a deeper understanding
fostering vocational and educational attainment and of the basic pathophysiology of depression and how
reducing utilization of emergency services in young this is addressed by ketamine; 2) Articulate a clear
people with FEP over 18-month follow-up. Horyzons understanding of the clinical trial evidence for both
was appealing for young people, with almost 50% of ketamine and intranasal esketamine; 3) Understand
participants logging on for at least 9 months. The the risks and side effects of ketamine and
implications for the field will be presented and esketamine treatment and will be able to describe
discussed followed by a roundtable discussion of them accurately and thoroughly to their patients; 4)
technology and serious mental illness Understand the place of esketamine therapy among
other neuromodulation approaches such as ECT and
John Fryer, M.D. American Civil Rights Icon: How rTMS; 5) Articulate the limitations of ketamine
the APA Bent the Arc of Justice treatment and controversies surrounding it.
Introduction: Saul Levin, M.D., M.P.A.
Presenter: Malcolm Lazin, J.D. SUMMARY:
At least one third of patients with major depressive
EDUCATIONAL OBJECTIVES: disorder do not experience adequate response to
At the conclusion of this session, the participant several rounds of antidepressant therapy, and a core
should be able to: 1) Apply quality improvement 20% fail to respond to available antidepressants and
strategies to improve clinical care.; 2) Provide evidence-based psychotherapies. Advanced
culturally competent care for diverse populations.; neuromodulation approaches have been developed
3) Describe the utility of psychotherapeutic and including repetitive transcranial magnetic
pharmacological treatment options. stimulation and vagal nerve stimulation, but all have
significant limitations. Ketamine, a dissociative
SUMMARY: anesthetic that has been available in the US since
Starting in 1952, DSM-I listed homosexuality as a 1970, has been developed as a novel antidepressant
mental disorder. Treatments included electric shock for difficult to treat depression (DTD) and major
therapy, mental institutionalization and lobotomies, depressive disorder with suicidal ideation (MDDSI)
among others. The designation was used to buttress over the last 15 years. Following early studies by Drs.
homophobic statutes and regulations. Most states Robert Berman and colleagues at Yale University and
would not license a homosexual to practice Carlos Zarate and collaborators at the intramural
medicine. Homosexual psychiatry residents feared program of the NIMH, evidence of the effectiveness
disclosing their sexual orientation to their of IV ketamine and, later, an intranasal form of the
psychoanalysts. The 1972 Annual Meeting included S(+)-enantiomer of ketamine called esketamine has
“Should Homosexuality Be in the APA steadily accumulated. This culminated in the
Nomenclature?”. This controversial and well approval of esketamine (SpravatoTM) for DTD in
attended panel included John Fryer with the 2019 and MDDSI in 2020. Ketamine and esketaminehave been among the most “rationally developed” making, language skills and social cognition each
medications in Psychiatry, in that they target one of play important roles in patient care. As a result of
the putative underlying pathophysiological professional, economic, and social forces, our
mechanisms underlying depression, neuroplasticity. current physician work force now includes many
This presentation will review the clinical data in professionals actively working into their 70’s and
support of the effectiveness of ketamine and even 80’s. In several countries, public concern about
esketamine for DTD and MDDSI; the limitations, the quality of care delivered by our oldest physicians
adverse effects, and controversies surrounding their has led to the development and implementation of
use; their hypothesized mechanisms of action and age-based “Late Career Physician” screening policies.
