What Is State of Psychiatry Today? And More From APA’s 2018 Annual Meeting Day Two

Day two of APA’s Annual Meeting included a reflection on the state of psychiatry by APA President Anita Everett, M.D.; a pledge by incoming APA President Altha Stewart, M.D., to see APA take a leading role on issues of diversity and inclusion; and a discussion of the role clinicians, researchers, and members of the public have in making DSM a “living document.”

From now through May 9, Psychiatric News will deliver an evening digest of some of the day’s highlights. Whether you are here in New York or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

Everett Sums Up State of Psychiatry in America and Where the Profession Is Headed

Psychiatry is strong and growing and in demand, said APA President Anita Everett, M.D., at the Opening Session of APA’s 2018 Annual Meeting. During the speech, she outlined the efforts of three work groups she appointed around her priority interests: physician well-being and burnout, innovation and technology, and smart prescribing. Read More >

Stewart to Focus on APA’s Being a Leader on Issues of Diversity and Inclusion

At the Opening Session, incoming APA President Altha Stewart, M.D., pledged to devote her presidential year to expanding APA’s global reach, its mentorship of young trainees and early career psychiatrists, and its involvement in contemporary social issues. Read More >

Experts Discuss Steps Being Made to Ensure DSM Is Living Document

APA has initiated a process for incorporating changes to the DSM on an incremental basis, making use of digital technology. This is a process in which APA members, other mental health clinicians, members of the research community, and members of the public can participate.
Read More >

Immunotherapies for Schizophrenia and Bipolar Disorder Not Quite Ready for Prime Time

The intersection between the immune system and psychiatric illness has been a long time coming and still has a long way to go, said Mark Weiser, M.D., at APA’s 2018 Annual Meeting. Read More >

Leonard Bernstein Lived a Life of Contradictions, Says Richard Kogan, M.D.

As with previous presentations in his series, Kogan delighted the audience with an engaging biography of Bernstein’s life and career mixed in with musical performances from his two most popular works, “On the Town” and “West Side Story.” Read More >

Equine Therapy Can Benefit Patients With Anxiety, Depression, and More

For the past two years, Psychiatrist Diego L. Coira, M.D., has been helping patients obtain benefits from equine therapy and collecting data on the results. Some patients work on the ground with the horses, petting or grooming them, whereas others ride with assistance. Read More >

APA Foundation Presents Advancing Minority Mental Health Awards

The awards, created in 2003, recognize psychiatrists, other health professionals, and organizations that have undertaken innovative efforts to raise awareness of mental illness in underserved minority communities, increase access to care, overcome cultural barriers to care, and improve the quality of care for underserved minorities. Read More >

APA Releases New Practice Guideline on AUD Pharmacotherapy

APA today released a new practice guideline for the pharmacological treatment of alcohol use disorder (AUD). Despite the high prevalence of AUD and its significant public health consequences, patients with this disorder remain undertreated.

“This new guideline is an important step in bringing effective, evidence-based treatments for alcohol use disorder to many more people and in helping address the public health burden of alcohol use,” APA President Anita Everett, M.D., said in a press release.

The guideline aims to increase physician and public knowledge on the effectiveness and risks of the five medications that may be used for the treatment of AUD: acamprosate, disulfiram, gabapentin, naltrexone, and topiramate.

• Of these five, naltrexone and acamprosate have the best available evidence related to their benefits, and both have minimal side effects. As such, they should be considered the preferred pharmacological options for patients with moderate to severe AUD who want to reduce drinking or achieve abstinence. However, acamprosate should be avoided in patients with significant renal impairment, and naltrexone should be avoided in patients with acute hepatitis or liver failure, or in patients currently taking opioids or who may be expected to take opioids.
• Disulfiram, gabapentin and topiramate are also options for treatment of AUD but should typically be considered after trying naltrexone and acamprosate, unless the patient has a strong preference for one of these medications. Disulfiram is a special case as it does cause a series of adverse reactions if alcohol is consumed within 12 to 24 hours of taking the medication; the reactions include elevated heart rate, flushed skin, headache, nausea, and vomiting. Therefore, disulfiram is suggested only to patients who wish to achieve abstinence from drinking. Patients taking topiramate are at an increased risk of cognitive dysfunction, dizziness, and loss of appetite, whereas patients taking gabapentin may experience fatigue, insomnia, and headache.

