Academy of Medical Psychology

ACADEMY UPDATE FROM THE PRESIDENT BY STEPHEN GARY MCCLURE, PHD, ABMP Dear Colleagues, public at large. Psychologist, social I am both honored and humbled to assume worker, therapist, counselor and life coach the role as the next President of the Acad- are often used interchangeably to describe emy of Medical Psychology (AMP). I mental health providers, regardless of the have been serving on the board of direc- significant differences in training and tors as the chairman of the credentialing clinical experience of each specialty. committee for the past several years and To complicate things further, APA is de- NOVEMBER 2018 VOL. 7 ISSUE 1 the experience has been both challenging veloping a “Masters’ Program in Psychol- and rewarding. During my time as an ogy Accreditation Initiative.” APA’s A C A D E M Y U P- 1 DATE FROM THE AMP board member, I have witnessed consensus statement for the Masters’ Initi- PRESIDENT BY DR GARY what can be accomplished by a few dedi- ative states, MCCLURE cated psychologists, working toward a We recognize the expertise in sci- EXECUTIVE D I- 2 common goal. RECTOR COLUMN ence, clinical practice and leader- BY DR. JERRY MORRIS My goal as president is to build on the ship offered by psychologists. Our foundation established by the Medical responsibility is to address the PATIENT EDUCATION 3 Psychology pioneers preceding me that shifting demographics and behav- BY DR. RORY RICHARD- SON includes Drs. Lawson, Morris, Caccavale, ioral health needs of the U.S. pop-

PRESCRIPTIVE AUTHORI- 4 Barngrover, Galle, Cole, Childerston, ulation. We need to bring addi- TY BY DR. SUSAN BARN- Nessetti, and Wiggins, to name a few. tional scientifically informed and GROVER These leaders have committed their time, culturally and linguistically re- HEALTH AND SCIENCE 5 resources, experiences and vision to the sponsible practitioners to all popu- BY DR. JEFF COLE future of medical psychology and all psy- lations, including underserved NEW DIPLOMATE AND NEW RESIDENT INTRO- 6 - chologists have benefitted exponentially populations, using approaches dis- DUCTION: DRS. ROSSILLI 7 AND SOSA from their tireless efforts. tinct from those offered by other ACMC INTERNSHIP AND behavioral health practitioners. 8 However, despite the tremendous accom- RESIDENCY BY DR. MATTHEW NESSETTI plishments of a few, our profession con- We believe this can be accom-

tinues to lack a clear identity with the plished by the development of a HEAT RISK AND 11 PSYCHOTROPICS (Continued on page 10 ) BY DR. GALLE 14 SAN ANTONIO American Board of Medical Psychology Board of Directors: Gary McClure, PHD, ABMP, President and Head of Credentialing Committee; Jerry Mor- ris, PsyD, MBA, MSPharm, ABPP, NCSP, NBCC, CCM, Executive Director; Ward M. Lawson, PhD, ABPP, ABMP, Past President, Archives Edi- CONFERENCE tor; John Caccavale, PhD, ABMP, ABPP Director and NAPPP liaison; Jeffrey D. Cole, PhD, ABMP, Director, AMP Newsletter, Facebook Page Editor, Archives Assoc. Editor: Susan Barngrover, PhD, ABMP - Secretary, Archives Assoc. Editor; Susana Galle, PhD, ABMP—Director, Archives Science Editor, Cal Robinson, PhD, Director, Bethany Nevins administrative 660-200-7135. Page 2 VOL 7, ISSUE 1 NOVEMBER 2018

Executive Director’s Column walk in lock step with APA. state by Dr. Jerry Morris, PsyD, They often have most of their associ- ABMP, ABPP board members and leadership ations. APA has had a summit and con- that are academics since academ- It is cocted a “Master’s Program in ics get release time and are paid hard Psychology Accreditation Initia- for this type of service and practi- for tive” (http://www.apa.org/pi/mfp/ tioners must lose $1000 a day of many masters-summit/default.aspx )! income to take these positions. at Once again, as has occurred sev- States are falling in line, as state APA, eral times in my lifetime has APA psychological associations often in the started an initiative to help our do and take whatever comes re- academic colleagues who train down the pike from APA. Many search industry and in the aca- masters psychologists in opposi- states, such as my own are ap- demic industry, to understand tion to the APA Policy that the pointing academics as a liaison to practitioner’s angry resistance to title Psychologist is reserved for the APA master’s accreditation just accepting the national's revi- Doctors of Psychology. The aca- task force. They are decent people sion of their "Dr" only position demics indicate that this is a re- who will represent their industry that many of us in the past gener- sponse to both the national coun- well, but I have little expectation ation fought in the trenches and selor’s association’s maneuver that they will represent the practi- bled financially and took lots of with state licensure to stop allow- tioner movement or practice. retaliation to establish in the na- ing master’s in psychology (as It is immaterial to many states tion and my home state of Mis- opposed to counseling’s masters) that the practice community is souri. I am licensed in Missouri, to sit for Professional Counselor strongly behind the doctorate only Louisiana, and Kansas and have Licensure (the market for MS in position that has long been estab- several specialty Board certifica- Psychology departments for lished in APA, NAPPP, and all tions. I am an aging senior psy- years), and due to workforce Psychology Specialty Boards. chologist who understands the needs in the mental health indus- There has been little coordination importance of the issue at hand. try. Clearly, accrediting master’s with the practitioner movement I'm glad we want a depth discus- Degree Programs at Universities and associations that should be sion that thought about this dan- is not the only, or even the most involved in these debates. When gerous and complicated helpful solution to the workforce practitioners speak up people in move. I'm glad that respect for demand for Psychologists. The state associations whose loyalty is the idea that many problem could be solved by mak- greater to APA than the practi- practitioners are not sure or com- ing it easier and less expensive, tioner movement often call them fortable about this path, and that and more collaborative and uncivil, negative, or uncoopera- true respect and belief in how growth oriented to develop doc- tive. This is the typical in group- complicated the decision is should torate programs in psychology. outgroup lack of interest in allow- notbe just left for APA but should A second problem is that many ing practitioners to have the be well discussed and thought state psychological associations preeminent say so over any deci- (Continued on page 11) are dwindling in membership and sions that affect practice. That logic escapes both APA and many Page 3 VOL 7, ISSUE 1 NOVEMBER 2018

