Psychiatry Fellowship Research Articles

How a Birthday Celebration Changed the Course of My Life

How a Birthday Celebration Changed the Course of My Life

Columbia Fellow Leads Effort To Help Those on Temporary Protected Status

Back to table of contents Previous article Next article Community NewsFull AccessColumbia Fellow Leads Effort To Help Those on Temporary Protected StatusMark MoranMark MoranSearch for more papers by this authorPublished Online:29 May 2018https://doi.org/10.1176/appi.pn.2018.6a24AbstractSevere and her colleagues hope to link individuals who may have to return to Haiti with health and mental health care services.Psychiatrist Jennifer Severe, M.D., a public psychiatry fellow at Columbia University, is leading an effort by a small group of physicians to rally support for Haitians and other foreign nationals in the United States residing under Temporary Protected Status (TPS). Jennifer Severe, M.D., hosted a booth in the Exhibit Hall during APA’s 2018 Annual Meeting to talk to attendees about the plight of individuals who may lose Temporary Protected Status.Mark Moran Part of that effort involved reaching out to attendees at APA’s 2018 Annual Meeting by sponsoring a booth in the Exhibit Hall. The TPS program is a visa program created by Congress for immigrants who are unable to safely return to their home countries because of ongoing armed conflict, environmental disaster, or other extraordinary conditions.TPS was granted to Haitians in January 2010 after a devastating earthquake destabilized the country’s fragile infrastructures, resulting in over 300,000 deaths. The Trump administration terminated the program in November 2017 on the basis that the extraordinary conditions under which the status was granted no longer existed in Haiti. The Department of Homeland Security extended Haitians’ stay to July 2019 “to allow for an orderly transition.” (TPS has been terminated for individuals from several other countries. Most recently, TPS was terminated for individuals from Honduras.) Severe and her colleagues hope to start a pilot program to reach out to Haitian communities in the states with the highest density of Haitians. The goal of the program, called the Pilot Initiative to Empower Haitians on Temporary Protected Status and Support Their Mental Health, is to create a cushioned transition for Haitians returning to their home country (or to permanent residence in the United States when possible). This will be achieved by providing a platform for coordinating psychiatric and psychological support services to TPS holders and information to help TPS holders and their U.S.-based health providers familiarize themselves with the Haitian mental health system and make an educated decision about care options when they return. Such information will include the location of clinics and providers, psychotropic medications available in Haiti, costs of care, and support groups in Haiti that can help returning TPS holders. More information can be accessed here.“Our goal is to raise awareness around the anguish of individuals and families affected by the termination of TPS and this includes trainees, colleagues, and patients,” Severe told Psychiatric News. Severe was appointed by APA President Altha Stewart, M.D., to be a corresponding member of the Council on International Relations. The Council is reviewing a proposal for a position statement addressing the mental health needs of individuals on Temporary Protected Status, as well as of individuals residing in the United States on other visas who may be facing challenges related to immigration. Severe’s group is supported by the Haitian American Psychiatric Association, the Association of Haitian Physicians Abroad, and Professional Risk Management Services Inc. ■ ISSUES NewArchived

A model for increasing access to behavioral health services in low‐ and middle‐income countries

This month's commentary comes to you from Eldoret, Kenya, where a group of child clinical psychologists and child and adolescent psychiatry fellows from Brown Medical School are completing a rotation in global mental health. We are collaborating with Kenyan colleagues in the Psychiatry and Behavioral Sciences Department at the Moi University School of Medicine, learning about providing mental health services in resource‐poor settings, and hoping to provide some training in treatments that are more commonly provided in the United States.

Bullying in Child and Adolescent Psychiatric Training: The Need for Identification and Prevention

Case: A 26-year-old first-year psychiatry resident presents for rounds on her first day of a child consult-liaison rotation. She is anxious to begin the rotation because she will be working with an attending psychiatrist who is known as being difficult to please. The resident presents the case of a child in the emergency room to the attending, a second-year child and adolescent psychiatry fellow, and several medical students. The resident who is presenting the case begins to notice that the attending makes eye contact only with the fellow and then asks him to present the assessment and plan for the patient she just has presented. Using “herself as an instrument” to pick up on subtle interpersonal dynamics, the resident senses that the attending is annoyed with her and that she is not doing a good job on her first day.

