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Spring 2014 Message from Our President—Building a Cathedral James P The Westchester Psychiatrist A quarterly publication of the Psychiatric Society of Westchester County Spring 2014 Message From Our President—Building A Cathedral James P. Kelleher, M.D. 2013-2014 We are grateful to the Bronx DB for wel- Executive Council coming us this year and for providing a James P. Kelleher, MD memorable evening. The speakers, Dr. Su- President san Whitley, Director of Chemical Depend- ency Services, Kings County Hospital Center, Carlo Bayrakdarian, MD President-Elect and Sandra Turner, Program Manager, Pal- liative Syringe Program, St. Ann’s Corner of Barbara Goldblum, MD Harm Reduction, gave a very important Secretary presentation about saving lives through ear- Richard McCarthy, MD ly intervention in heroin overdose. Some of Treasurer their data indicated that by providing sup- Fady Hajal, MD plies of naloxone and training to community Past-President members, a life could be saved for about (2012-2013) There is a story of three men working un- $50. I admire their work. Anthony Stern, MD derground. When asked what they’re do- Program Coordinator ing, the first two say they’re digging a hole. The theme of this year’s APA meeting, held in New York, was Changing the Practice and Karl Kessler, MD The third answers, “I’m building a cathe- Program Coordinator-Elect dral.” I think that metaphor represents the Perception of Psychiatry. I learned a great attitude of the Westchester District Branch deal from the presentations of Drs. Matthew Susan Stabinsky, MD State (about developments in psychiatric Legislative Representative during the last year and I hope it has shone through in our work. Professional challenges genetics), Thomas Insel (about the BRAIN Richard Altesman, MD are less formidable and accomplishments Initiative and the possibility of a new psychi- APA Representative more rewarding with our pride and enthusi- atric diagnostic schema), and Nora Volkow Edward Herman, MD asm. It’s been an honor to serve as Presi- (about the neurobiology of substance APA Representative dent. abuse). The conference, as always, repre- sented the many ways our profession is de- Karen G. Gennaro, MD NYSPA Representative Since the last newsletter, members of our veloping. group attended meetings of the New York Enrique Teuscher, MD State Psychiatric Association, the Westches- Finally, I welcome Dr. Carlo Bayrakdarian, Councilor a respected colleague who has been of ter-Bronx combined District Branches, and great service to our organization, as our Alex Lerman, MD the American Psychiatric Association. Each Councilor new Westchester DB President. As we enter provided an opportunity to meet colleagues an exciting new year, we already have Sally Ricketts, MD and to learn. At the first, we were intro- several different projects on the agenda. Councilor duced to the new NYS Commissioner of Mental Health, Dr. Ann Sullivan, and the Jerry Liebowitz, MD Newsletter/Website Editor incoming NYSPA President, Dr. Seeth Vivek. From this vantage point, it appears we are Megan Rogers Executive Director in good hands as we enter a new healthcare era. Page 2 The Westchester Psychiatrist—Spring 2014 Book Review— by Karl Kessler, M.D. Schizophrenia: A Very Short Introduction by Christopher Frith and Eve Johnstone, Oxford University Press, 2003, 197 pages. Oxford University Press has published a large number of texts in their “A Very Short Introduction” series. One of these books is A Very Short Introduction to Schizophrenia. The authors are British researchers and the book is written from a British/European perspective, which includes the Present State Examination, the CATEGO diag- nostic program and the art of Richard Dadd. It is aimed at a non-medical audience, so the neuroscience aspects are very simply presented. Basic topics such as the experience of schizophrenia and possible causes of the ill- ness are discussed at length. The authors also give space to their own research interests, such as the possible effects of institutionalization on the course of the illness and the effect of schizophrenia upon IQ. The discussion of epidemiology is weak. The book is altogether interesting, especially for its European perspective and its brevity makes it attractive to busy psychiatrists. Genes Eve Kellner, M.D., RFM Representative Garnering recording historical mention as early as 1550 BC, can help guide treatment choices for psychiatric conditions such psychiatry is a field of medicine that boasts a relatively long as depression, bipolar disorder, schizophrenia, anxiety disor- history, yet there remains an abundant need for the further ders, OCD and ADHD. This is some next level technology! study of many aspects of mental illness. The discoveries yet to Though there is no direct cost to clinicians who choose to use come will undoubtedly be made with the assistance of an