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 and parent drug concentrations (S-FLX + R-FLX; P= 0.021) symptoms of disordered eating, including those of suggest a need for increased dosing as which may be most concerning.; 2) Recognize the concentrations diminish in the 2nd half of epidemiology of disordered eating behaviors in pregnancy. These findings have shaped recent athletes, and subsequently be able to identify changes in clinical practice and informed the patients who are at the highest risk.; 3) Identify development of advanced pharmacokinetic studies methods which can be utilized within the community of antidepressants in pregnancy. Objective 4. Discuss to recognize and potentially reduce disordered approaches in the management of antidepressant eating behavior.; 4) Describe the developing therapy in perinatal women, given our study research from Michigan State University – the findings. Objective 5. Reflections on a career path in Disordered Eating Screen for Athletes (DESA-6) – and psychiatry: pursuits in research, clinical care, know how it can be used to identify disordered education and the advocacy of women’s mental eating quickly.; 5) Exercise intervening and providing health. nutritional counseling to simulated clinical case patients, which can then be implemented into a Cognitive-Behavior Therapy for Reducing Suicide physicians’ practice.. Risk Chair: Donna Sudak, M.D. SUMMARY: Presenters: Jesse H. Wright, M.D., Judith Beck, Ph.D. Disordered eating (DE), a subclinical spectrum of eating disorders, has a dramatically increased EDUCATIONAL OBJECTIVES: prevalence in athletes. It has been linked to stress At the conclusion of this session, the participant fracture, menstrual cycle dysfunction, and mood should be able to: 1) Assess and modify disturbances and is a major component of both the hopelessness and suicidal thinking with CBT Female Athlete Triad and Relative Energy Deficiency principles; 2) Describe research that supports CBT in Sport (RED-S) syndrome. DE may progress to a for reducing suicide risk; 3) 3. Implement CBT- clinical eating disorder (ED), which has one of the oriented safety plans with at-risk patients. highest mortality rates of all mental illnesses. An extremely large number of athletes are at risk for the SUMMARY: development of DE, including adolescents, young CBT approaches to the suicidal patient have been adults, college athletes, and professionals. proven to reduce rates of future attempts. Active Individuals participating in lean-type sports may be and collaborative work to reduce hopelessness and at an even higher risk. Though many athletes specific anti-suicide plans are important features of develop disordered eating in an attempt to increase this approach to patients. This workshop will briefly performance within their sport, in reality DE is linked review research on CBT for treating suicidal patients. with decreased athletic achievement. DE is subsequently associated with a prolonged return-to- the current expansion of TA and training through play duration. Luckily, there are methods to which numerous initiatives.. DE can be identified and strategies which have been shown to be protective against the development of SUMMARY: DE. For example, coaches have the opportunity to Educating and supporting the mental health encourage protective behaviors (such as motivation workforce is a challenge that has only increased as or enthusiasm) rather than focusing on shape or the workforce shrinks and new methods are weight. Nutritional counseling for athletes has also required by the “new normal.” SAMHSA supports shown to be effective in halting the progression from initiatives that provide ongoing, free support of the DE to ED. If mental health professionals and general workforce that can be useful to junior and senior physicians were able to provide actionable changes, clinicians. The Centers work to accelerate the such as nutritional counseling and small adoption and implementation of evidence-based environmental modifications, individuals with DE practices in mental health services across our nation; would potentially have a lower risk of progressing to foster regional and national alliances among deadly EDs. Additionally, recent research from our culturally diverse practitioners, researchers, policy lab at Michigan State University has been directed at makers, family members, and consumers of mental developing the Disordered Eating Screen for Athletes health services; and ensure the availability and (DESA-6), which would serve as a much more rapid, delivery of publicly available, free of charge, training easy, and cheap way of identifying DE. In adolescent and technical assistance to the mental health field. populations, the DESA-6 has shown an area under This session will provide an overview of the the ROC curve (AUC) of 0.892, a sensitivity of resources available and highlight two Centers: The 92.00%, and a specificity of 85.96% with a sample Mental Health Technology Transfer Centers and SMI size of 308 initial participants. During our session, we Adviser. will provide participants with an audio-visual infographic regarding the demographics and Empathy, Therapeutic Rapport, and Military epidemiology of DE, provide sample cases of Service: How Our Personal Journey Into Psychiatry individuals struggling with DE behaviors, and engage Impacts Our Practice in small group sessions where we encourage teams Chair: Jerry Trotter, M.D. to come up with “next steps” regarding nutritional Presenters: Hamid R. Tavakoli, M.D., Eric Luehrs, counseling and DE intervention. M.D., Johnathan Heller, M.D., Matthew McGirr, M.D.

