Psychiatric Residency Programs Research Articles

Study finds training in ASD and ID at psychiatry programs deficient

The journal Autism recently published a study about the quality of training that psychiatric program residents receive in autism spectrum disorder and intellectual disability, as measured by lectures and patient contact. Psychiatrists are one of the care professionals with whom students with autism and ID frequently interact. However, the study concludes that there is a shortage of psychiatrists to treat such conditions — and a lack of adequate training/education on these conditions in many psychiatric residency programs.

Spirituality and Religion in Canadian Psychiatric Residency Training: Follow-up Survey of Canadian Psychiatry Residency Programs.

This study assesses the availability and nature of psychiatry resident training in religion and spirituality across Canada. Evidence shows that religious and spiritual topics are important to psychiatric patients and that psychiatrist competence in approaching these topics is correlated to whether they have had previous training in them. Prior studies have shown a lack of training in religion and spirituality in Canadian psychiatry programs and recommended incorporation into psychiatry residency curricula. A survey was conducted, asking questions about the amount and type of training in religion and spirituality that was accessible to psychiatry residents in the 17 psychiatry residency programs in Canada. One response was sought from each institution by reaching out to the institutions' program directors and requesting that a knowledgeable faculty member complete the survey. Out of 14 responding psychiatric residency programs, 2 reported no training opportunities in religion or spirituality, 4 reported only voluntary training opportunities that were largely resident directed, and 8 reported mandatory training. The number of Canadian psychiatry residency programs providing mandatory training in religion and spirituality has increased since the prior published survey in 2003 and there are fewer programs reporting no training at all. However, overall, Canadian psychiatry institutions still place less emphasis on religious/spiritual education than recommended by the international psychiatric community. Several Canadian institutions report well-received implementation of curricula on religion and spirituality that could inform other Canadian institutions.

Psychiatry Match Numbers Increase for 12th Consecutive Year

Back to table of contents Previous article Next article Education & TrainingFull AccessPsychiatry Match Numbers Increase for 12th Consecutive YearMark MoranMark MoranSearch for more papers by this authorPublished Online:30 Mar 2023https://doi.org/10.1176/appi.pn.2023.05.5.043AbstractPsychiatry’s numbers have been increasing yearly since 2011. This year psychiatry was one of just 10 specialties with increases of more than 10% over the last five years.A total of 1,746 U.S. medical school graduates—1,343 from allopathic schools and 403 from osteopathic schools—matched into psychiatry residency programs this year as part of the 2023 National Resident Matching Program (NRMP). It marks the 12th year in a row that psychiatry’s match numbers have increased.Additionally, 351 U.S. and non-U.S. international medical graduates (IMGs) and 46 other applicants (allopathic and osteopathic graduates from a previous year) also matched into psychiatry, bringing the total to 2,143 medical school graduates. Just 21 psychiatry positions went unfilled.The annual match, in which the program choices of graduating medical students are paired with those of residency programs seeking trainees, is typically watched as an indicator of workforce size and makeup of the various medical specialties for the coming years. Psychiatry’s numbers have been increasing yearly since 2011. This year psychiatry was one of just 10 specialties with increases of more than 10% over the last five years.“There continues to be a sustained interest in psychiatric careers by both M.D. and D.O. medical graduates,” said Sidney Weissman, M.D., a former APA trustee and past president of the American Association of Directors of Psychiatric Residency Program Directors (AADPRT) who has been a longtime observer of workforce trends. “Their interest mirrors a heightened national focus on mental health and wellness. Since 2013 we have added over 130 new programs and 700 new positions in the match, and the number of U.S. senior medical students entering psychiatry has doubled. For the near term, these trends are likely to continue.”Vishal Madaan, M.D., APA’s chief of education, said, “It is heartening to see such a successful match for psychiatry. I am delighted that our medical students continue to rise to the occasion and meet the challenge of growing mental health needs in our communities, especially in the post-pandemic world. Not only does psychiatry offer an opportunity for our medical students to answer the societal call and gain a better understanding of social determinants of mental health, but also it allows them to sustain a career that offers job security and quality of life.”He pointed out, however, that the number of IMGs matching into psychiatry had declined from about 30% in 2013 to 16% in 2023, of whom just 6.9% are non-U.S. IMGs. “The number of IMG applications and matched positions, especially those for non-U.S. IMGs, continues to indicate a worrisome decline, creating potential workforce challenges for subspecialty recruitment and future public sector and rural psychiatry positions,” he said.APA CEO and Medical Director Saul Levin, M.D., M.P.A., urged new residents to visit the APA webpage for resources for residents and medical students. “Mental health is now on the national agenda in a way it has never been before, and our profession is critical to meeting our country’s mental health crisis,” he said. “Psychiatry is an exciting field with an expanding array of effective treatments for mental illness. I welcome our new physicians in training and urge them to consider joining APA. Our trainees are our future.”The NRMP is a private, nonprofit organization established in 1953 to oversee the match at the request of medical students to provide an orderly and fair mechanism for matching the preferences of applicants for U.S. residency positions with the preferences of residency program directors. The NRMP is sponsored by the American Board of Medical Specialties, the AMA, the Association of American Medical Colleges, the American Hospital Association, and the Council of Medical Specialty Societies. ■ResourceThe National Resident Matching Program website ISSUES NewArchived