Patient Education, Informed Consent & Profes- time on these sional Competence and other is- Rory Fleming Richardson, Ph.D., TEP, ABMP sues, but this tends to be In the early 1970s, Oakland Kaiser Permanente, the limited. How Commonhealth Club in Santa Rosa, and other many of us, as healthcare centers, started to pioneer the field of practitioners, preventive, and prospective medicine through pa- spend time tient education, and health risk assessment. The talking to the introduction of the use of statistics for personal patient about health assessment took a significant leap through the issues of the work done by Lewis C. Robbins, MD and Jack name brand Hall, MD which resulted in the publication of How versus generic medications, the complications of to Practice Prospective Medicine (1970). With the taking over-the-counter medicationsand/or drinking interest in preventative methods, the nurse educa- alcohol, with prescription medications, or changes tion program at Sonoma State College began offer- in health habits impacting psychiatric and medical ing courses in Patient Education, and Health Risk treatment? Counseling, which were attended by nursing stu- dents and one psychology student, myself. We real- In the treatment of various psychiatric and physio- ized that the best way to garner patient compliance logical conditions, practitioners make decisions with health recommendations was through educa- based on assumptions drawn from research, testing, tion, and providing personalized knowledge, of that clinical experience, and observations. This pro- patient’s health risk. The choice was still the pa- vides the patient with the best available therapeutic tient’s to make, but it was more likely that if they intervention. One of the complications comes from were engaged as co-producers of their health care, patient behavior which the practitioner does not they would be more likely to make the best deci- know about. For example, if the patient takes over- sions. the-counter (OTC) medications for an acute condi- tion, such as a bad cold, these medications may Informed consent has always been a hallmark of compete with the prescribed medications for isoen- patient care. What is sometimes forgotten is that zymes altering the therapeutic effect. proper informed consent must be inclusive of ade- quate knowledge about benefits and risks. If the Just as a prescriber should alert the patient to the professional providing the informed consent is una- possibility of tobacco smoking habits altering ware of the scope of the benefits and risks, proper Olanzapine levels, or the impact of Prozac on birth informed consent is not possible. control medications, it is the clinicians duty to edu- cate the patient that various changes in health habits Since beginning in the mental health field in 1976, I can impact his/her reaction to regularly taken medi- have discovered that in the face of time-constraints, cations.1 practice quality often deteriorates. One of the areas which has been most impacted is attending to pa- Cytochrome P450 includes over 20 different isoen- tient education. Back in the 1970s, while attending zymes in humans which are required for metaboliz- California State College, Sonoma, I started by vol- ing of different medications. For the prescriber, it unteering at the Commonhealth Club, a preventa- would be optimal to be able to use a basic chart of tive/prospective medicine center in Santa Rosa: do- each medication combination and compare it with ing EKGs, and talking to individuals about the the specific patient, but there are simply too many need for good nutrition and exercise. Over the variables. To determine the amount of availability years, I have come to understand that patient edu- of each isoform, and the overall level of P450, one cation is not an option, but a requirement. would have to take into account all of the factors which can impact these levels. These include: During an intake interview, we will ask about medi- cations being taken and any allergic reactions. As a Genetic predisposition, medical psychologist attempting to determine the Supplements, subtle problems which are present, we ask about the Daily food and substance intake, other health habits. Physicians, who are pressured Physiology of digestion, metabolism, ab- to see as many patients as possible, will also spend sorption, and elimination, (Continued on pg. 12 ) Page 4 VOL 7, ISSUE 1 NOVEMBER 2018

The following article, are the entrepreneurs of in psychopharmacology. “Prescriptive Authority creative, evidenced-based They must have supervised Enhancing Our Scope of Prac- psychotherapy, which practicum and pass a national tice for Patient Welfare”, by Dr. remains the backbone of our exam, like the PEP for Susan Barngrover, is reprinted “psychotherapeutic matrix” example. For the American from Missouri Psychologist with (Galle, 2014). Likewise, Board of Medical permission of their Editor: when we have a case that is Psychology, of which I serve outside our scope of practice as a board member, a medical Ever feel frustrated at your we refer to a specialty psychologist must also pass a inability to help your psychologist. If a peer review committee patient’s access services? neurologically compromised including case presentations Missouri currently has a patient presents for treatment and a credential review and deficit of psychiatrists, and for reasons such as post possess an understanding of according to SAMHSA, this CVA, dementia, TBI, etc. we complex ethical standards amount is not likely to may refer to a that insure principled practice increase. In 2013, work force neuropsychologist for a more (Caccavale, 2013). demands did not meet comprehensive evaluation What kinds of courses are projected patient needs, while and diagnostic testing to required for this advanced 20% of behavioral health enhance treatment planning. training? These programs patients did not receive care Similarly, a medical require a compendium of from any health professional psychologist can provide a medical courses including: (SAMHSA, 2010). Primary cost effective, competitive biochemistry, clinical care and specialty physicians and comprehensive medicine, anatomy and often feel inadequately assessment of mind/body physiology, nutrition and trained to diagnose and interactions through lifestyle management, as well prescribe psychiatric distinctive mental health as psychopharmakinetics and medications, and unless you lenses, while distilling the psychodynamics of have a strong bond built on relevant personal and medications and their trust and fidelity, they are sociocultural narratives to interactions with other drugs unlikely to honor your implement both and disease states. Properly recommendations. In fact, psychological and medical trained medical psychologists these physicians are risking treatment with “one stop have been prescribing safely their own liability not to shopping.” Therefore, with since 1995: that includes no mention their patient’s safety, complex comorbidities ethical complaints or deaths when they have limited especially most prudent or serious injury caused to training in behavioral psychologists would their patients. Currently, only diagnosis and treatment. In welcome one of our own five states, including reality, complications can guild’s diagnoses and Louisiana, New Mexico, include prescribing treatment recommendations Illinois, Idaho and Iowa as ineffective or long-term in the form of a medical well as Guam, the military medications that not only psychologist, perhaps rather and the Indian and Public increase side effects and than the myopic view of Health Services allow iatrogenia but also discourage psychiatry. medical psychologists to patients from embracing So what is a medical prescribe. Most states, for psychotherapy and healthy psychologist? In addition to example require five years lifestyle changes (Galle, being a doctorally trained post doctoral experience in 2014). Clearly, a shift in psychologist, a medical addition to one or two years Missouri policy is needed to psychologist holds a of supervision of prescriptive enhance our scope of practice postdoctoral masters degree authority to insure safe and and improve patient welfare. from an accredited university As licensed psychologists, we (Continued pg. 14 Page 5 VOL 7, ISSUE 1 NOVEMBER 2018