Educating and Supporting the Mental Health EDUCATIONAL OBJECTIVES: Workforce At the conclusion of this session, the participant Chairs: Anita Everett, M.D., Humberto Carvalho, should be able to: 1) Appreciate how physician M.P.H. experiences impact therapeutic rapport; 2) Apply Presenters: Tristan Gorrindo, M.D., Amy Cohen, psychological principles to engaging with special Ph.D., Heather Gotham, Ph.D. populations, such as veterans; 3) Gain insight into the impact prior combat exposure has on mental EDUCATIONAL OBJECTIVES: health engagement; 4) Appreciate the role previous At the conclusion of this session, the participant military service may play in developing a therapeutic should be able to: 1) Explore the framework of alliance; 5) Develop and incorporate military-specific SAMHSA’s current TA and training initiatives, their knowledge to enhance patient buy-in to treatment areas of focus, what they can provide to whom, how of patients with military history, effecting improved they work synergistically, and the organizations that treatment compliance and quality outcomes.. lead them.; 2) Identify resources within these initiatives which can assist clinicians in the SUMMARY: implementation of evidence-based practices.; 3) Meet the patient where they are. A common refrain Understand the difference between the current in the discussion of therapeutic interventions, approach and SAMHSA’s previous TA approach and especially in mental health, which takes on special significance in the treatment of patients with participants will be afforded an opportunity to speak military service history. Psychiatrists, psychologists, with wartime veterans who later became mental and allied providers may perceive their lack of health professionals to explore specific topics in military experience as creating a barrier to providing greater detail. The speaker session will include optimal patient-centered care. Patients report military psychiatry senior residents with prior baseline assumptions that their providers will combat experience and the lead consult-liaison neither understand, nor value their military psychiatrist from one of the military’s largest experiences. At the nexus of these assumptions, teaching hospitals. building a therapeutic alliance can be difficult and patients may choose not to follow-up despite Enhancing Use of the DSM-5 Outline for Cultural recommendations for evidence-based care. A Formulation: Linking Social Determinants of Mental hallmark of successful mental health delivery is Health to Structural Competency Through V Codes closing this gap and establishing genuine, intimate Chair: Francis G. Lu, M.D. communication, underscored by empathy both Presenters: Helena Hansen, M.D., Ph.D., Lise Van offered by the provider and recognized by the Susteren, M.D., Merrill Rotter, M.D. patient. While a core feature of evidence-based treatment for most psychiatric morbidity includes EDUCATIONAL OBJECTIVES: highly standardized, templated psychotherapy, we At the conclusion of this session, the participant must always ask if previous research results are should be able to: 1) Understand the use of the generalizable to our treatment population. In DSM-5 Outline for Cultural Formulation as a method treating military-affiliated patients including their of scanning for social determinants of mental health family members, the ability to personally relate to (Part C).; 2) Understand the use of the DSM-5 wartime and deployment experiences based on Outline for Cultural Formulation as a method of military service prior to becoming a physician linking social determinants of mental health to V provides an inherent sub-cultural keystone to the codes (Part E).; 3) Understand the use of the DSM-5 therapeutic alliance, providing emotional validation Outline for Cultural Formulation as a method of through knowledge and experience. The intensity of using V codes as part of the diagnosis to activate the military camaraderie assumed by many patients structural competency methods in the treatment implies a seemingly automatic assumption of plan (Part E).; 4) Understand how a system of care meeting the goals of each of Kohut’s three identified (New York State Office of Mental Health) has begun self-object needs; the prior-military physician in to influence use of the social determinants of mental speaking with a veteran assumes the role of an health to improve diagnosis and treatment idealized veteran, one who offers kinship while planning.. representing a role model, having become a physician as our patients perceive it in spite of, SUMMARY: though perhaps actually because of the challenges of Clinicians are increasingly called upon to incorporate military service. Rather than avoiding the unknowns social determinants of health/mental health in their of military-related patient scenarios, participants