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Syllabus & Proceedings Finding Equity Through Mind & Brain Syllabus & Proceedings #APAAM21 General Sessions well) and establish preventative care wherever possible (stay well). Saturday, May 01, 2021 Advancing Ethics and Equity in Psychiatry: A New Narrative for Behavioral Health: Eliminating Perspectives From the Royal College of Psychiatrists Defects and Promoting Value Chair: Saul Levin, M.D., M.P.A. Chair: Patrick S. Runnels, M.D. Presenters: Adrian James, M.D., Gertrude Presenters: Heather M. Wobbe, D.O., M.B.A., Jeanne Seneviratne, M.B.B.S., Wendy Katherine Burn, M.D., M. Lackamp, M.D. Kate Lovett, M.D., Paul Rees EDUCATIONAL OBJECTIVES: EDUCATIONAL OBJECTIVES: At the conclusion of this session, the participant At the conclusion of this session, the participant should be able to: 1) Define defect-free behavioral should be able to: 1) Apply quality improvement healthcare; 2) Define key leadership principles to strategies to improve clinical care.; 2) Provide promote value in behavioral health; 3) Discuss and culturally competent care for diverse populations.; debate process and outcome metrics opportunities; 3) Describe the utility of psychotherapeutic and 4) Identify Structural Metrics that need to be put pharmacological treatment options.; 4) Integrate into place to capture value; 5) Consider barriers to knowledge of current psychiatry into discussions taking a value-based approach to Behavioral Health. with patients.; 5) Identify barriers to care, including health service delivery issues.. SUMMARY: The past ten years has seen significant growth and SUMMARY: evolution in value-based payment models, many In recent years, examples have occurred of ushered in by initiatives contained in the Affordable psychiatrists and psychiatric bodies involving Care Act (ACA) and expanded upon by subsequent themselves with local processes of reconciliation as legislation and policy at the Federal and State well as in advocacy for the rights of mental health level. Despite the accumulation of evidence and psychiatric care users. The RCPsych’s supporting a growing number of quality measures, Professional Practice and Ethics Committee has behavioral health care has lagged behind other developed a guide for psychiatrists, and the Royal health disciplines both in utilizing system-wide College of Psychiatrists is also working with the UK metrics to guide evidence-based care and in government to change mental health policies in adequately distributing data to frontline clinicians order to improve the rights of mental health for use in supporting quality improvement and patients. Presentations in this session will address enhancing value. In order to improve value, systems psychiatrists’ and Psychiatry’s role and responsibility should seek to eliminate defects in behavioral in the process of preventing and engaging with healthcare. A defect framework should have three current, as well as remembering and reconciling parts: creating and promoting a vision for defect- past, human rights abuses in mental health and in free care, designing analytics to guide how care the community. should be delivered, and then making defects that impede expected outcomes visible and improving At the Interface of Science and Society: Integrating them. To carry out these tasks, leadership Neuroscience Into Modern Psychiatry must support culture change across the entire Chair: David Ross, M.D. continuum of care to both break down silos and Presenters: Melissa Arbuckle, M.D., Ph.D., Joseph enhance value. At the same time, frontline clinicians Cooper, M.D., Michael Travis, M.D., Ashley E. Walker, must embrace the role of system engineer to M.D. shepherd this process. An ideal system should work to not only help people get better from acute illness, EDUCATIONAL OBJECTIVES: but also manage chronic disease effectively (get At the conclusion of this session, the participant should be able to: 1) Appreciate the relevance of cutting-edge neuroscience to the future of Examine outcome measures of LT response that are psychiatry; 2) Describe different approaches for relevant to patients with BD, remission rate, integrating neuroscience education into classroom depression scores, functioning, sleep quality, teaching, clinical settings, and for self-study; 3) chronotype, seasonality, functioning and polarity Describe key neurobiological findings relating to a switch.; 3) Explore putative novel visual and neural selected clinical topic. biomarkers of response to bright light therapy.; 4) Discuss approaches in the management of SUMMARY: antidepressant therapy in perinatal women, given Psychiatry is in the midst of a paradigm shift. While the study findings on changes in antidepressant the diseases we treat are increasingly understood in concentration across pregnancy and postpartum.; 