HEALTH AND SCIENCE tion below, because social construc- and how to be healthy" (end quote) tion is the answer, as well as the pre- Social Construction, Health, Ill- vious individual factors (knowledge, And, they note that these perceptions ness and Healing skills, attitude, genetics)" (end and mores can vary between cultures quote) and societies: Review of Webpage article: “Perceptions of Health as Social The author notes some of the socio- "We also expect people in different Constructs” (pdhpe.net)) economic and sociocultural factors contexts and from different cultures that affect our perceptions of health to have different perceptions of Reviewed by Jeffrey D. Cole, PhD, and illness: : health. They have different meanings ABMP, Director, Board of Direc- and interpretations of health because tors, AMP, ABMP "Your understanding of perceptions their understanding is a result of of health as social constructs should their society, just as our perception is Sometimes it's not given as much identify that an individual’s interpre- a result of ours" (end quote) weight in common discourse as the tation of health is largely influenced Medical psychologists are doctors in "bio" and the "psycho" components. by their: socioeconomic status But, the "biopsychosocial" model (education, employment, income), psychology with advanced post- also has a social component! sociocultural status (family, peers, doctoral training in medical science media, religion, culture), and envi- and integration of psychological, This is a very interesting and im- ronment (geographical, political, portant area of inquiry and important social, access to information and biomedical and social concepts and part of informed practice. Our bodies technology) among other approaches to health, illness and and minds exist in larger social, rela- things" (end quote) healing tional, environmental contexts that extend beyond our personal relation- They also note that these perceptions Link to reviewed webpage: https:// and mores can change as the society ships and families. In addition to the www.pdhpe.net/better-health-for- more commonly referenced "social or culture changes: stressors" and "social supports" that individuals/what-does-health-mean- contribute to our psychological and "Perceptions of health as social con- to-individuals/perceptions-of-health/ structs also means that the interpreta- physical health and illness there are perceptions-of-health-as-social- societal and cultural assumptions tion of health changes with time. and mores about health, illness and This can be seen with the commodi- constructs/ tisation of fitness and the growth of healing that are internalized by ______"society's elements" -- ourselves -- the health industry along side phar- affecting how we relate to our own maceuticals and the medical system. health and health-and-illness related We have many large groups invested Figure below is reposted from the matters in general heavily in the concept of health, in- pdhpe.net website and can be ac- cluding what is means to be healthy The reviewed webpage, "Perceptions cessed at the above link of Health as Social Con- structs" (pdhpe.net) provides an ex- planation of social construction as this concept pertains to health and health-related perception:

From the page: "Perceptions of health as social con- structs requires you to understand that the various understandings and different meanings people have or attribute to health are mostly created by their society. That is, our under- standing and interpretation of health is created and developed by our soci- ety. A good way to think about it is that your perception of health is greatly affected by your context. Have you ever wondered the ques- Page 6 VOL 7, ISSUE 1 NOVEMBER 2018

Introducing New Diplomate:

Christopher Rossilli, PsyD, MS, ABMP Dr. Rossilli recently met all the stringent criteria set by Academy of Medi- cal Psychology and the American Board of Medical Psychology — post- doctoral studies in psychopharmacology, preceptorship, case writeups, oral and written exams — to qualify as a diplomate in Medical Psychology!

Dr. Rossilli earned his Bachelor of Arts in Psychology from Radford Uni- versity in 1997. He obtained a Master of Science in Mental Health Coun- seling from Nova Southeastern University in 2003. He graduated from Car- los Albizu University in Miami, FL, with a Doctorate in Clini- cal Psychology Psy.D and specialization in Neuropsychology in 2009. Dr. Rossilli completed a post- doctoral residency in Neuropsychology at Lynn University in 2011. He graduated from Nova South- eastern University with a Post-Doctoral Master’s in Psychopharmacology in 2014.

He currently serves as the President of Medical Psychology Division of the Florida Psychological Asso- ciation. He also is a Board member for the RxP political action committee. Dr. Rossilli is commonly asked to present at Grand Rounds on topics such as Post-Stroke Delirium and Traumatic Brain Injury, and his medical errors course, How to think like a RXP psychologist and prevent medical errors. He speaks throughout the community on topics such as stress management, memory disorders, and cogni- tive changes after brain aneurysm. He currently has a private practice call Cognitive Care. He currently holds privileges in 4 area hospitals. In March of 2018 he passed the Psychopharmacology Examination for Psychologists. He is a adjunct professor at Florida Institute of Technology and teaches Clinical Psy- chopharmacology. He was recently recruited to be an instructor for GME's for incoming medical resi- dents in hospital settings for HCA.

JOIN OUR GROUP OF PROFESSIONALS

Members are licensed psychologists who have an interest in medical psychology and will have full voting privileges in elections of officers and board members. Members are not Diplomates/Specialists in Medical Psychology, but are licensed psychologists who have an interest in medical psychology… http://amphome.org/wordpress/ why-join-amp/

BOARD CERTIFICATION INFORMATION

Board certification in Medical Psychology indicates specialty exper- tise, which distinguishes you from other psychologists who do not have post-doctoral specialty training in medical psychology, basic science, and psychopharmacology and work with patients in or in affiliation with healthcare facilities in the nation’s core healthcare system… http://amphome.org/wordpress/abmp-requirements/

GET THE TRAINING YOU NEED

The national practitioner's association (National Alliance of Professional Providers in Psychology) in psychology (www.nappp.org ), one of our affiliated organizations has kindly offered the below CE courses relevant to our discipline. There are several continuing education courses available to members… http://amphome.org/wordpress/continuing-education/ Page 7 VOL 7, ISSUE 1 NOVEMBER 2018