in formulation and treatment planning to prevent this session will learn to more confidently address misdiagnosis and mistreatment so as to provide this subset of patients through a presentation of optimal clinical care (Holmes, 2020). This attention is cases highlighting challenges and accommodating also driven by fiscal and public health priorities as techniques utilized. Participants will further gain well as considerations of health equity and social improved understanding of their colleagues with justice. This general session equips clinicians to military experience, in part to dispel common enhance their use of the DSM-5 Outline for Cultural misconceptions. Additionally, participants will have Formulation by linking social determinants of mental the opportunity to reflect on their own experiences health to structural competency in the treatment within a framework of refreshing their motivations plan by greater use of V codes that can be part of for practice and better understanding their approach the medical record. First straw polling will be used at to patient care. After case highlights and discussion, the start of the session to assess participants’ knowledge of these concepts. Second, a didactic Chair: Ramotse Saunders, M.D. lecture will outline how these major concepts can be Presenters: Tobias Marton, M.D., Ph.D., Robert synergistically linked through the DSM-5 Outline for Estrada, M.D., Richard A. Bermudes, M.D. Cultural Formulation. Brief case presentations involving two social determinants of mental health— EDUCATIONAL OBJECTIVES: discrimination (Hansen, 2018) and climate change At the conclusion of this session, the participant (Dumont, 2020)—will illustrate the value of routinely should be able to: 1) Describe the evidence assessing for social determinants of mental health as supporting transcranial magnetic stimulation in the part of the use of DSM-5 Outline for Cultural treatment of major depressive disorder; 2) Describe Formulation to include appropriate V codes so that the evidence supporting electroconvulsive therapy in structural competency (Hansen, 2018) can be the treatment of major depressive disorder; 3) activated as part of the treatment plan. Finally, a Describe the evidence supporting ketamine in the brief didactic lecture will present how the New York treatment of major depressive disorder; 4) Appraise State Office of Mental Health, one of the most patient-selection criteria, and propose timing of a complex in the country, has begun to influence particular interventional approach; 5) Discuss access policy and program at the statewide and local level limitations to interventional psychiatry treatments. to address social determinants for both individual clients and the community-at-large (Rotter, 2020). SUMMARY: Panel discussion with the participants will address A sizeable proportion of patients with major questions and comments. The DSM-5 Outline for depressive disorder do not achieve an adequate Cultural Formulation provides clinicians with a response with pharmacotherapy. For the Treatment- clinical tool for assessing information about cultural resistant depression population, a number of FDA- features of an individual’s mental health problems approved/cleared alternatives now exist, including and how it relates to a social and cultural context Electroconvulsive therapy (ECT), Transcranial and history. Part C entitled “Psychosocial stressors Magnetic Stimulation (TMS), and Ketamine-based and cultural features of vulnerability and resilience” treatments. As a result, These options engender asks the clinician to “Identify key stressors and clinical dilemmas: While consensus guidelines exist supports in the individual’s social environment which should ideally be a next-step treatment, and (which may include both local and distant events)…” in which patient? Can they be combined? Are there which include the social determinants of mental predictive phenotypes? What about clinically- health. Part E entitled “Overall cultural assessment” available biomarkers? Are there age and gender asks the clinician to “Summarize the implications of considerations? What about response, efficacy and the components of the cultural formulation… for durability? There is also the access dilemma: Which diagnosis and other clinically relevant issues or of these treatments can my patient afford? This problems” that are the V codesdescribed in DSM-5 presentation will begin with concise overviews of as “other conditions and problems that may be a these modalities, putative mechanisms of action, focus of clinical attention.” Relevant to the social and their clinical indications. Short didactics will be determinant of mental health of discrimination is used to provide a high-yield review of key “V62.4 Target of (Perceived) Adverse Discrimination publications relevant to each modality. Case or Persecution” and for climate change, “V62.89 examples will highlight clinical phenotypes and Other Problem Related to Psychosocial treatment ‘red flags’. With each of these modalities, Circumstances.” Through increased use of these V there is a compromise between beneficial effects codes, the social determinants of mental health will and tolerability. A proposed interventional