Editorial introductions

Editorial introductions

AAGP Session to Focus on Evaluation, Treatment of Older Minority Patients

Back to table of contents Next article Annual MeetingFull AccessAAGP Session to Focus on Evaluation, Treatment of Older Minority PatientsShilpa Srinivasan,M.D., , Iqbal “Ike” Ahmed,M.D.Shilpa Srinivasan,Search for more papers by this authorM.D., , Iqbal “Ike” Ahmed,Search for more papers by this authorM.D.Published Online:29 Jan 2018https://doi.org/10.1176/appi.pn.2018.2a26AbstractAs the U.S. population ages, there will be more seniors coming from diverse backgrounds. Psychiatrists need to be prepared to offer culturally sensitive treatment.As the U.S. population ages, the percentage of older adults from diverse backgrounds is increasing. Psychiatrists need to be prepared to provide culturally sensitive care.iStock/a_TaigaThe role of culture and diversity in geriatric psychiatry will be highlighted in a session presented by the American Association for Geriatric Psychiatry (AAGP) at APA’s 2018 Annual Meeting in May. In the session, titled “Culture and Diversity in Geriatric Psychiatry Across the Clinical Continuum,” a panel of geriatric psychiatrists will discuss the growing diversity of the aging U.S. population and the demographic imperative to address diversity and the importance of incorporating patients’ ethno-cultural and sexual identity and orientation in assessment and treatment and as part of the overall approach to the mental health care of older adults. This session is particularly timely and salient, given the evolving landscape of the increasing diversity of the aging population within a rapidly changing health care environment.When we talk about patients’ diversity, we are referring to such demographic characteristics as race, ethnicity, culture, gender, sexual orientation, sexual identity, and immigration status. Currently, 50 million seniors, or 15 percent of the U.S. population, are over the age of 65, and this number is projected to increase to over 80 million, or 24 percent, by 2060, with an accompanying increase in diversity. The United States is also projected to become a majority-minority nation by this time. Ethnic elderly people aged 85 and above comprise the most rapidly growing segment of the U.S. population. Culture and ethnicity have an impact on what are considered normal changes with aging, as well as on psychopathology leading to differences in the prevalence, presentation, and etiology of symptoms and disorders. Culture can also affect therapeutic relationships and attitudes toward treatment as well as contribute to the burden of stigma. Cultural and ethnic differences between patients and health care providers can further exacerbate disparities in health care, such as access and quality of care provided. A framework for culturally informed, aware, and culturally competent care is therefore a critical component of meeting the mental health care needs of the diverse aging population. Among our presenters are current and past AAGP presidents, as well as leaders within AAGP, including Daniel Sewell, M.D., a professor of psychiatry and director of senior behavioral health at UC San Diego School of Medicine; and national experts Maria Llorente, M.D., deputy chief medical officer at the Maryland Veterans Administration Medical Center, and Ladson Hinton, M.D., director of geriatric psychiatry and director of the Latino Aging Research Resource Center at UC Davis.We will present an overview of culture and diversity in aging. Llorente will review the role of cultural psychiatry education and curriculum in training the health care workforce to meet the needs of minority elderly individuals. Sewell will discuss culturally sensitive clinical care of LGBTQ older adults, and Hinton will offer insights on innovative and culturally sensitive approaches incorporating families and caregivers of older adults. ■The preliminary program of APA’s 2018 Annual Meeting can be accessed here.Shilpa Srinivasan, M.D., is the program chair of the American Association for Geriatric Psychiatry (AAGP) 2018 Annual Meeting and program director of the Geriatric Psychiatry Fellowship at the University of South Carolina School of Medicine. Iqbal “Ike” Ahmed, M.D., is the president of AAGP, a faculty psychiatrist at Tripler Army Medical Center, and a clinical professor of psychiatry at the Uniformed Services University of the Health Sciences. ISSUES NewArchived

Fellowship Expands Behavioral Health Care Where Needed the Most

Fellowship Expands Behavioral Health Care Where Needed the Most

Addiction and Mental Health: The New Norm

Back to table of contents Next article EditorialNo AccessAddiction and Mental Health: The New NormCornel N. Stanciu, M.D.Cornel N. StanciuSearch for more papers by this author, M.D.Published Online:1 Dec 2017https://doi.org/10.1176/appi.ajp-rj.2017.121201AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As a current addiction psychiatry fellow and editorial board member for several addiction-focused journals, I am thrilled to have the opportunity to serve as this month's Guest Editor for the American Journal of Psychiatry Residents' Journal. The aim of this special issue is to shine light on the impact of substance abuse on our health care system. As we have seen throughout training, substance use disorders are highly prevalent and morbid conditions that result in significant social, financial, and human costs. Their prevalence is highest in clinical populations, especially among those with mental illnesses. It is estimated that 25% of the U.S. hospital beds are occupied by individuals with active substance use disorders (1). Ongoing use of substances and lack of properly addressing behaviors that lead to substance abuse impede upon our ability to treat substance use disorders from psychiatric and medical standpoints.By 2020, substance use disorders are expected to surpass all physical diseases as the major cause of disability (2). Tobacco use is the current number-one worldwide cause of preventable death (3), with many of our patients with mental health conditions being tobacco users. To make matters worse, we as physicians tend to avoid implementing pharmacotherapies for tobacco use and alcohol use disorder, despite strong supportive evidence of the efficacy of such therapies. Looking at the broader picture, for the first time in history the average life expectancy in the United States is decreasing (4, 5), and the conditions responsible for this epidemic of earlier deaths are directly or indirectly related to addiction (for example, chronic obstructive pulmonary disease, lung cancer, hepatitis C, cirrhosis, and fatal overdoses) (4, 5). It is imperative for us and our health care system to start addressing addiction as a top priority. Early intervention following first identification of substance use targets such disorders at a less advanced phase and hence prevents progression. A report published in 2009 showed a significant cost-benefit ratio for early detection and treatment interventions (6). These reduced costs relate to health care, the adult and juvenile criminal justice systems, education, and work productivity (6).To date, significant emphasis has been placed on the need for more physicians trained in substance abuse to alleviate the treatment gap and increase system capacity (7). There is also an effort to increase the capacity of general mental health care providers to identify and treat high-risk individuals earlier, before referring them for specialty health care (7). This would reduce patients' health risks associated with substance use much sooner while at the same time reducing the burden placed on more costly health care specialties (7). It is in this latter role that trainees and general mental health providers can best have an impact on the care of patients with substance use disorders.Dr. Stanciu is an Addiction Psychiatry Fellow in the Department of Psychiatric Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, N.H. He is also the Guest Editor for this issue of the Residents' Journal.