Street Psychiatrists Build Trust, Offer Hope to Homeless Patients With SMI

Street Psychiatrists Build Trust, Offer Hope to Homeless Patients With SMI

Publication rates and characteristics of PGY2 psychiatric pharmacy resident research projects.

To describe the publication rates and characteristics of PGY2 psychiatric pharmacy residency projects presented as a poster presentation at the annual meetings of the College of Psychiatric and Neurologic Pharmacists (CPNP) from 2002 to 2018. (As of 2022 the organization is under the name, American Association of Psychiatric Pharmacists.). CPNP abstracts from even years were strategically searched in PubMed, Ovid MEDLINE, and Google Scholar. If a publication was identified, additional data were collected for characterization, including study information, journal information, author information, institutional affiliation, publication year, and time to publication. A total of 348 abstracts were evaluated. Publication in a journal was achieved for 60 projects (17.2%), with publication rates decreasing from 2012 to 2018. The mean time to publication was 17.3 months after completion of the residency, with most projects published at 8 months. More than half (51.7%) of these projects were published in a psychiatric pharmacy journal affiliated with CPNP. Study designs were predominantly retrospective, observational, cohort studies with a focus on evaluation of a drug therapy outcome. The PGY2 resident was the first author in 90% of the publications. Forty percent included other health care professionals outside of pharmacy as a coauthor. PGY2 residencies affiliated with academic institutions had overall higher publications rates. Publication rates for PGY2 psychiatric pharmacy residency projects are low and are decreasing over time despite an increasing number of PGY2 psychiatric pharmacy residency programs. This publication rate is lower than that reported in the literature for PGY2 critical care residency programs. The downward trend of publication rates for PGY2 psychiatric pharmacy residency projects is concerning.

COVID-19-Related Disruptions Are an Opportunity for Reflection on the Role of Research Training in Psychiatric Residency Programs

This commentary describes COVID-19-related disruptions and responsive accommodations to facilitate a research project required to complete postgraduate psychiatry training in a resource-limited small island developing state. After providing context concerning the impact of the pandemic on medical education, we focus on implications for postgraduate training in psychiatry. Lessons learned from this experience have relevance for ongoing discussions concerning the role and implementation of research training in residency programs. Research skills are essential for evidence-based practice as well as academic careers. Longitudinal integration of research training and flexibility of research requirements are needed in postgraduate psychiatry to balance residents’ development of research skills with demands of clinical service.

Outpatient Psychiatric Care Not for the Poor—What Is Our Obligation?

Outpatient Psychiatric Care Not for the Poor—What Is Our Obligation?