be included in the diagnosis so they can be treatment algorithm (decision tree) will be addressed in the treatment plan through structural presented. Combination therapy will be discussed. competency methods. The faculty will then present data as well as experience-based vignettes on access and access Equity and Building an Interventional Treatment challenges across treatment systems including Decision Tree university-based, VA-based, private sector and public sector. Models of public/private partnership will be EDUCATIONAL OBJECTIVES: explored. The effects of equity issues on the At the conclusion of this session, the participant treatment algorithm will be discussed. This will should be able to: 1) At the end of this session, include multifactorial contributors to disparate participants will be able to describe the roles and access to care, system-of-care barriers, and patient- functions of the APA Ethics Committee.; 2) At the related concerns. Our faculty bring considerable end of this session, participants will understand how experience in all of the aforementioned modalities to identify and address the ethical issues raised by and work in the aforementioned clinical contexts. participant case presentations and questions.; 3) At Additionally there is expertise in clinical, research the end of this session, participants will gain ethics, and neuroethics. At the conclusion of the appreciation of central ethical topics of importance session, practitioners will have increased insight into to practicing psychiatrists.. the appropriateness of a particular interventional approach. Attendees will acquire tools with which SUMMARY: they can make evidence-based interventional This workshop will be entirely devoted to the APA treatment choices for TRD. They will also be Ethics Committee members’ taking questions from conversant with regard to access challenges, and the audience on ethics dilemmas they have oriented toward potential workarounds. encountered, participated in, or read about. Audience interaction will be encouraged, and Equity, Ethics, and Future Directions in ensuing discussions will be mutually driven by Telepsychiatry audience members and Ethics Committee members. Chair: Avrim B. Fishkind, M.D. All questions related to ethics in psychiatric practice Presenters: Avrim B. Fishkind, M.D., Gonzalo J. Perez- will be welcomed. Possible topics might include Garcia, M.D. boundary issues, conflicts of interest, confidentiality, child and adolescent problems, dual agency conflicts, EDUCATIONAL OBJECTIVES: acceptance of gifts, emergency situations, trainee At the conclusion of this session, the participant issues, impaired colleagues, and forensic matters. should be able to: 1) Recognize inequities in the Questions may not relate to any pending ethics delivery of telepsychiatry; 2) Define ethical complaints. challenges in telepsychiatry; 3) Identify future areas of expansion in the use of technology in psychiatry. Ethnopsychopharmacology Chair: William Bradford Lawson, M.D., Ph.D. SUMMARY: Presenters: Daniel Y. Cho, M.D., Rahn K. Bailey, M.D. This session will provide an overview of three topics in telepsychiatry in the changing landscape of the EDUCATIONAL OBJECTIVES: Covid Pandemic and growing acceptance of At the conclusion of this session, the participant telepsychiatry as the norm. As clinicians seek should be able to: 1) Recognizing the biologic and to more quickly offer remote visits, it is imperative social determinants in ethnopsychopharmacology; 2) that they be aware of the issues of equity, ethics and Understanding there are ethnic differences in technological advancement in the field. psychopharmacologic drug metabolism; 3) Realizing Telepsychiatry continues to offer great opportunity that special care must be taken with side effect for psychiatry to expand it's importance throughout profiles when different ethnic groups are integrative care and geographical territory. considered; 4) Acknowledging the disparity in minority groups in relation to, access to care, and Ethical Dilemmas in Psychiatric Practice stigma involved in seeking care and Chair: Rebecca Brendel, M.D., J.D. psychopharmacologic treatment. Presenters: Charles Dike, Daniel J. Anzia, M.D., Tia Patricia Powell, M.D., Philip Candilis, M.D., Richard P. SUMMARY: Martinez, M.D. In this presentation, we will discuss the factors in which ethnicity plays a role in psychiatric pharmacological treatment. It is important to be At the conclusion of this session, the participant aware of these points as they affect patient should be able to: 1) 1. Summarize the state of the outcomes for these specific groups. Today we will be early psychosis field in terms of effective focusing on the biological considerations, as they interventions/services promoting long-term relate to the pharmacokinetics and recovery.; 2) 2. Describe new models of digital pharmacodynamics of various medications. interventions designed to be linked to clinical Furthermore, the panel will touch upon the cultural services.; 3) 3. Identify the pitfalls of existing online and social factors that contribute to varied clinical mental health interventions.. outcomes of ethnic populations. The audience will be informed of the mechanisms