While the guideline focuses specifically on evidence-based pharmacological treatments for AUD, it also includes recommendations and suggestions related to psychiatric evaluation of patients with AUD and developing a person-centered treatment plan. Evidence-based psychotherapeutic treatments for alcohol use disorder also play a major role in treatment and peer support groups such as Alcoholics Anonymous, and other 12-step programs can be helpful for many patients. However, specific recommendations related to these treatments are outside the scope of this guideline.

The full guideline, executive summary, and related materials are available here.

(Image: iStock/shironosov)

Alleviating Conflict Between Work, Home Life May Improve Physician Mental Health

The medical internship year can be a challenging time for many physician trainees. A study published yesterday in JAMA Internal Medicine found that female medical interns are more likely than male medical interns to experience symptoms of depression. The study also found that the sex disparity in depression during the internship year may be driven in part by increasing conflict between work and personal obligations (work-family conflict). 

“Systemic modifications to alleviate conflict between work and family life may improve physician mental health and reduce the disproportionate depression disease burden for female physicians,” wrote psychiatrist Constance Guille, M.D., of the Medical University of South Carolina and colleagues. “Given that depression among physicians is associated with poor patient care and career attrition, efforts to alleviate depression among physicians has the potential to reduce the negative consequences associated with this disease.”

Guille and colleagues invited medical students matching to residency programs across all specialties throughout the United States during the 2015-2016 academic year to complete online assessments two months prior to the start of the internship year and again at six months into the internship year. As part of these assessments, the participants were asked to report depressive symptoms using the Patient Health Questionnaire (PHQ-9) and the degree to which work responsibilities interfered with family life (“family” was defined from participants’ perspective) using the Work and Family Conflict Scale.

Of the 3,121 students entering internships who completed the initial survey, 2,108 completed the six-month survey. The authors found that while men and women experienced a marked increase in depressive symptoms and work-family conflict over the first six months of their internship year, the increase in depressive symptoms among women was higher than the increase among men (mean increase in PHQ-9: 3.20 versus 2.5). When work-family conflict was accounted for, the sex disparity in the increase in depressive symptoms decreased by 36%.

The findings suggest that “work-family conflict [is] an important potentially modifiable factor associated with elevated depressive symptoms in training physicians,” Guille and colleagues wrote.

“Pilot programs designed to ease work-family conflicts among physicians through providing free home-delivered meals, childcare, and housecleaning are in their infancy,” the authors wrote. “Our findings suggest that these programs should be expanded in scope and number and that they should be rigorously tested to see if they not only reduce work-family conflict but also depression and its consequences, such as physician suicide, poor quality of patient care, medical errors, and career attrition.” 

For more about what APA is doing to address physician burnout and wellness, see the Psychiatric News article “Working Toward Wellness: Exploring Burnout and Resiliency in Physicians” by APA President Anita Everett, M.D. Addressing physician burnout and improving wellness is one of Dr. Everett's presidential initiatives.

For additional related information, see the Psychiatric News articles “How I Became Active in Fight For Trainee Wellness” by Matthew L. Goldman, M.D., M.S., and “Suicides of Young Physicians Raise Alarm About Burnout Among Trainees” by Carol Bernstein, M.D.

(Image: iStock/PeopleImages)

Everett, Others Discuss Importance of MH Block Grants at Hill Briefing

Anita Everett, M.D., medical director of the Substance Abuse and Mental Health Services Administration (SAMHSA), participated in a Capitol Hill briefing yesterday on the importance of the agency’s Community Mental Health Services Block Grant (MHBG) program.

The MHBG program provides funds and technical assistance to all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and U.S. Pacific to support comprehensive, community mental health services. The program funds are divided among the states and territories based on the estimated at-risk population.

“These block grants are a small but vital part of a state’s health care funding,” said Everett, who is also president of APA. “They provide flexibility for states to implement new, evidence-based strategies that are not covered by insurance.” The grantees have leeway in how they spend the money, although a provision added by Congress in 2015 mandates that 10% of each grant be set aside specifically for early psychosis intervention programs. These programs identify as early as possible people who have experienced their first episode of psychosis and use a comprehensive, team-based approach to prevent or delay the onset of serious mental illness, such as schizophrenia or bipolar disorder, and reduce relapse episodes.

For the most recent fiscal year, the SAMHSA budget included $533 million for MHBG grants, and thus $53 million set aside for early psychosis programs. Everett and the other speakers at the Capitol Hill briefing, which was hosted by the National Alliance on Mental Illness (NAMI), discussed multiple studies demonstrating how individuals who have experienced a first episode of psychosis benefit from early psychosis programs. For example, Everett highlighted the Alexandria, Virginia-based program TRAILS (Transitioning Adults Into Living Successfully), which has successfully placed 74% of the program’s clients in jobs or school.