Introducing Medical Psychology Resident: tance experience (5 years) and also has Maria L. Sosa, Psy.D. Dr Sosa is currently been actively in- completing her postdoctoral residency at AllCare volved in many re- Medical Centers (ACMC), a Medical Psychology search projects rang- and Neuropsychology Program where she is estab- ing from cultural fac- lishing herself as a knowledgeable and conscien- tors in suicide pre- tious Clinical Psychologist and Neuropsychologist vention to the over- with specialty in Psychopharmacology. These areas representation of bi- of expertise distinguishes her from other profession- lingual children in als as she can understand the psychosocial com- our school systems, plexities of cases commonly seen in medical set- and neurodevelop- tings while integrating the biopsychosocial model mental and neuro- into her professional practice. Her holistic and pa- degenerative disorders. Dr. Sosa’s research endeav- tient-centered approach to care encompasses her ors have led to presentations at national conferences work at ACMC. This outpatient clinic serves a such as at the National Academy of Neuropsycholo- broad variety within the population from children to gy and regional research symposiums. Being of pre-teens, teens, young adults, adults and geriatrics. immigrant descent and multilingual, cultural impli- Dr. Sosa is experienced in completing comprehen- cations and the impact of neuropsychological func- sive assessment of patients suffering from a variety tioning is one of her research interests as well as of psychological and neuropsychological conditions medical psychology and the holistic approach. Re- including neurodevelopmental and neurodegenera- markably, Dr. Sosa traveled to Bolivia to see the tive disorders and diseases. Additionally, Dr. Sosa first-hand effects of CHIKV in her native country conducts clinical diagnostic interviews, medication and became interested in pursuing this area of infec- review and management, implements evidenced- tion disease a research topic for her dissertation. base therapeutic interventions, provides supervision This research interest became a personal pursuit as to interns and externs, and offers consultation to she witnessed her mother’s affliction with the dis- other health care providers (i.e., physicians, nurses, ease and months of misdiagnosis and suffering. physical therapists, speech pathologists, occupation- She is hopeful with this contribution to the scien- al therapists, and others). She graduated from an tific literature that practitioners will take notice of APA- Accredited Clinical Psychology Program of- the impact this disease has on neuropsychological fered by Albizu University-Miami campus with and psychological functions long-term and, ulti- concentration in Neuropsychology, and completed mately, find a cure. her internship year at Miami Dade Community Ac- tion Human Services Department (an APA- ______accredited program). She taught as an adjunct pro- If you are interested in AllCare Medical fessor in Albizu University for the undergraduate Center’s (ACMC) Medical Psychology and program the subject of Health Psychology. Dr. So- Neuropsychology Residency Training Pro- sa completed her Bachelors of Science in Psycholo- gram please see their advertisement on the gy and her Masters in Science of Psychology at Al- following page bizu University. During her time in the doctoral program, Dr. Sosa has an extensive teaching assis- Page 8 VOL 7, ISSUE 1 NOVEMBER 2018

ALLCARE MEDICAL CENTERS (ACMC)

IS OFFERING: PRE-DOCTORAL INTERNSHIP AND POST-DOCTORAL RESIDENCY TRAINIING OPPORTUNITIES FOR PSYCHOLOGY STUDENTS AND GRADUATES IN:

CLINICAL PSYCHOLOGY, MEDICAL PSYCHOLOGY AND NEUROPSYCHOLOGY

Dr. Matthew Nessetti, one of AMP's pioneering founders and specialists in medical-psychology is also a physician specializing in family medicine. He and his wife, who is also a physician, operate AllCare Medical Centers (ACMC) comprehensive clinics in Florida providing medical, psychologi- cal and integrative healthcare services. AllCare is offering a psychological internship as described in the advertisement below.

AllCare is a family owned organization providing primary healthcare to patients of all ages, from new- born to aging adults. A psychological component is integrated throughout the primary healthcare prac- tice, concentrating on the necessity to concurrently treat both the mind, as well as the body. Interns will provide psychological services, including individual and family therapy, to an outpatient population to children, adolescents, adults, and geriatrics that present with acute mental health issues. Interns will have the opportunity to provide neuropsychological assessments to patients presenting with psychologi- cal, neuropsychological, and medical conditions. Interns will also provide comprehensive psychological assessments to children, adolescents, and adults for diagnostic clarity and treatment planning.

ACMC offers a one-position two-year Residency in Medical Psychology. Throughout the pro- gram, each resident will benefit from a planned, programmed sequence of supervised training experi- ences. The first year serves as the post-doctoral year required by most states for licensure. Each resi- dent is evaluated based on their experience, training and level of competency in clinical services, with training activities then tailored to meet each resident’s needs. The second year serves to meet the licen- sure requirements in some states and build toward the board certification process. Selection is based upon the quality of the application and the compatibility between the applicant’s inter- ests and their ACMC goals and objectives.

Please contact Kelly L. Nessetti Prather at AllCare (contact information below) for additional infor- mation on the program and for information on applying:

Kelly L. Nessetti Prather CPC Practice Administrator AllCare Medical Centers, P.C. 5860 Ranch Lake Blvd. Suite 200 Bradenton, Florida 34202 Phone: 941-388-8997 www.AllCareMedicalCenters.com [email protected]

Page 10 VOL 7, ISSUE 1 NOVEMBER 2018

(President’s cont.’d from pg. 1) and planning to retire psycholo- the Certificate of Proficiency in complementary model of gists. Drs. Caccavale and Morris the Treatment of Alcohol and training and credentialing have emphasized on multiple oc- Other Psychoactive Substance

for master’s level practi- casions that psychology needs a Use Disorders Certification for tioners in psychology. new generation of leaders willing psychologists. The AMP board is This alliance and integra- to commit time and effort to the currently discussing alternative tion in the field of psy- cause. They speak from experi- options to address the void creat- chology that includes ence, both having contributed ed by APA’s action. The market both doctoral and mas- tireless hours, intellectual proper- for substance abuse certification ter’s level practitioners ty, financial resources and com- programs is competitive, to say who are committed to passion for the greater good of the least, however there may be a the scientifically driven our psychology community. need that AMP can fill, specifical- practice of psychology I recently reached out to several ly for psychologists. will greatly expand the psychologists and AMP members Finally, as the president of AMP, reach of our field in the requesting that they increase their my primary objective is that my coordinated delivery of participation in the AMP effort. service will be measurably benefi- behavioral health services. cial to medical psychologists, our The typical response was, “I am patients and the future of psychol- The cause may be noble, but APA too busy” which is understanda- ogy. ble. But having served on the is tasked principally with repre- ______senting the interests of psycholo- AMP board for the past few Illustration: Asclepius was a battlefield gists. My concern is the Masters’ years, it is evident that everyone physician who later became identified as accreditation initiative will con- is “too busy.” However, I am the Greek god of medicine. His snake- astounded by what my AMP col- entwined staff is the symbol of medicine found the identity of psycholo- today and, when together with the Greek gists with other behavioral health leagues accomplish for AMP Psi symbol comprises the symbol of care providers even further, re- members and other psychologists, Medical Psychology sulting in the unintended conse- despite their other time commit- quence of diluting the identity of ments and this underlies my in- psychologists to a greater extent. tention of recruiting more psy- chologists to AMP to contribute Dr. Morris writes eloquently as members, diplomates or board about the pros and cons of the members. APA Masters’ accreditation initi- ative, in his article in this newslet- The future of psychology lies ter. with the next generations of medi- cal psychologists and my inten- A second goal is to recruit new tion is to work with the next gen- psychologists to AMP to secure eration of leaders so that medical the future of psychology as an psychology survives and thrives independent profession. AMP is as a psychological specialty. currently guided by a board of directors in their late 50’s, 60’s Thirdly, as many psychologists and 70’s of retired, semi-retired know, the APA has discontinued