how that relates to theoretical causal processes for Such policies are spreading, though not without
depression. Participants should understand if and resistance, among US health care systems. The
how they might use esketamine in their practice. evidence in favor of LCP screening includes both
They should also be able to describe the theoretical general findings about cognitive and physical aging
mechanisms, benefits and limitations of esketamine as well as specific associations found between age
to their patients. This should help them make and various physician performance outcome
rational decisions about choosing among the variables. Nonetheless, doubts about the validity of
available advanced treatment options for neuropsychological tools as an indicator of clinical
depression. performance, concern about professionals’ dignity
and legal rights, and fear of succumbing to ageist
Late Career Physician Cognitive Screening: Policies, bias have made LCP screening policies very
Practice, and Perspectives controversial. Should we as psychiatrists, including
Chair: James Ellison, M.D., M.P.H. our aging members, support or oppose such
Presenters: Andrew White, M.D., Kelly Garrett, Ph.D., programs? In this session, we will examine the issue
Karen A. Miotto, M.D. of LCP screening from several different angles. The
respected and influential screening approach
EDUCATIONAL OBJECTIVES: promulgated by the CPPPH will be discussed by a
At the conclusion of this session, the participant psychiatrist who participated in its development. A
should be able to: 1) Summarize the issues neuropsychologist actively involved in LCP screening
underlying the spread of late career physician (LCP) will discuss the instruments used for this purpose
cognitive screening programs.; 2) Describe the with a focus on their role in identifying performance
ethical norms and stakeholder viewpoints that issues. Finally, a hospitalist who has explored
influence the adoption of a late career health care stakeholder attitudes in focus groups will illustrate
provider screening program; 3) Explain the practical the LCP perspective on age-based screening.
and legal considerations and the process involved in Attendees will be invited to share their experiences,
a physician wellbeing committee's response to the concerns, and suggestions through discussion of case
referral of a late career physician for perform; 4) vignettes and open question and answer period.
Differentiate instruments used for screening and
evaluation of cognitive status in a LCP program and Measuring Quality and Equity of Mental Health
appreciate their value and limitations.. Care: Existing Challenges and Future Opportunities
Chair: Bonnie T. Zima, M.D., M.P.H.
SUMMARY: Presenters: David Kroll, M.D., Juliet Beni Edgcomb,
Among many factors relevant to the performance of M.D., Ph.D.
clinical duties, the effects of cognitive ageing have Discussant: Grayson Norquist, M.D., M.P.H.
become an important focus of public and
professional interest. The delivery of health care EDUCATIONAL OBJECTIVES:
demands a consistent, high level of cognitive At the conclusion of this session, the participant
functioning, Learning and recall, complex attention should be able to: 1) Be aware of the health policy
and multitasking, manipulation of familiar and novel context for mandated public reporting of statewide
detailed information, abstract reasoning, decision adherence to national quality measures by Medicaidin 2024; 2) Be familiar with the basic specifications of be reviewed in light of the implications for data
the national quality measures related to mental interpretation. The session will then pivot towards
health in the 2021 National Core Set; 3) Understand the future by providing examples of potential
how type of data source (e.g., screening tool, survey, selection bias of measures in the 2024 Core Set that
claims, electronic healthcare records) impacts utility may negatively influence measures utilizing
and data interpretation of quality measures; 4) screening tools or patient experience surveys. The
Recommend how advances in clinical informatics can remaining presentations will introduce advances in
be adapted to examine the quality and equity of federated electronic health care record systems with
psychiatric care; 5) Provide one example of a how a common data elements. Participants will be
recommended care process for psychiatric care can introduced to the Accural to Clinical Trials Network
or cannot be easily captured in a quality measure or (ACT) and PCORNet®, and how these resources may
assessed using an existing administrative data be applied to track quality of care and disparities. To
sources. counter balance, overview of these innovations will
be followed by a brief critical assessment of
SUMMARY: advances made and challenges ahead for utilizing
Under the auspices of the Agency for Healthcare large-scale common element data sources to report
Research and Quality, an initial core set of 24 quality quality of care and disparities over time. Together,
measures was submitted to the Secretary of our session will engage participants through
Department of Health and Human Services on interspersed questions that stimulate self-inquiry on
January 1, 2010. Every year starting in 2013, the how quality measures for mental health can be
National Core Set is reviewed and measures are improved, how reporting on quality measure
considered for addition or removal. Currently, state adherence should be refined to interpret results
Medicaid agencies voluntarily report adherence within clinically relevant contexts (i.e., social
rates on 33 adult quality measures of which 12 are in determinants), and how data infrastructure can be
the behavioral health domain, and 24 child quality improved to build greater capacity to measure and
measures that include four related to behavioral report quality of care and disparities that is
health. Beginning in 2024, state reporting of all meaningful.