5) terms of the complex interactions between genetic Reflections on a rewarding career path in psychiatry: and environmental factors and the development and pursuits in research, clinical care, education and the regulation of neural circuitry, most psychiatrists have advocacy of women’s mental health.. relatively minimal knowledge of neuroscience. This may be due to many factors, including the difficulty SUMMARY: of keeping pace with a rapidly advancing field and a Patients with bipolar disorder (BD) often have major relative dearth of accessible educational resources. depressive episodes and residual symptoms. Nonetheless, it is crucial that practicing clinicians Antimanic drugs improve depressive symptoms in learn to embrace a modern neuroscience only one-third of patients. Antidepressant therapy perspective. New research is already translating into pose risks for hypomania and rapid cycling. Given a range of immediate clinical applications: from the limited options, developing new treatments for improved diagnostic tests (e.g. via chromosomal bipolar depression is a high-priority concern. Bright microarray testing for Autism Spectrum Disorders) to light therapy (LT) is a circadian based intervention new medications (e.g. brexanolone for post-partum that can improve mood symptoms even in cases in depression) and interventional approaches (e.g. which disruption in circadian rhythms is not the deep brain stimulation for obsessive-compulsive primary cause. We conducted a dose-finding, disorder). A neuroscience perspective can also offer preliminary safety and efficacy study of morning LT insight into some of the most important in women with stable bipolar depression. contemporary societal issues – such as the impact of Unexpectedly, morning LT induced hypomania in 3 police violence on communities of color and other of 4 patients. A careful literature review and forms of structural racism. In this session we will consultation with experts informed our decision to briefly review findings that highlight the importance adjust the protocol and implement LT at midday. of integrating a neuroscience perspective into Three of 5 subsequent patients reported a full modern clinical care. We will then offer an response and one responded fully after transitioning individualized educational activity that illustrates a to morning light. Building on our findings, we contemporary approach to online learning and conducted a 6-week placebo controlled RCT to introduces a framework for ongoing engagement confirm the efficacy of adjunctive midday bright LT with cutting-edge neuroscience. for bipolar depression. In the first part of the talk, I will address 3 objectives: 1, Discuss the known and Bright Light Therapy for Treatment of Bipolar novel clinical indications of bright LT particularly for Disorder treatment of SAD, non-seasonal MDD, perinatal Presenter: Dorothy Sit, M.D. depression and sleep/wake phase disorders. 2. Examine outcome measures of LT response that are EDUCATIONAL OBJECTIVES: relevant to patients with BD, remission rate, At the conclusion of this session, the participant depression scores, functioning, sleep quality, should be able to: 1) Discuss the known and novel chronotype, seasonality, functioning and mood clinical indications of bright light therapy particularly polarity switch. 3. Explore putative novel visual and for treatment of SAD, non-seasonal MDD, perinatal neural biomarkers of response to bright LT. The depression and sleep/wake phase disorders.; 2) focus of my research encompasses studies of the phenomenology, pathophysiology and Then the central features of CBT methods for suicide pharmacologic responses in women across the life risk will be demonstrated. Role-play demonstrations cycle. I have contributed studies on changes in will illustrate key points. Particular attention will be antidepressant concentrations across pregnancy. paid to development of the CBT elements of safety These studies illustrated that the mean plasma planning in a depressed patient. concentration-to-dose (C/D) ratios for sertraline, fluoxetine (FLX) and Citalopram / escitalopram Dieting to Win, Be Thin, and Feel Comfortable in (CIT/esCIT) decrease in the second and third My Own Skin: Disordered Eating in Athletes trimesters, presumably from hepatic metabolism Chair: Ryley Paul Mancine induction. In pregnant women treated with CIT, the Presenters: Samantha F. Kennedy, D.O., Shea D. parent drug and metabolite decreased between 20 Repins weeks gestation and delivery and returned to baseline at 12 weeks postpartum. The significant EDUCATIONAL OBJECTIVES: negative relationship between depression scores At the conclusion of this session, the participant and dose-corrected S-FLX (P=0.008) and chiral should be able to: 1) Understand the signs
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