64.2 TEACHING ADULT PSYCHIATRY RESIDENTS ABOUT PERINATAL MENTAL HEALTH

The objective of this presentation is to address the knowledge gap in perinatal mental health (MH) in adult psychiatry training. Psychiatric residency programs rarely include formal training in women’s mental health issues across the life span, including during pregnancy and the postpartum period. Pregnant women frequently discontinue their mental health medications when learning they are pregnant—often at the suggestion of their psychiatrist or obstetrician, unfamiliar with the reproductive safety profile of commonly prescribed medications. This can lead to poorer outcomes of morbidity and mortality and higher rates of suicide and infanticide. Current robust evidence shows that exposing the developing fetus to untreated psychopathology may result in long-term adverse consequences for the child and the mother-baby dyad. These interconnections between perinatal MH and infant mental health can get lost in the “silos” of medical specialty training. This knowledge gap can result in critical errors in assessment, diagnosis, and intervention, and can contribute to poor outcomes for the mother, her child, and society in general. The presenters, a perinatal expert and a psychiatry trainee, use media-based educational content to demonstrate how an expert trains an adult psychiatry resident in important perinatal MH topics. The trainee explores the gaps in their understanding of perinatal MH, and the expert addresses these knowledge gaps through a lecture and videos following 2 pregnant women’s mental health experiences in a “telenovela” format. These dialogues offer compelling and relatable narratives that place didactic content in the social and cultural context of learners. This demonstration of media-based adult psychiatry training in perinatal MH and the related effects on infant development begins to fill an important knowledge gap for adult psychiatrists caring for pregnant women and their infants. The method of using interactive dialogue and video offers critical knowledge to clinicians treating this important population. There remains a significant knowledge gap in perinatal MH and infant mental health in adult psychiatrists. This gap can be recognized, understood, and filled by the development of innovative didactic and videotaped content that can be widely distributed across adult psychiatry residency programs.

From Requisite to Right: Assessing and Addressing Paid Maternity Leave in US Psychiatry Residency Programs.

ObjectiveData on the physical and mental health benefits of paid maternity leave for mothers and infants is abundant. Data on the make-up of current maternity leave policies in US psychiatry residency programs is not. This survey of program directors was undertaken to assess the components of their program’s policies and the perceived impact of maternity leave on the training of childbearing residents, co-residents, and programs.MethodsAn anonymous 19-question survey was emailed to US psychiatric residency program directors. Questions assessed demographics for respondents and their programs, composition of maternity leave including paid and unpaid components, and the perception of effects of maternity leave on childbearing residents, co-residents, and programs (with optional free-text elaboration).ResultsThe response rate was 19.5% (49 out of 262 program directors). Many programs require the use of FMLA (81%), vacation days (75%), sick days (75%), and short-term disability (30%) for maternity leave. Around a third (34%) offer separate paid time off varying from 2 to 12 weeks at 80–100% of pay. Most respondents relate a neutral to strongly positive impact of leave on the psychiatric training of childbearing residents (98%) and co-residents (84%), citing benefits like improved empathy, compassion, and patience.ConclusionsMaternity leave is seen to have minimal negative impact on training received within psychiatry residency programs. A minority of residents have access to paid maternity leave policies that would best support their health and career trajectories.

Prevalence and impact of patient suicide in psychiatrists: Results from a national French web-based survey