Page 11 VOL 7, ISSUE 1 NOVEMBER 2018

(Exec. Dir.’s column cont.’d from p. 2) Vendorship in MO. I know how doctorate education in psychology that has afforded me and pa- important our -not certification of master’s grad- tients. I led the efforts to get our Doctor Identity to our efforts to uates called graduate psycholo- law revised to doctorate only li- protect, extend, and defend our gists! Specialty boards need to be censure. I have been active in the profession. heard loud and clear on this issue Professional school movement and about the more realistic solu- and the Practitioner movement Trust me. I agree that a respect tions. I will be asking our board nationally. I have held positions for the complexity of this issue, and specialists and society mem- in leadership in APA, NAPPP, and not letting the national associ- bers to weigh in on this national two psychology specialty boards, ation lull us into simply accepting issue and educate me and the and understand the numerous and master's accreditation is for prac- board further. You can contact powerful factions in APA. I am titioners in each state. We simply me at [email protected] an LPC as well as licensed Family don’t have to accept APA’s lead Jerry Morris, PsyD, MBA, Therapist and have trained many on everything. In our specialty MsPharm, ABMP, ABPP, disciplines including physicians board, we are a Doctorate Only ABBHP, NASP, CCM and nurse practitioners. I am an Specialty, with one of the most Executive Director approved supervisor and have em- complex and arduous post- ployees who are LPCs. I doctoral specialization training Academy of Medical Psychology understand their important role and examination requirements. and American Board of Medical Psychology and help in our industry and We favor allowing doctors to healthcare system. have assistants that function as Illustration: Santiago Ramon Y Cajal psychological technicians, and (1913) , “Nerve outside the spinal The issue is bigger than manpow- cord” Medicare and many Insurers al- er and need. The issue is our low this if they are closely super- identity. I agree we need more vised and the doctor ensures the practitioners, but I think the solu- quality of data and does the diag- tion is "train more doctorate psy- nostic interpretation and treatment chologists". I was the largest plan development. We don’t need clinical division in APA Hospital accredited masters programs in and Healthcare Facilities Chair psychology to do that and such an for 11 years as we fought for pari- action is the first step toward a ty with psychiatrists and recogni- dual level licensure down the tion with general physicians as road. Clearly, our communities specialists. I know how need more psychologists, special- important our identity is in that ized psychologists, and highly effort. I was a lobbyist with Bry- skilled diagnosticians and scien- ant and Donna when we called on tifically valid treatment planning. HEW and eventually politicized The answer is to pay specialists at our way into Medicare. I was a a rate that encourages advanced lobbyist (registered) when we got study and specialization and pro- hospital privileges and Medicaid vide more financial support for Page 13 VOL 7, ISSUE 1 NOVEMBER 2018

Transcript of NBC interview with ABMP killed 27 people found that more than half of those Board Member and Archives Science Director, deaths had mental illness, and half of those were Dr. Susana Galle, PhD, ABMP on heat risk as- taking psychiatric medication. sociated with psychotropic use, titled: Not all patients taking psychiatric medication will Here's a Surprising Heat Risk for 1 in 6 Ameri- have increased sensitivity to extreme heat, but cans: Psychiatric Medications can Interfere many who do suffer in the heat may not under- with the Body's Ability to Regulate Tempera- stand why. ture and Most Patients don't Know, NBC News, Avichai Scher, June 28, 2018 Dr. Susana Galle, a medical and prescribing psy- chologist who has researched the effects of heat on It hit 101 degrees Thursday in Wichita, and special people with mental illness, said that there’s not education teacher Sherry White knows to stay in- enough awareness of the effect psychiatric medi- side. cations can have. She said psychiatrists prescrib- That's because this kind of heat -- currently mak- ing medication need to warn patients about the risk ing much of the country sweat -- can be especially heat presents, and encourage them to drink more dangerous for people like her, who take certain water and stay out of the heat. psychiatric drugs. “I’ve seen people who say they are feeling fever- White has fibromyalgia, which her doctor treats ish. They don’t realize it’s the medication,” Galle with Cymbalta, an antidepressant that helps treat told NBC News. the symptoms. But because of the drug, White's For years, White didn’t understand why she strug- ankles swell, she sweats profusely, feels faint, and gled more in the summer than other people around is short of breath when it gets too hot. her. “I’ve seen people who say they are feeling fever- She remembers the first time she realized the heat ish, they don’t realize it’s the medication.” was getting to her. A parent came in to pick up a As a result, she spends her summers cloistered in child and asked her why she was sweating so her home. much and if she was all right. White is overweight and she said she blamed her weight for the ex- “I used to love to garden and taking my grand- treme sweating. daughter to the zoo in the summer,” White said. “Now, I feel like I’ve let them down.” “It was humiliating,” White said. “I didn’t know it was the antidepressants.” White is among the one in six Americans who take psychiatric medications. Many can interfere with No doctor ever told her, either. She took it upon the activity of the hypothalamus, a part of the herself to read up on all the medications she was brain that helps regulate temperature and thirst. taking and saw that dehydration and sensitivity to heat was a possible side effect. Other medications Some people taking psychiatric medications can that cause sensitivity to heat and interfere with lose some of their thirst even as their body is more temperature regulation include antihistamines, be- prone to dehydration. It's a dangerous combina- ta-blockers and amphetamines. Patients taking tion. drugs should look into the side effects and plan Extreme record heat is hitting much of the U.S. ahead. they should also take care to properly store this week, exposing an estimated 160 million medication. Americans to dangerously high temperatures. The Centers for Disease Control and Prevention It's no secret that such high temperatures can kill. offers a guide for how to prepare for and withstand According to the National Weather Service, from extreme heat, as well as a more detailed explana- 2006-2016, an average of 97 people died each year tion of heat-related illnesses. from extreme heat. Children under four and adults over 65 are most at risk of heat stroke, but people Galle stressed that the importance of being in- taking a variety of medications have a dispropor- formed about heat-related side effects of medica- tionate risk. Studies have shown that those with tion isn't just physical, but emotional too.“Not mental illness are at higher risk during heat waves. knowing what is wrong with them exacerbates A study of the 2012 Wisconsin heat wave that their problems,” she said. Page 12 VOL 7, ISSUE 1 NOVEMBER 2018