quality measures from the Core Set will be
mandatory, as stipulated by the 2018 Bipartisan Medical Mimics of Psychiatric Disorders After TBI
Budget Act. Nevertheless, statewide capacity to Chair: Gregory John O'Shanick, M.D.
report adherence rates widely varies and of the
behavioral health quality measures, only one related EDUCATIONAL OBJECTIVES:
to follow-up mental health care after a At the conclusion of this session, the participant
hospitalization for mental illness is frequently should be able to: 1) Identify questions and exam
reported. Criteria for removal include significant procedures to differentiate agoraphobia from
challenges in accessing an available data source that vestibular disorders;; 2) Identify questions and exam
contains all the data elements necessary to calculate procedures to differentiate social phobia from
the measure, including an identifier for Medicaid oculomotor and vergence disorders;; 3) Identify
and Child Health Insurance Program (CHIP) questions and exam procedures to differentiate
beneficiaries. Criteria for addition include a high bar; attention deficit disorder from auditory processing
namely, at least half the states should be able to disorder;; 4) Identify questions and exam procedures
produce the measure for FFY 2021 or FFY 2022, and to differentiate post-traumatic neuroendocrine
all the states should be able to produce the measure disorders from primary affective disorders;; 5)
by FFY 2024. Within this context, our session will Identify vulnerabilities of psychometric instruments
engage participants by introducing a brief health (eg. MMPI) in misdiagnosing psychopathology after
policy context underlying the urgency to be aware of TBI..
the need to interpret publicly reported rates of
mental health quality cautiously. The basic SUMMARY:
specifications of the national quality measures willWhile psychiatrists are licensed as Doctors of
Medicine or Osteopathy, conducting any form of SUMMARY:
physical or neurological examination on one’s The year 2020 saw simultaneous nationwide crises
patient is unfortunately not a common practice. This that posed significant threats to mental health. The
oversight results in the possibility of critical combined effects of an unprecedented pandemic,
misdiagnosis and engagement in unnecessary mitigation measures and economic distress, and a
treatment especially when one is evaluating an national crisis and reckoning over racism, had
individual who has sustained a concussion or any widespread effects on our economy and society. It is
other form of traumatic brain injury. This lecture will crucial that we understand the mental health
provide essential training and clinical tips for impacts of these events, and implement mitigation
identifying neurosensory abnormalities that can measures to help reduce these impacts. I will detail
imitate commonly encountered anxiety, mood and the research approach taken by the National
attentional disorders using a combination of case Institute of Mental Health, in collaboration with
material, audience participation and didactics. The other NIH institutes, in response to the events of
origins of balance dysfunction and the interplay of 2020 that will inform the mental health response
environment and conditioning will be discussed as it over the coming months.
pertains to post-TBI behaviors. Impairments of
binocularity and near point convergence will be Psychotherapeutic Approaches to Sexual Problems
discussed as triggers of interpersonal anxiety. Chair: Stephen B. Levine, M.D.
Auditory processing and sound localization
abnormalities similarly may present as distractibility EDUCATIONAL OBJECTIVES:
and attentional deficiencies, only to fail when At the conclusion of this session, the participant
treated with standard courses of stimulant should be able to: 1) Increase clinical interest in
medications. Impairments in interhemispheric learning about patients' sexual lives/concerns; 2)
transfer of spoken communication will be reviewed Encourage clinicians in their ability to assist patients
as distinct from those defects in global attention. with their problems; 3) Appreciate the differences
Post-traumatic neuroendocrine disorders will be between DSM-5 sexual diagnoses and what patient
reviewed with specific attention to those involving present with; 4) Recognize the abilities and
the anterior pituitary and mimicking primary limitations of prosexual medications; 5) Perceive the
depressive disorders. Finally, the challenge of two-way relationships between anxiety/depression
overreliance on traditional psychometric and sexual dilemmas.