BackgroundPatient suicide (PS) is known to be a frequent and challenging occupational hazard for mental health professionals. No study previously explored the prevalence and impact of PS in a large sample of French psychiatrists. MethodA national web-based survey was performed between September and December 2019 to assess (a) the prevalence of the exposure to PS, (b) the emotional, traumatic and professional impacts of PS, and (c) the perceived support in the aftermath of PS in French psychiatrists. Participants were contacted through email to answer the online 62-item questionnaire, including a measure of traumatic impact through the Impact of Event Scale-Revised. Emotional and professional impacts and perceived support were assessed through dedicated items. ResultsA total of 764 psychiatrists fully completed the survey. Of them, 87.3% reported an exposure to PS and 13.7% reported PTSD symptoms afterward. Guilt, sadness and shock were the most frequent emotions. Among the exposed psychiatrists, 15.1% have temporarily considered changing their career path. The most emotionally distressing PS occurred during their ten first years of practice or during residency. A total of 37.1% of respondents felt unsupported and 50.4% reported that no team meeting had been organized in the aftermath. The feeling of responsibility for the death was strongly associated with negative impacts. ConclusionOur results entail considerations to prevent negative mental health outcomes in psychiatrists after PS. Notably, our results advocate for the implementation of educational programs during psychiatric residency and postvention programs in healthcare settings to effectively help psychiatrists in dealing with PS.

Innovations in Psychopharmacology Education in U.S. Psychiatric Residency Programs.

Medications available to treat psychiatric illnesses continue to increase, in conjunction with a shifting of outpatient psychiatric practice from psychotherapy toward medication management. To be successful in this climate, a psychiatrist needs to select the appropriate pharmacologic option(s) for their patient, drawing from old and new psychotropics while accounting for variables such as a patient's comorbid medical conditions and potential drug-drug interactions. In the absence of any national psychopharmacology training guidelines, these skills are taught to varying degrees in American psychiatric residency training programs. The past 20 years have seen an increase in innovations in the areas of psychopharmacology curricula topics, teaching strategies, and assessments of psychopharmacology knowledge and skills. Psychiatric training programs can benefit from and build on these innovations, ensuring that all physicians graduating from a psychiatric residency program meet psychopharmacology-based learning objectives and that their learning can be measured in a valid and reliable way.

Editorial introductions

Current Opinion in Psychiatry was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Hans W. HoekHans W. HoekDr Hans W. Hoek is Professor of Psychiatry at University Medical Center Groningen, the Netherlands, and has an adjunct position as Professor of Epidemiology at Columbia University, New York, USA. He is based in The Hague where he is Director of the psychiatric residency program and Dean of the Parnassia Academy, part of Parnassia Psychiatric Institute, a large mental health institute with branches throughout the Netherlands. Dr Hoek has a long-term interest in both schizophrenia and eating disorders. In the schizophrenia field he has been involved in studies on schizophrenia spectrum disorders after prenatal exposure to famine and on first episode psychosis among immigrants in The Netherlands, with research ongoing in rural South Africa. Dr Hoek's main publications in the eating disorder field relate to the epidemiology and treatment of eating disorders. Dr Hoek has been chair of the work group that developed the recent Dutch practice guideline for the treatment of eating disorders. Dr Hoek participated in the revision of DSM–5 as member of both the Eating Disorders Work Group and the Impairment and Disability Study Group. He has been consultant for the development of the WHO Disability Assessment Schedule (WHODAS 2.0). He is past president of the Eating Disorders Research Society and was the recipient of the Academy for Eating Disorders Leadership Award in Research 2011. Anna Keski-RahkonenAnna Keski-RahkonenDr Anna Keski-Rahkonen, MD, PhD, MPH is a psychiatrist, an epidemiologist, and a sexologist. She currently works as a Professor of Mental Health at the University of Helsinki in Finland. She is board certified in public health, psychiatry, and medical education. She received her medical training at the University of Helsinki and studied public health at Columbia University in New York, USA. She has published over 70 original articles on various aspects of eating disorders and has received many awards for her teaching and mentoring. She has also written several books on eating disorders for the general audience. She is particularly interested in the epidemiology of eating disorders and body image. Richa BhatiaRicha BhatiaRicha Bhatia, MD is a Child, Adolescent and Adult psychiatrist, dual Board certified in Child, Adolescent and General Psychiatry by the American Board of Psychiatry and Neurology. She serves as Section Editor for the Child and Adolescent Psychiatry issue of Current Opinion in Psychiatry. She has also served as an Associate Editor for the journal, Current Psychiatry, and presently serves as a member of its editorial board. She is a former faculty member in the departments of psychiatry at Harvard Medical School, USA, and Geisel School of Medicine at Dartmouth, USA. She completed her child and adolescent psychiatry fellowship from Children's National Medical Center / George Washington University in Washington, DC, USA. Dr Bhatia has been the recipient of Marian Butterfield Award by the Association of Women Psychiatrists, and has been recognized as a Fellow of the American Psychiatric Association. She is the author of two books on psychiatry: Demystifying Psychiatric Conditions and Treatments and 65 Answers about Psychiatric Conditions. She has been an active member of the Anxiety and Depression Association of America and the American Psychiatric Association. She has chaired and lectured at workshops at various psychiatric conferences. Some of her areas of interest are global mental health, compassion cultivation, and integration of psychotherapy and psychopharmacology into clinical practice. Her expert professional opinions have been quoted in prominent news media such as CNBC, The Guardian, US News and World Report.