(Pt Education cont.’d from p. 3) Disintegrants (such as so- dium starch glycosylate to neurotoxins, radiation, environ- Another variable which can occur promote breakdown and mental variants, etc.). without the awareness of the pre- absorption), One of the best known food that scriber, and sometimes the pa- Fillers and diluents (such impacts on P450 levels is that of tient, is the substitution of a ge- as lactose, sucrose, mag- the intake of grapefruit juice neric medication or one from a nesium stearate, glucose, which lowers P450.2 Although different manufacturer. Although plant cellulose, and calci- there has been controversy over the equivalency is designed to um carbonate that add the research, there has been evi- minimize concerns, differences bulk), dence that P450 is also impacted are present which, for some pa- Lubricants (such as silica, by environmental contaminants tients, can significantly alter the talc, stearic acid, magnesi- such as glyphosate, a key ingredi- effectiveness of the medication. um stearate), ent in Round Up herbacide and in The exact reason is unclear, but Preservatives (such as vit- GMO products.3 may be related to the combination and type of fillers and congeners amin A, C, E, selenium,

used. Prescribers and pharma- amino acids, methyl para- To complicate this picture, P450 cies attempt to minimize these ben, propyl paraben), isoenzymes have different affinity concerns to prevent a placebo (or Coloring (for differentia- for different medications (or nocebo) affect from occurring, tion of medications and dosages). chemicals), choosing to metabo- but awareness of the potential 5 lize one chemical prior to anoth- problems are needed. Artificial flavoring er. This results in the level of one medication being higher in the Since different manufacturers of a body than another, possibly One of the things that is not cov- medication are likely to use dif- causimg unpredictable drug inter- ered in the information on most ferent excipients and fillers, a actions and complications.4 medications is the other ingredi- medication manufactured by one ents in the medications, and the company may impact the patient fact that the exact amount of ac- different than another. In addi- The best way to address the prac- tive ingredients will vary from tion, some individuals appear to tical issues involved consists of a pill to pill. So what is the “other present unusual hypersensitivity two step process: (1) avoid taking stuff” in the pills? These are to some excipients and fillers. potentially competing medica- what are known as inactive ingre- This can bring on additional com- tions at the same time, and (2) dients, which is somewhat of a plications. It is also a currently monitor patient symptoms and misnomer. They are only inac- common practice for pharmacies reactions to medication changes. tive in that they are substances to substitute medications unless Since the patient is likely to which do not relate to the purpose the prescriber specifically states, change eating habits, health hab- of the medication. These include: “No substitution,” or “Name its, and take over-the-counter Anti-adherents (used to Brand Only,” or “No substitutions medications without the prescrib- resolve problems in medi- without prior approval by pre- er's knowledge; one of the most cation manufacturing), scriber.” Generics are frequently important tasks of the prescriber Binders (such as lactose, substituted for Name Brand be- is to educate the patient as to the sucrose, microcrystalline cause of cost. Periodically, this is impact these changes can have on cellulose, malitol, sorbitol, less than “cost saving.” In one of effectiveness of their medica- or xylitol to hold medica- my long-term patients who had an tions. Just as a prescriber of tions together and add extremely complicated profile, Olanzapine should caution his/her weight), she had been on Name Brand patient as to the impact of tobac- Coatings (such as hydrox- fluoxetine (Prozac) for three co smoking on the effectiveness ypropylmethocellulose years without problems. The of the medication, the prescriber making it easier to swal- pharmacy changed the medication should provide the necessary in- low pills, modulate break- to generic without the knowledge formation for a patient to self- down, and reduce deterio- of the prescriber. Within a week, monitor. ration), the patient deteriorated to the point that hospitalization was Page 14 VOL 7, ISSUE 1 NOVEMBER 2018

(Pt. Ed. Cont.’d from previous able to order labs that would opportunity to increase scope pg. ) of practice and insure our (Prescriptive Authority, cont.’d ability to treat patients within necessary. from p. 4) the unique perspective of a psychologist’s prevue. In the coarse of practice, some efficacious treatment. Unfortunately, we are in elements of informed consent and So what are some of the needless competition with patient education can be omitted. advantages to our patients? other midlevel providers, But it is important for us to re- Besides the shortage of perhaps because member the subtle, everyday hab- psychologists have not its of our patients to be able to trained physicians, nurse advocated for their own provide the best treatment possi- practitioners, etc. to write unique and superior skills of ble. prescriptions, we would be diagnosis, most notably with able to order labs that would psychological testing, help rule out or confirm evidence-based psychotherapy and treatment 1 Chiu CC, Lu ML, Huang diagnostic comorbidities. For evaluation. If given MC, Chen KP. Heavy example, hypothyroidism or prescriptive authority, smoking, reduced olanzap- vitamin deficiencies could be medical psychology will no ine levels, and treatment referred back to the longer be mitigated to effects: a case report. Ther appropriate physician for fractional treatment, but will instead promote state of the Drug Monit. 2004 Oct;26 treatment in concert with a (5): 579-81. art care on behalf of our most psychotherapeutic approach vulnerable patients. 2 Hukkanen J1, Jacob P 3rd, that focuses on lifestyle and Benowitz NL. Effect of nutrition interventions by a References: grapefruit juice on cyto- medical psychologist or Caccavale, J. et. Al. (2013). Medi- chrome P450 2A6 and nic- referring psychologist. ca Psychology Practice and Policy otine renal clearance. Clin We could also Perspectives. NAPPP books. Pharmacol Ther. 2006 UNPRESCRIBE! Many of Galle, Susana A. (2014). Minding Nov;80(5): 522-30. the patients that I treat as a the Mitochondria: From Cell to 3 Seneff S, Samsel A. medical psychologist are on a Psyche, (6), 10-35. Glyphosate’s Suppression plethora of drugs, and that SAMHSA, National Projections of Cytochrome P450 En- cocktail may be producing of zymes and Amino Acid psychological sequelea that Supply and Demand for Selected Biosynthesis by the Gut are an unnecessary burden on Behavioral Health Practitioners Microbiome: Pathways to the patients mind and 2013-2025 November, 2010. Modern Diseases. Entropy body. With prescriptive Prescriptive Authority 2013, 15(4), 1416-1463; privileges, we have the skills Enhancing Our Scope of Practice doi:10.3390 to recommend a slow titration for Patient Welfare off many psychiatric INTEGRATED CARE COM- 4 Gakis C1, Cappio-Borlino A, medications or recommend to Pulina G. Enzymes their physician, a medication MITTEE MEMBER (isoenzyme system) as home- with a dual purpose. For SUSAN BARNGROVER, PH.D., ostatic mechanisms the isoen- instance, a blood pressure MS.C.P., A.B.M.P. zyme (ADA2) of adenosine medicine that treats anxiety DRBARN- deaminase of human mono- or PTSD as well as [email protected] cytes-macrophages as a regu- hypertension. Another current lator of the 2'deoxyadenosine. advantage, with the advent of ASPPB and MOPA’s Biochem Mol Biol Int. 1998 PSYPACT promoting Oct;46(3):487-94. interstate telepsychology, 5 5 http:// psychologists would be able www.ndhealthfacts.org/wiki/ to reach more underserved populations, for example, Excipients_and_Fillers practi- including rural and tioners, etc. to write geropsychology patients. prescriptions, we would be This is psychology’s golden Page 16 VOL 7, ISSUE 1 NOVEMBER 2018