Everett said there is a growing momentum for implementing these early psychosis programs, and she hopes that resources will continue to be available to expand these services.

To read more about early psychosis interventions, see the Psychiatric News articles “Digital Advertising Is Effective Tool for Engaging People on Early Psychosis” and “Psychosocial Treatments Found Effective for Early Psychosis.”

(Sylvia Johnson)

Innovative Solutions for Expanding MH Care and More From APA’s 2017 Annual Meeting Day Two

Day two of APA’s Annual Meeting included an announcement of the results of a national poll on Americans’ views on access to mental health care, an address by the director of NIAAA, and discussion about ways to strengthen the therapeutic alliance with a patient after a suicide attempt.

From now through May 24, Psychiatric News will deliver an evening digest of some of the day’s highlights—from the lecture halls to the exhibit floor. Whether you are here in San Diego or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

Oquendo Recounts Victory of 21st Cures Act, APA’s Ongoing Efforts on AHCA

“We are at the threshold of a wonderful era for psychiatry,” said APA President Maria A. Oquendo, M.D., Ph.D., recapping an eventful presidential year highlighted by her presence at the White House for the signing of the 21st Century Cures Act.
Read More >

Everett to Center Presidency on Innovative Solutions to Expanding Care, Increasing Support to Members

During the Opening Session, APA President-elect Anita Everett, M.D., said the development of innovative systems for improving access to care, team-based care for first-episode psychosis, and initiatives regarding physician wellness and burnout would be key goals for her presidency. Read More >

Large Majority of Americans Say MH Care Should Be Covered by Insurance

Mental health is important to Americans, and they think it should be important to their elected representatives as well, according to the results of a national poll released today by APA. Read More >

NIAAA Director Describes ‘Dark Side of Addiction,’ Hope for Future Treatments

The negative emotional states experienced by people with substance use disorders are an integral part of the addictive process, according to George F. Koob, Ph.D. Read More >

Winners of Assembly Election Announced

At their meeting held yesterday in conjunction with the Annual Meeting, members of the APA Assembly chose James R. Batterson, M.D., of Kansas City, Mo. (right), as the group’s next speaker-elect. He is the Area 4 representative and is concluding his term as recorder. Steven Daviss, M.D., a representative from the Maryland Psychiatric Society, was elected recorder. The new officers begin their terms at the close of the Annual Meeting, at which time Theresa Miskimen, M.D., of Piscataway, N.J., will become the speaker of the Assembly.

Asking Patients About Suicide Narrative May Improve Long-Term Outcomes

Placing greater emphasis on a patient’s narrative of the feelings leading up to a suicide attempt may not only strengthen the therapeutic alliance, but create a foundation from which safety planning and long-term outreach can be maintained. Read More >

What Can Children’s Books Teach You About Your Patients?

All literature is born from the human need to tell stories that help us understand ourselves and others. Children’s books—which allow young readers to experience love, loss, and betrayal through the lives of characters—can lead to cognitive and emotional growth in young people. Read More >

Psychiatrists Have Tools Needed to Help Patients in Pain

Physicians today appreciate that chronic pain involves vicious cycles of both physical and psychological feedback. Read More >

Historical Survival Traits May Be to Blame for Some Mental Health Disorders

Depression and anxiety are, paradoxically, directly linked to the same genetic traits that evolved to help our ancestors survive, said Lee Goldman, M.D., author of Too Much of a Good Thing: How Four Key Survival Traits Are Now Killing Us. Read More >

Everett Appointed Chief Medical Officer of SAMHSA

APA President-Elect Anita Everett, M.D. (pictured left), today was named the Chief Medical Officer at the Substance Abuse and Mental Health Services Administration (SAMHSA). She is expected to begin her duties at SAMHSA on September 5.

In her new role, Everett will lead the newly created Office of the Chief Medical Officer, which is expected to provide valuable input into strategic initiatives, policy directions, and legislative issues to ensure that medically researched and clinically approved practices are incorporated in the development and implementation of SAMSHA programs and activities. The office will also play a key role in representing SAMHSA’s clinical perspectives, particularly when working with other Department of Health and Human Services (HHS) entities and federal agencies.    