An Innovative Approach for Graduate Education for Psychiatric Nurse Practitioners.

A major transformation in nurse practitioner (NP) education is the emergence of post graduate residencies; their foci include (a) educating NPs in population health; (b) increasing clinical proficiency; and (c) incorporating quality and safety into practice. We describe a psychiatric NP residency program supported by an academic-practice partnership, known as the Veterans Affairs Nursing Academic Partnership for Graduate Education (VANAP-GE) between the Birmingham Veterans Administration Medical Center (BVAMC) and the University of Alabama at Birmingham (UAB) School of Nursing (SON) for a population of Veterans with complex mental and physical health needs. Topics which are covered include risks of suicide among Veterans, post-traumatic stress disorder, depressive and anxiety disorders, and substance use disorders. During this one-year traineeship during the first year after NP certification, residents engage in development of crucial skills for improving the future of U.S. health care. All residents are newly licensed PMHNPs, but some are also pursuing DNP degrees. For residents who are simultaneously enrolled in BSN to DNP programs, the additional clinical training afforded by NP residency education provides a natural laboratory for their projects with foci of quality and safety, leadership, and clinical scholarship. Reduction in NP turnover as well as cost savings of orientation and recruitment are significant benefits for the practice partner with zero vacancies since the partnership's inception. These multiple successes predict increased establishment of residencies as viable post graduate pathways for NPs.

Developing an Advocacy Curriculum: Lessons Learned from a National Survey of Psychiatric Residency Programs.

Advocacy by physicians, defined as a physician's public support for causes, policies, or actions that advance patient health, is increasingly recognized as a professional responsibility as well as a core competency in medical training. The authors describe a survey they conducted on advocacy curricula in psychiatric residency training programs across the USA, from their vantage point as members of an advocacy council within a medical professional organization. Between Fall 2016 and Winter 2018, psychiatry residency programs with advocacy curricula were identified through personal communications with stakeholders as well as a blast email to the American Association of Directors of Psychiatric Residency Training. Semi-structured interviews were conducted with program leaders at residencies with an advocacy curriculum to collect detailed information on these curricula. Seven psychiatry residency programs with advocacy curricula were identified. All seven programs agreed to be interviewed and are included in the survey results. Lessons learned from this survey include how to approach the development of an advocacy curriculum; the components, attributes, and supports of an effective curriculum; and the challenges commonly encountered by medical educators trying to implement such a curriculum. The authors hope that these observations will contribute to the development of a best practice guideline for advocacy teaching within psychiatry and perhaps for other medical disciplines.

Whatever Happened to Couples and Family Therapy in Psychiatry?

Whatever Happened to Couples and Family Therapy in Psychiatry?