instruments in the assessment of those with TBI will
be addressed with reference to those instruments SUMMARY:
that may falsely identify psychopathology rather There is no single therapy for the broad range of
than neurological dysfunction sexual problems. Instead, psychiatrists are
challenged to develop comfort with and interest in
Mental Health Research in the Era of Competing the diverse symptomatic ways that satisfying sexual
Crises lives are thwarted. Some of these sex/love
Chair: Joshua A. Gordon, M.D., Ph.D. predicaments are helped by our knowledge of
personality development, interpersonal
EDUCATIONAL OBJECTIVES: relationships, and mental and physical disorders and
At the conclusion of this session, the participant their medication treatments. It is our
should be able to: 1) Describe what is known from psychotherapeutic skills, however, that enable some
prior research on disasters, racism, and economic patients to overcome their obstacles to more
distress on mental health;; 2) Detail research satisfying sexual experiences, more relationship
findings on the mental health impacts of the events stability, and better mental health. This session will
of 2020;; 3) Compare and contrast alternative provide an overview of the forms of suffering
interventions to reduce the mental health impacts of mediated through sexual identity issues and sexual
disasters, and economic distress. dysfunction. These problems are very private,subjective, and interpersonal matters that patients tenure as chairman from 1979 till 2013, will be
want to discuss in a safe psychotherapeutic presented.
context. The psychiatrists' ideology, from behavior
therapy through psychoanalysis, ethnicity, Scope of Practice: The Evolution of Physician-Only
or gender are far less important than the Paradigm in Psychiatry
professionals' comfort, knowledge, and integrity. A Chair: Michelle Riba, M.D., M.S.
new interest in clinical sexuality can reinvigorate Presenters: Kamalika Roy, M.D., Varma Penumetcha,
psychiatrists who are growing tired what they have M.D., Vishal Madaan, M.D.
been doing and who wish to continue developing
their psychotherapeutic means of helping. EDUCATIONAL OBJECTIVES:
At the conclusion of this session, the participant
Religion, Psychiatry, and Mental Health: Past, should be able to: 1) Explore the status of non-
Present, Future physicians' practice authority across the states; 2)
Chair: Driss Moussaoui, M.D. Understand the differences in education and training
among physicians and advanced practice nurse
EDUCATIONAL OBJECTIVES: practitioners; 3) Explore the differences in practice
At the conclusion of this session, the participant pattern among physicians and nurse practitioners; 4)
should be able to: 1) Recognize the importance of Understand and balance the needs and effects of
Religion in Psychiatry and Mental Health by all non-physicians' practice privileges.
mental health professionals; 2) Recognize and
implement ‘Religion sensitivity’ within cultural SUMMARY:
sensitivity every psychiatrist should have; 3) Use for Expanding advanced practice nurses’ (APRN) scope
diagnosis and psychotherapeutic techniques that of practice has been proposed to solve many deficits
take into account the socio-religious background, in the current healthcare delivery system. The initial
but adapt them to each individual. argument was that the mid-level providers could
help the stark discrepancy in primary care
SUMMARY: physicians’ geographical distribution across the
There is no human society without religion. Belief underserved and urban areas. The expanded scope
systems seem to be universal to respond to all kind of practice was proposed to be helpful in better cost-
of anxieties, especially the one of death, and the effectiveness in medical care. In this workshop,
inextinguishable search for meanings of life. Directly speakers will dissect some of the effects of this
or indirectly, every human being deals with some expansion of independent practice scope. Speaker
form of relationship with religious beliefs and one will discuss the current status of the scope of
practices. This is also the case when the person is practice in different states in the US. At least 28
physically or mentally ill. In “Western” countries, states allow the statutory authority to APRNs to
mental health workers have great difficulties practice independently without any physician
addressing this domain, as it is considered to be the oversight or collaboration. It is unclear whether all
intimate intimacy of the person’s life. It is not the the APRNs are actually practicing independently in
case in other parts of the world, and traditional these states, as there is no method to track their
practices contain part of the religious beliefs of a employment information. The availability and the
community. In this presentation, historical, social extent of supervision varies. Speaker will describe
and anthropological aspects of the main religions in specific authorities in different states in terms of
the world will be addressed, with a psychological independent diagnosis, treatment planning, and
and/or psychiatric perspective. The work of various prescribing. He will also inform the audience of
committees on religion and psychiatry will be resources for county-specific data on APRN practice.