The National Alliance Of Professional Psychology Providers and The Academy of Medical Psychology Present a Three Day Continuing Education Conference March 22nd to 24th, 2019 Theme: Psychological Methods: Traditional and Innovative Treatment Hotel Room Reservation

Attendees will receive the conference discounted room rate from Drury's. The conference room rate for Friday and Saturday is $159.00. To guarantee the above room rates, attendees can regis- ter online or call in their reservations toll free at 1-800-325-0720 and refer to the code. 2350867. There is limited room availability at these prices so pleas make your reservations as early as possi- ble. You can also make a reservation at: http://nappp.org/hotel.html

Under reservation, click group reservation and use the 2350867 Group code.

Drury Plaza Hotel-River Walk. Formerly the Alamo National Bank Building, this 24-story skyscraper was renovated to maintain its historical character while creating modern comfort. The Drury Plaza creates the perfect ambiance for your stay and sits on the beautiful banks of the San Antonio River Walk. Conference Program: https://nappp.org/program.pdf Conference Registration: https://nappp.org/registration.html Meeting Chair: Sharna Woods, Ph.D.

(Brochure continues on next page)

Page 17 VOL 7, ISSUE 1 NOVEMBER 2018

(Brochure continues from previous page)

FRIDAY March 22, 2019

Keith Petrosky, Ph.D., ABMP: "Analog Thinking in Advancing Our Knowledge of Mental Health" Howard S. Rubin, Ph.D., ABMP: "Medical Cannabis: Guidance for Clinicians" David Reinhardt, Ph.D., ABMP: Mental Health Effects of Endocrine Dysfunction: Symptoms, Assessment and Treatment Strategies Larry Waldman, Ph.D., ABPP : "Ethical, Effective and Efficient Private Practice Marketing "

David Clayman, Ph.D. "Methods and Knowledge for Innovative Service Delivery"

SATURDAY March 23, 2019

John Caccavale, Ph.D. "Clinical Practice Is Not Dead Yet " Jerry Morris,Psy.D., ABPP, ABMP."Pain Control and Related Problems: Medical and Practitioner Opportunities" Ward Lawson, Ph.D., ABPP,ABMP. "Contextual and Lifestyle Factors in Medical Psychology" Roger Morgan, Ph.D., MD. "Culture counseling considerations in the Hispanic population." Karyn Hall, Ph.D. "Radically Open DBT Treatment"

SUNDAY March 24, 2019

Robert North, Ed.D., MD. & Roger Morgan, Ph.D., MD. "Use and Misuse of Antipsychotic Medications in a Nursing Home Setting Per CMS Guidelines" Lendell W. Braud, Ph.D. "Relaxation, Imagery & Art – Effective Interventions for Trauma, Behavioral and Emotional Problems"

Registered participants are eligible for 18 CE credit hours for attending all three days.

VOLUME 5 ISSUE 1 NOVEMBER 2018 Page 16

“Greetings,” and Services Offered, From Our Highly Trained and Credentialed Membership

~*~ Dear AMP members and ABMP diplomatEs: If you would like to have a copy of your business card included on the page please scan your card and email the scan to me, Dr. Jeff Cole, Editor “The AMP” at: [email protected] and, your card will be included on our Business Cards page with the next issue of "The AMP"!

There is a $20 fee for the service, payable to "Academy of Medical Psychology" deliverable to our Nevada, Missouri corporate office address as shown on our home page.

http://www.amphome.org/

Perk!: the $20 fee is waived for all Board members and AMP governance and for editorial staff of our "Archives of Medical Psychology" peer-reviewed journal!!

Dr. Cole

Editor, “The AMP”

VOLUME 5 ISSUE 1 NOVEMBER 2018 Page 17

Invitation for Contributions “The AMP” NewsleTTer -- newsletter of the Academy of Medical Psychology (AMP) – invites you to contribute short articles and brief pieces for our upcoming issue! Our theme is the integration of psychological and medical theory and practice and move- ments within psychology that increase psychology’s role in both mental healthcare and medicine, all falling under the rubric and specialty designation of “Medical Psychology”. Specific topics that past articles have addressed, or that would be welcomed, include but are not limited to the following: *Psychological and behavioral approaches as first-line treatments and in combination with medication and other medical treatments *Behavioral health, placebo phenomena, and psychosomatics in healthcare and mental healthcare *Interdisciplinary practice, e.g., Psychologists as part of — or leaders of — health teams in clinics and institutional medical and mental health settings *Reviews and discussions of scientific and scholarly articles and books supporting medically and psychologically- integrated understanding of psychiatric and medical illnesses, e.g., research into stress and immune response, stress and protective factors (e.g.., relationship and oxytocin phenomena), cardiovascular health, epigenetics *Commentary, on matters associated with relevant to Medical Psychology e.g.,: DSM, and other diagnostic nosologies their uses, abuses and relevance to healthcare; RDoc *Emerging Practice Trends, e.g., Articles on Telehealth and other alternative delivery modalities

We have a column specifically dedicated to student writing. “Student” can include any one in the course of his or her formal learning process, e.g., undergrad, grad, post-doctoral or specialty/diplomat training

If you would like to sample previous editions of “The AMP” to see what sort of entries are there, here is the link to our newsletter archives:

http://www.amphome.org/newsletter.php

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VOL 7, ISSUE 1 November 2018 Page 18

The Academy of Medical Psychology received final approval of its trademark and logo of the Ar- chives of Medical Psychology in November 2009. The Board of AMP and ABMP seeks your assis- tance in the editing and publishing of the Archives of Medical Psychology.