Editorial introductions

Current Opinion in Psychiatry was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Hans W. HoekHans W. HoekDr Hans W. Hoek is Professor of Psychiatry at University Medical Center Groningen, the Netherlands, and has an adjunct position as Professor of Epidemiology at Columbia University, New York, USA. He is based in The Hague where he is Director of the psychiatric residency program and Dean of the Parnassia Academy, part of Parnassia Psychiatric Institute, a large mental health institute with branches throughout the Netherlands. Dr Hoek has a long-term interest in both schizophrenia and eating disorders. In the schizophrenia field he has been involved in studies on schizophrenia spectrum disorders after prenatal exposure to famine and on first episode psychosis among immigrants in The Netherlands, with research ongoing in rural South Africa. Dr Hoek's main publications in the eating disorder field relate to the epidemiology and treatment of eating disorders. Dr Hoek has been chair of the work group that developed the recent Dutch practice guideline for the treatment of eating disorders. Dr Hoek participated in the revision of DSM–5 as member of both the Eating Disorders Work Group and the Impairment and Disability Study Group. He has been consultant for the development of the WHO Disability Assessment Schedule (WHODAS 2.0). He is past president of the Eating Disorders Research Society and was the recipient of the Academy for Eating Disorders Leadership Award in Research 2011. Anna Keski-RahkonenAnna Keski-RahkonenDr Anna Keski-Rahkonen, MD, PhD, MPH is a psychiatrist, an epidemiologist, and a sexologist. She currently works as a Professor of Mental Health at the University of Helsinki in Finland. She is board certified in public health, psychiatry, and medical education. She received her medical training at the University of Helsinki and studied public health at Columbia University in New York, USA. She has published over 70 original articles on various aspects of eating disorders and has received many awards for her teaching and mentoring. She has also written several books on eating disorders for the general audience. She is particularly interested in the epidemiology of eating disorders and body image. Richa BhatiaRicha BhatiaRicha Bhatia, MD is a Child, Adolescent and Adult psychiatrist, dual Board certified in Child, Adolescent and General Psychiatry by the American Board of Psychiatry and Neurology. She serves as Section Editor for the Child and Adolescent Psychiatry issue of Current Opinion in Psychiatry. She has also served as an Associate Editor for the journal, Current Psychiatry. In addition, she serves on the editorial board of other psychiatry journals such as Culture, Medicine and Psychiatry. She is a former faculty member in the departments of psychiatry at Harvard Medical School, USA, and Geisel School of Medicine at Dartmouth, USA. She completed her child and adolescent psychiatry fellowship from Children's National Medical Center / George Washington University in Washington, DC, USA. Dr Bhatia has been the recipient of Marian Butterfield Award by the Association of Women Psychiatrists, and has been recognized as a Fellow of the American Psychiatric Association. She is the author of two books on psychiatry: Demystifying Psychiatric Conditions and Treatments and 65 Answers about Psychiatric Conditions. She has been an active member of the Anxiety and Depression Association of America and the American Psychiatric Association. She has chaired and lectured at workshops at various psychiatric conferences. Some of her areas of interest are global mental health, compassion cultivation, and integration of psychotherapy and psychopharmacology into clinical practice.