“I’m really excited and really looking forward to starting the new position as Chief Medical Officer at SAMHSA,” Everett told Psychiatric News. “Having a psychiatrist as a member of the leadership team at SAMHSA will enable psychiatrists to join other mental health and public health professionals in guiding the federal component of our nation's behavioral health system.”  

Everett is currently the division director of Johns Hopkins Community and General Psychiatry, Bayview Campus, and an associate professor in the Department of Psychiatry at Johns Hopkins School of Medicine in Baltimore, where her research focuses on health behavior of individuals with long-term mental illness. 

Everett was elected president-elect of APA in February and will assume the office of president at the conclusion of the APA Annual Meeting in San Diego in May 2017. She has held numerous leadership roles within the organization, which include trustee-at-large on the APA Board of Trustees and chair of the APA Task Force on Healthcare Reform 2015. 

“SAMHSA has selected a great physician whose experience and expertise as a psychiatrist will add value to SAMHSA through its newly created medical office,” said APA President Maria A. Oquendo, M.D. “Her experience will also benefit providers of prevention, treatment, and recovery services for those with mental illness. We look forward to working with Dr. Everett in her new role and with SAMHSA and HHS.”

To read more about Anita Everett, M.D., see the Psychiatric News articles “Everett Chosen APA’s Next President-Elect” and “APA Continues Charting Course on Health Care Reform.”

Inside the Supreme Court and More From APA’s 2016 Annual Meeting

Highlights from Day Four

Our coverage of APA’s Annual Meeting continues with U.S. Supreme Court Justice Stephen Breyer’s address on the inside workings of the Supreme Court; a report on the results of an APA poll on “phantom” insurance networks; and the continued debate over the ethics of involuntary outpatient commitment laws.

Justice Stephen Breyer Gives Inside Look at Country’s Highest Court U.S. Supreme Court Justice Stephen Breyer spoke today at APA’s 2016 Annual Meeting in Atlanta about his latest book, The Court and the World: American Law and the New Global Realities, and what it’s like to work at the highest court in the land. Read More >

Frieden Calls for Joining Psychiatry, Public Health During Convocation Lecture Thomas Frieden, M.D., M.P.H., director of the Centers for Disease Control and Prevention, told attendees at APA’s Convocation of Distinguished Fellows that depression and severe mental illness, alcoholism, opioid addiction, suicide, HIV/AIDS, and a host of other conditions are amenable to solutions that look at broad societal influences, as well as the factors that influence individual behavior. Read More >

Psychiatry Plays an Important Role in Palliative Care, Experts Say In a session at today’s Annual Meeting, Nathan Fairman, M.D., M.P.H., and Scott A. Irwin, M.D., Ph.D., described the expanding interface between palliative medicine and psychiatry and opportunities for psychiatrists to enhance the care of seriously ill patients and their loved ones. Read More >

APA’s Incoming President-Elect to Emphasize Increasing Access to Care Psychiatric News Editor-in-Chief Jeffrey Borenstein, M.D., interviews Anita Everett, M.D., who becomes president-elect of APA at the conclusion of APA’s 2016 Annual Meeting. Watch Video >

APA Poll Finds Access to Care Stymied by ‘Phantom’ Networks in D.C. Because of frequently heard complaints that patients are unable to find a psychiatrist in their insurance network who is available to see them within a reasonable time or even at all, APA engaged the American Psychiatric Association Foundation to conduct a study to see how pervasive this problem really is. The results were announced yesterday at APA’s 2016 Annual Meeting. Read More >

Dangerousness, Not Mental Illness, Should Guide Gun Restrictions Reducing death and injury by firearms should focus less on people who are mentally ill and more on reducing access to lethal means by individuals who want to harm themselves or others, according to Jeffrey Swanson, Ph.D. There is only a tiny intersection between gun violence and mental illness, he pointed out. Read More >

Debate Persists on Ethics of Involuntary Outpatient Commitment Laws Are involuntary outpatient commitment laws a good thing? Depends on who you ask and how that person is looking at the question, said experts in a symposium yesterday at APA’s 2016 Annual Meeting. Read More >

NIDA Session Offers Scientific Solutions to Address Opioid Crisis Opioid misuse is at epidemic proportions in the United States, with deaths due to opioid overdose quadrupling since 1999. Shedding some light on ways to address this problem through science, the National Institute on Drug Abuse (NIDA) sponsored an Annual Meeting session on therapeutic developments that may one day potentially be used to help reverse this public health crisis. Read More >