The Academy of Medical Psychology was founded as an organization of practitioners for practition- er interests through volunteerism. Service on the Board is an unpaid duty of psychologists dedicat- ed to the advancement of Medical Psychology. Medical Psychology's goal is to enhance access to specialty behavioral health care that is in such short supply that it has been declared an emergen- cy in some states and recognized by military and veterans’ services as a critical shortage. State prisons have been designated as mental health shortage areas by HRSA and prisons in some states are in the hands of federal receivership. Thus, the Academy has a crucial role as practitioner organization in advocating for the health and safety of the public at large and the military and other governmental agencies designed to serve public needs. The advocacy role for public health service must be a primary mission of the Academy.

The Archives of Medical Psychology, on the other hand, is a repository of information that can serve this advocacy function of the organization and collect valuable new data for continuing education of members of the Academy. Editing of the Archives must be by people that have the necessary experience in medical psychology and the skills to carry out these functions. Editing also requires electronic communication skills for the actual publication of the Archives. The variety of the skills necessary for publication in the journal are unlikely to be found even in a complete Editor. Mem- bers of the Board of the Academy are already assigned specific tasks and duties within the organi- zation and cannot be expected to contribute routinely in the editing and publishing of the Archives. Therefore, the Board has begun a search for members of the Academy to volunteer in the editing and publishing of the Archives and ask your personal support. The Board of AMP invites you to contribute your services to the Archives. We welcome AMP members with prior publishing experi- ence and those with computer expertise who are willing to learn the rudiments of editing and elec- tronic publishing. For further information contact Ward Lawson at [email protected] .

Page 19 Dr. Ward M. Lawson: Editor Call for Manuscripts The Archives of Medical Psychol- ogy is now accepting submissions for the next issue. We welcome original articles of interest to readers of medical psychology. For information about requirements for sub- mission of articles go to www.amphome.org and click on Journal Archives in the left- hand column or simply type in Archives of Medical Psychology on Google. Editor at [email protected].

VOLUME 5 ISSUE 1 NOVEMBER 2018 Page 20

AMERICAN BOARD OF MEDICAL PSYCHOLOGY

A Psychology Specialty Encompassing Behavioral Healthcare,

© Psychopharmacology, and Mental Health Treatment in Multi-disciplinary and team Treatment Approaches and Healthcare

SEE THE ARCHIVES AT OUR WEBSITE

SEE: WWW.AMPHOME.ORG

Four opportunities that involve different designations in Medical Psychology; Medical Psychologist (American Board of Medical Psychology Diplomate). Fellow of the Academy of Medical Psychology. Member of the Academy of Medical Psychology, or Student Member of the Acad- emy of Medical Psychology, is someone interested in the area, but not qualified for diplomate status at this time. Manuscript submissions: Qualifications for each of these AMP Membership categories are described on Dr. Ward M. Lawson, Editor, our website at www.AMPhome.org. at [email protected]

Join the Most Sought After Specialists in the Emerging Era of Integrated Care

Affirmations to Diplomates: Our society is a growing and vibrant specialty representing the highest trained and most relevant psychologists in America to the emerging healthcare system. During the next year, our specialty will appear in The National Psychologist, The Psychology Times, and in various APA Scientific and Professional Journals. We represent specialists and those interested in Medical Psycholo- gy across America. We are setting standards in our field and influencing practice standards with govern- mental agencies. We are becoming recognized by states and practitioner associations. We are develop- ing integrated care and hospital practices, becoming leaders in prevention and lifestyle management, and our specialists are being asked to present at national physician societies and professional work- shops. We prescribe complex psychological treatments, recommend and/or prescribe psychotropic medications, treat addictions, and establish treatment and prevention for patients with chronic illness- es such as obesity, diabetes, hypertension, asthma, etc. You are a member of an im- portant psychological and healthcare specialty! ACADEMY OF MEDICAL PSYCHOLOGY The Official Journal

of the American Board of Medical Psychology

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AMP’s new journal needs specialty editors and authors. Help us have a great place to keep our specialists aware of emerging practice is- sues, science, and opportunities. Volunteer! Sign up for the Journal at http://amphome.org/.

ANNOUNCEMENTS FROM Y OUR EDITOR

In this issue of “The AMP” leading medical psychology ist Dr. Susan Barngrover a little “yin” and a little into a new era: The era of writes about the role of ex- “yang”. On the “yin” side, medical psychology resi- panded RxP training and President Dr Gary McClure dency training programs. credentialing in our special- and Executive Director Dr. Multiple new residencies, ty and psychology as a Jerry Morris write about the directed by Executive Di- whole and Specialist Dr. problem of the APA push rector, Dr. Jerry Morris and Rory Richardson writes for licensed Master’s level AMP pioneer, physician and about his own training expe- Jeffrey D. Cole, PhD, ABMP psychologists and the effect medical psychologist Dr. riences early in the interface this will have on our doctor- Matthew Nessetti are ac- of medicine and psycholo- Email address: al level profession. tively training residents in gy. [email protected] integrated treatment. Estab- On the “yang” side, both While I say it every issue, it lished medical psychology Or also write about the emer- is because it remains true: residencies will help to coa- gence of our specialty as an This is an exciting time to By US Mail: lesce, systematize and pro- increasingly-established be a Medical Psychologist! vide structured training ven- entity in healthcare. The The specialty is both new 1121 Upper Front Street ues for our up-and-coming Academy of Medical Psy- and established, and, from a Binghamton, NY 13905 specialists. chology (AMP) and the solid base is continually and

American Board of Medical exponentially growing Board member and Special- Psychology (ABMP) are