Long-Term Psychotherapy Jeopardized in Ontario

Back to table of contents Previous article Government NewsFull AccessLong-Term Psychotherapy Jeopardized in OntarioRenata M. VillelaM.D. , F.R.C.P.C. President, Ontario District BranchRenata M. VillelaSearch for more papers by this authorM.D. , F.R.C.P.C. President, Ontario District BranchPublished Online:17 Apr 2019https://doi.org/10.1176/appi.pn.2019.4b50Psychotherapy in Ontario is facing an extinction-level crisis. The first wave took the stage at the national level, with provinces across the country reworking their residency curricula to be competency-based instead of time-based. Under that guise, those opposing psychotherapy as an integral part of psychiatric residency programs began to claim that psychotherapy was too difficult to evaluate under the new system and argued for it to be sidelined. For those already in practice, a second, more localized hit was in place as part of the ongoing contract negotiations between the Ontario government and the province's physicians. Currently, Ontario patients can see psychiatrists or family physicians for psychotherapy via our universal health care system without any restrictions on the length of the treatment course. The government is proposing that psychotherapy be limited to about 24 hours per patient per year for a given psychiatrist, alleging a lack of evidence for long-term psychotherapy. While the health care system in the U. S. operates under a very different model, the conflict around protecting long-term psychotherapy as a valuable form of treatment crosses borders.There is solid evidence for long-term psychotherapy in the literature. We need only look to the works of Susan Lazar, M.D., Meiram Bendat, J.D., Glen Gabbard, M.D., and colleagues (for example, Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity). Long-term psychotherapy is not a luxury; it can be a life-saving treatment. Patients deserve better than fast-food medicine models that focus on a one-size-fits all mentality. There is room at the table for all of the tools at our disposal, and physicians may choose to focus their practice on one set more so than another. The psychotherapy debate appears to be an extension of the stigma of mental illness; it is hard to believe that a proposal to stop covering evidence-based treatments is even on the table. I am unaware of any other medical specialty that would consider doing something similar. Yet psychiatry can be seen as low-hanging fruit, an easy target.A recent opinion article by Dr. Norman Doidge in The Globe and Mail highlights the current conflict within our profession in Ontario. He speaks to the impact that the proposed session cap would have on long-term psychotherapy in a variety of forms, with psychoanalysis being one example. Some argue that this drastic change is necessary to cut out the supposed cancer of the mythical elite, worried-well who are engaging in self-indulgent navel-gazing at taxpayers' expense. Yet the remuneration changes are being suggested without a complete dataset/understanding of whether this feared misuse of the system is taking place on a massive scale. Furthermore, it could easily become standard practice for documentation to include a clear indication of the need for ongoing intensive treatment. We can be part of the solution around these misconceptions. The movement against long-term psychotherapy in Ontario has also been suggesting that having more access to psychiatrists in the form of consults should ideally replace the role of treatment. Essentially, patients would be advised about possible pharmacotherapy/structured, short-term psychotherapy options and then be on their own to implement extended treatment privately. The longitudinal therapeutic relationship (whether via pharmacotherapy, psychotherapy, or both) that psychiatrists can offer is, to me, a fulfilling aspect of our work. Patients would get understandably angry by repeated consults telling them the same general impression/plan when there is no improvement in their symptoms because they are no longer covered for longer-term, intensive psychotherapy as needed. With advances in technology that have become available via the Ontario Telemedicine Network (OTN), an encrypted form of telepsychiatry, patient access to treatment, including psychotherapy, has increased. OTN allows physicians to do virtual home visits and to connect with health teams to offer shared care. The argument that psychiatrists offering psychotherapy in Ontario are disproportionately in urban centers and are ignoring those in more remote areas falls flat. Our patients look to us to advocate for their needs when they are at their most vulnerable. When our patients ask whether these changes will come to pass, I hope that we can collectively as a profession say "Not on my watch" and have it be true. ■ ISSUES NewArchived

Bringing Neuroscience to the Bedside.

Clinical psychiatry has not historically expected practitioners to learn the basic science of psychiatric illness. Despite wide recognition that all effective psychiatric treatments have neurophysiological mechanisms, the field has struggled to integrate concepts of the mind and brain. Because of historical separations of clinical psychiatry and evolving neuroscience research, many psychiatric residency programs feel underresourced to teach clinically relevant neuroscience, and current residency graduates are not being prepared to integrate neuroscience findings into their practice. Significant strides have been made in the understanding of the neurobiology of psychiatric disorders. Similarly, the neurobiological mechanisms of a wide variety of treatments have been elucidated, spanning interventions from psychotherapy to physical exercise, electroconvulsive therapy, and modern neuromodulation techniques. The authors discuss strategies for integrating the language of clinical neuroscience into everyday psychiatric practice and review resources available to clinicians and trainees to help them acquire and practice these skills.