ever enzyme testing, the financial impact of medical interventions -expanding catalogue of developing diagnostic tools, includ- and treatments will always play a key role in everything we ing functional MRIs, transcranial magnetic brain stimulation, as physicians do; this is especially true in the light of the emer- and gene detection assays. The brand of awe, respect, and gence of the newest health care policies. It is unfortunate that wonderment being generated in the psychiatric community by as of the time of this writing, the majority of these assays can- these progressive feats of science and technology may not be not be billed to government funded insurance plans, including unlike that produced by the introduction of the Wallace- Medicare, Medicaid, and Tricare. Farmer Electric Dynamo at the first World’s Fair in Pennsylva- nia in 1853. Whether the advancement is the aforementioned What that means to me is that psychiatry also has the most 19th century precursor to electric light or the more recent pro- exciting future of any field of medicine, which is one of the gress in psychiatric medicine, innovation captivates and moti- many reasons that I shoes to pursue Psychiatric Residency. The vates the human mind and spirit, consequently precipitating Wallace-Farmer Electric Dynamo was a only of a kind inven- even further, even limitless, discovery. tion, a spectacle at a fair most onlookers appreciated but nev- er believed would be practical in everyday use; but it wasn’t Earlier this year, a psychiatrist introduced me to “Personalized long before there were lightbulbs in every home. Innovation Medicine” in the form od Gene Assay Reports during one of has always taken time to evolve into common practice, but my didactic classes. He instructed us in its relative ease of use when it does, the possibilities for meaningful change are limit- at no cost to the clinician and showed us a sample report. This less. I believe this will prove to be the pattern of evolution with was my first introduction to the practical use of enzyme testing genetic enzyme testing as well. by a psychiatrist, and I was instantly filled with childlike giddi- ness, vis-à-vis the first World’s Fair. The causes of the psychiatric disorders are vast and no one is immune. We are working to help human beings. We hope that There they were! The genes I studied for boards… Of course one day we will find a cure for psychiatric conditions. I believe the famous CYP3A4… and let us not forget CYP2D6! These Gene Assays are a step in the right direction, shedding light are the genes we study to make sure that we don’t inhibit and on the complex physiology of the inner workings of the human don't induce when we don't want to… and what is this, a pa- mind, functioning as psychiatry’s own Electric Dynamo. tient’s own concentration of these genes! But wait, there’s more! On the report, there is a literature review included alongside a list of relevant therapies that target these genes. This assay The Westchester Psychiatrist—Spring 2014 Page 3 Page 4 The Westchester Psychiatrist—Spring 2014 Book Review—By Anthony Stern, M.D. Becoming a Mensch: Timeless Talmudic Ethics for Everyone by Ronald Pies, M.D., Hamilton Books, 2011, 146 pages tal health professionals hold what Dr. Ronald Pies has tales and brief sermons of out more modest hopes for done in his book, Becoming a the Talmudic rabbis with the treatments we provide. Mensch: Timeless Talmudic illustrative stories of current We know that both medica- Ethics for Everyone; and he interpersonal challenges we tion and psychotherapy are has done it exceedingly well. all encounter. Thus the book solutions, but we also know At the start, he invites us “to emerges as a skillful inter- that they are only partial join the community of ethi- weaving of three elements: solutions for the many if not cists, rabbis and scholars” an introduction to the Jewish most of the problems pre- throughout Jewish history, tradition, a set of down-to- sented by our patients. We and his sincere admiration earth case examples in prac- are less inclined to feel we for these insightful forerun- tical ethics, and a fine run- have all the answers and ners continues to shine ning commentary about Jew- Once upon a time, at the more likely to perceive our- through all of his writing to ish lore and how we can all beginning of the twentieth selves as new kids on an old the end. His central aim is to reflect on it and be enriched century, the medical science block. We have come to describe and inspire us by it. The tone of the writing of psychoanalysis was the appreciate more fully that about the cluster of virtues is mainly gentle exhortation new cure for all mental diffi- “the old block” has its own embodied in a “mensch” – leavened by bursts of de- culties. Once upon another time-tested set of sacred notably compassion, kind- scriptive vitality.
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