mentioned, included the one of the WPA Section on Speaker two will discuss the differences in training
Religion and Psychiatry. Personal experience of the and education, highlighting the duration, rigor, and
speaker and research studies conducted in his the nature of knowledge and clinical exposure in
department in Casablanca, Morocco, during his training between physicians and APRNs, includingpsychiatry specific comparison in training. The post- counteract current practices and policies created by
training licensing requirements and continuing structural racism.
education requirements will be discussed, as well.
These requirements vary from state-to-state. The SUMMARY:
implications of the lack of a national board Despite advances in understanding the mind and
requirement will also be explored. Speaker three will brain structural racism has historically impact
compare the expected outcomes and evidence- psychiatry and continues to influence psychiatric
based realities between physicians and APRNs practice and policy. In turn the larger public is
practice. Though APRNs were expected to relieve the impacted by implicit racism that affects the
healthcare workforce shortage in rural and knowledge base of mental disorders for the general
underserved areas, only 18% of them practice in public. Historically African Americans have been
those places. A recent Graduate Nursing Education misdiagnosed, are less likely to receive optimal
report revealed a $179 million grant funded project treatment if they are treated at all and more likely to
yielded 75% of APRN graduates practicing in already be impacted by incarceration, homelessness, and
adequately served places. This section will include a other punitive outcomes. Despite extensive research
rapid review of available data comparing opioid on diagnostic development, African Americans
prescription patterns between physicians and continue to be misdiagnosed. Despite evidence to
APRNs. Though opioid overdose is associated with the contrary substance abuse is thought to be more
overprescription, the difference in prescribing common than other ethnic groups. Violence is
patterns is strikingly unexplored. Despite the Centers thought to be more common, while suicide is
for Disease Control and Prevention (CDC) published thought to be rare. As a consequence, specialized
a guideline on the use of opioid medications for non- mental health services is less available and when
cancer pain, a significant number of Medicare Part D provided tends to be inpatient and involuntary.
patients continue receiving a higher dose than More punitive approaches such as incarceration and
recommended for non-cancer indications. The the consequence of lack of treatment such as
association between independent practice authority homelessness is more likely. We will explore how
and overprescription of opioid medication is shown structural racism contribute to these disparities and
in a recent study. In the end, the Chair will invite the how the historical treatment of African Americans
audience to an interactive poll regarding benefits vs. promotes the persistence of beliefs reinforced by
risks of expanding the scope of practice for APRNs. scientific racism. Historically African Americans
After the survey, there is a question-answer session during the antebellum period were thought to lack
for 20 minutes, moderated by the Chair. the affective and cognitive apparatus for genuine
feelings and intellect and were thought to be
Structural Racism in Psychiatry: The Past Is Driving impulse driven, intellectually incapable, and tend to
the Present be violent to others but not to self. This session will
Chair: William Bradford Lawson, M.D., Ph.D. explore how such beliefs persist and impact current
Presenters: King Davis, Ph.D., Cynthia Turner- psychiatric research, treatment, and mental health
Graham policy. We will explore the extent to which these
Discussant: John McIntyre misconceptions still persist, impact the research
literature and contribute to present day disparities in
EDUCATIONAL OBJECTIVES: care. We will also explore strategies that may
At the conclusion of this session, the participant minimize disparities and reduce implicit bias.
should be able to: 1) Gain knowledge about racist
practices that emerged in early America dictated The #MeToo Movement: Implications for
present policies and directions that persist today; 2) Psychiatrists
Understand how historical beliefs about African Chair: Renee M. Sorrentino, M.D.
Americans continue to persist through scientific Presenters: Ryan Hall, Susan Joy Hatters-Friedman,
racism; 3) Learn to develop strategies that M.D., Michelle Riba, M.D., M.S.You can also read