Psychiatrists Respond After Deadly Protests in Charlottesville

Back to table of contents Previous article Next article Professional NewsFull AccessPsychiatrists Respond After Deadly Protests in CharlottesvilleAaron LevinAaron LevinSearch for more papers by this authorPublished Online:12 Sep 2017https://doi.org/10.1176/appi.pn.2017.9b7AbstractMembers of the University of Virginia’s psychiatry department helped care for the caregivers throughout the medical center.The white nationalist rally in Charlottesville, Va., on Saturday, August 13, escalated from intimidation to outright violence when a participant drove his car into a crowd of counterprotestors, injuring over 30 people and killing 32-year-old Heather Heyer. Before the rally had started, members of the University of Virginia’s (UVA) Department of Psychiatry and Neurobehavioral Science had joined with others in the hospital to prepare for potential injuries, said Anita Clayton, M.D., a professor and department chair. When possible, patients were discharged early to free up bed space. However, once the incident was under way, the university locked down the campus and access in or out of the medical center became more difficult, even as it was needed most.The university’s psychiatry department then went to work to help colleagues throughout the hospital, said Clayton. “We provided care in the emergency department, the hospital, and on the psychiatry unit through the weekend.”They held town-hall style meetings with medical residents and School of Medicine faculty. Many expressed their fears over the weekend events and their dismay over negative Internet comments about the city and the university. Many were shocked that such an event could occur in such a progressive-minded community. Among the 30 injured were a psychiatry department staff member and her daughter, said Clayton.“We talked with psychiatry residents by class year because they already felt a sense of kinship with each other,” said Clayton. Some talked about how the white nationalist demonstrators had come into their churches to intimidate members. Black and Jewish staff members expressed particular fears, given the presence of the Ku Klux Klan and neo-Nazis among the demonstrators.“We told them how we supported them and that we would not tolerate discrimination,” she said.Members of the psychiatry department also helped out across the university’s medical community, said Amit Shahane, Ph.D., an assistant professor of psychiatry and neurobehavioral science and director of the Behavioral Medical Center.“We met separately with surgery faculty and residents to help them process their experiences after they cared for the injured,” said Shahane in an interview. “There was a general tension between our responsibility as providers to care for everyone and having to deal with people we didn’t agree with in an intense way. Overall, I think our health care system responded in an effective way to a horrific situation.”Zachariah Dameron, M.D., an associate professor of psychiatric medicine and residency program director at UVA, connected by email with his former colleague, Edward Kantor, M.D., now an associate professor and director of resident training at the Medical University of South Carolina in Charleston. Kantor, formerly on the UVA faculty, serves on APA’s Committee on the Psychiatric Dimensions of Disasters and was involved in the responses to both the Virginia Tech and Charleston church mass shooting events.Kantor suggested to Dameron that the department could help the university and the broader Charlottesville community by focusing on how to mitigate the effects of the immediate crisis and also start thinking about what to do the next time one occurred.Charlottesville’s experience also is another reminder that disasters and tragedies can happen anywhere. Advance preparation and coordination with the rest of the emergency response system can help communities and psychiatrists better prepare for them, said Kantor. In Charleston before the June 2015 shooting, the mental health community was already working with the sheriff, the state’s attorney, community mental health centers, and others. Knowledge of each group’s role and expertise and expectations derived from pre-planning and past response informed the response there. Getting psychiatry staff involved in preplanning for a disaster and developing specific roles can make responses more effective.Meantime, Clayton is also taking a deeper look into the future for her community and her university.“We’ll be dealing with this for a long time,” said Clayton. “It’s not easy to get over. You can’t be silent, and you can’t be passive. As a university community, we have a chance to stand together more and stand up for our values, the values of diversity, equality, and inclusiveness.” ■Disaster response information and resources are posted on APA’s website. ISSUES NewArchived

Collaborative Effort Among Stakeholders Can Reduce Barriers to Clozapine Use

Challenges surrounding prescribing clozapine may seem intimidating to clinicians with little or no training in use of the drug, but working with primary care physicians and more experienced prescribers can reduce the burdens.