Addiction and Suicide: An Unmet Public Health Crisis

Addiction and Suicide: An Unmet Public Health Crisis

Amphetamine-Induced Delusional Infestation

Amphetamine-Induced Delusional Infestation

Fitness for Duty Assessments: Teaching Forensic Psychiatry Fellows Best Practices in Workplace Safety Consultation.

Fitness for Duty Assessments: Teaching Forensic Psychiatry Fellows Best Practices in Workplace Safety Consultation.

APA’s Component Meetings: One Resident’s Experience

APA’s Component Meetings: One Resident’s Experience

Psychiatrists Go Beyond Call of Duty to Respond to Harvey’s Victims

Psychiatrists Go Beyond Call of Duty to Respond to Harvey’s Victims

2.44 Child Psychotherapy Training in the United States: A National Survey of Child and Adolescent Psychiatry Fellowship Program Directors

2.44 Child Psychotherapy Training in the United States: A National Survey of Child and Adolescent Psychiatry Fellowship Program Directors

41.3 Training Strategies to Support Integrated Care for Children

The goal of this session is to describe a shared training initiative, which resulted in an innovative Collaborative Practice Training Model among the Cambridge Health Alliance (CHA) department of psychiatry child and adolescent psychiatry fellowship program, the CHA Department of Pediatrics, and the Massachusetts General Hospital Pediatric Residency program.

2.46 Implementation of a Direct-Observation Diagnostic Assessment Clinic in a Child and Adolescent Psychiatry Fellowship Program

The literature outlines several models for teaching medical students and family medicine and general psychiatry residents to conduct a psychiatric interview. To our knowledge, there are no published reports describing the implementation of a direct-observation clinic for child and adolescent psychiatry fellows. We propose that a direct-observation model is a feasible and valuable educational experience. Our objective was to design and implement a direct-observation psychiatric assessment clinic for first-year child and adolescent psychiatry fellows.

2.48 Consultation/Liaison and Emergency Department Cross-Campus Initiative: How Do Child Psychiatry Fellows Optimize Learning on Two Different Campuses?

2.48 Consultation/Liaison and Emergency Department Cross-Campus Initiative: How Do Child Psychiatry Fellows Optimize Learning on Two Different Campuses?

2.16 Electronic Medical Record Identification of At-Risk Patients in a Child Psychiatry Fellow Outpatient Clinic

2.16 Electronic Medical Record Identification of At-Risk Patients in a Child Psychiatry Fellow Outpatient Clinic

Experiences with the Child and Adolescent Psychiatry Milestones: Results of Two Nationwide Surveys.

Child and Adolescent Psychiatry began using milestones in 2015 as a way to document observable progress through training. The study is the first assessment of Child and Adolescent Psychiatry (CAP) faculty and fellows' experience with the milestones. This study presents findings from two surveys conducted one year apart. The first electronic survey polled CAP fellows and faculty nationwide using five opinion questions; demographic data and comments were also gathered. The second, four-question survey polled CAP faculty at the American Association of Directors of Psychiatry Residency Training annual meeting. Seventy-nine fellows and 101 faculty members responded to the first survey. Averaged over the five questions, 53% of faculty and 49% of fellows responded positively, with 29 and 33% respectively giving neutral responses. Participants were a diverse group in terms of geographic distribution, program size, and experience level. Comments were predominantly negative or mixed. Fifty CAP faculty and fellows responded to the second survey. Of the three opinion questions, positive responses ranged from 62 to 90%. Forty percent of respondents reported having had no faculty development on the milestones. Implementing the milestones has been a mixed experience for faculty and fellows. Direct comparison between these two surveys is not possible given their different content and format. Future directions include standardization of faculty development sessions, and improved structures to create and share best practices for assessment of trainees.

Clinical Review of New Medications for Treating Attention-Deficit/Hyperactivity Disorder

As a busy child and adolescent psychiatry fellow, I appreciate having access to condensed information about new psychopharmacologic treatments available on the market, which helps me remain informed and improves my patients’ care. I appreciated when my faculty mentor brought to my attention Daughton’s 2009 article1 that reviews attention-deficit/hyperactivity disorder (ADHD) pharmacotherapies. However, several years have elapsed since that article was published, and there have been new medications released to market. These medications are not novel compounds but rather new preparations of existing compounds that broaden modes of administration and provide additional pharmacokinetic variations. Thus, a brief update is in order.