that underlie SUMMARY: dissimilar reactions in different racial groups. For Sustained social and vocational recovery are the instance, there are Ethnic differences in allele ultimate goals of first episode psychosis (FEP) expression of subsets of cytochrome P450. This services and the most valued outcome by young encompasses enzyme inhibition, induction, genetic people and their families. Yet, follow-up studies have polymorphism or duplication in coding regions of indicated that treatment benefits of early psychosis these enzymes; both psychotropic and non- services are not sustained and therefore functional psychotropic medications may be metabolized at and social recovery is often not fully realised. The different rates in different ethnicities. Speakers will recognition of these limitations has brought about a explore the different comorbidities that are seen in renewed focus on treatment approaches focused on certain minority populations including African improving long-term recovery from early psychosis. Americans, Hispanic Americans and Asian Along with studies evaluating psychosocial Americans. These predispositions must be taken into interventions focused on preventing relapse and consideration when choosing the optimum fostering social and vocational recovery, three antipsychotic to administer to minority groups. The recent clinical trials have evaluated the effects of speaker will then consider cultural-economic extending the duration of specialist support, with differences in relation to how mental health and mixed findings. Recent psychological models have psychopharmacology is viewed. It has been shown proposed self-efficacy, intrinsic motivation and that different ethnic groups in the United states positive emotions as important targets to promote have varying attitudes towards seeking psychiatric social functioning in psychosis. Strengths- and care and starting psychopharmacologic treatment. In mindfulness-based interventions have been put this session we will also highlight the misconceptions forward as key interventions, with preliminary and stigma maintained by various minority studies supporting their potential to improve social populations. The panel will speak on access to care functioning in psychosis. Similarly, self- and how that contributes to African Americans and determination theory posits that interventions Hispanics having longer courses and greater addressing the basic psychological needs of disabilities as a result of their mental illness. We will competence, autonomy and relatedness will numerate the current practices that are employed, increase engagement and improve overall and how we can continue to rectify some functioning. A promising and potentially cost- disadvantages that different ethnic populations face effective alternative to extending the duration of in regard to psychopharmacologic treatment. specialist FEP services is to provide lower intensity, maintenance treatment following the initial 2 years Harnessing Digital Technology to Bring About Long- of specialist support. Online, mobile and social Term Recovery in First Episode Psychosis media-based interventions provide a novel avenue Chair: Mario Alvarez-Jimenez, Ph.D. to offer young people lower intensity, effective, Discussants: Tristan Gorrindo, M.D., John Torous, sustainable and scalable support beyond discharge M.D. from specialist FEP services. Drawing on our previous interventions in preventing relapse and improving EDUCATIONAL OBJECTIVES: vocational attainment in FEP, combined with novel approaches to social recovery (strengths and mindfulness-based approaches) and the principles of pseudonym Dr. Henry Anonymous, disguised in a self-determination theory, our team developed a mask and using a voice modulator. His riveting world-first digital intervention (Horyzons) designed testimony started a process that resulted in member to foster long-term recovery in FEP. Horyzons blends approved DSM change. The lecture is a history of evidence-based models of social functioning, relapse one of the most remarkable chapters in psychiatric prevention and vocational recovery in a wrap- and American civil rights history around social media therapeutic environment supported by peer workers as well as clinical and Ketamine for Depression: Is the Hype Holding Up? vocational professionals. The effectiveness of Mechanisms and Evidence Horyzons has been examined via a single-blind Presenter: Richard C. Shelton, M.D. randomised controlled trial (RCT) designed to test whether treatment with both Horyzons and EDUCATIONAL OBJECTIVES: treatment as usual (TAU) for 18 months was more At the conclusion of this session, the participant effective than TAU alone. Horyzons was effective in should be able to: 1) Have a deeper understanding fostering vocational and educational attainment and of the basic pathophysiology of depression and how reducing utilization of emergency services in young this is addressed by ketamine; 2) Articulate a clear people with FEP over 18-month follow-up. Horyzons understanding of the clinical trial evidence for both was appealing for young people, with almost 50% of ketamine and intranasal esketamine; 3) Understand participants logging on for at least 9 months. The the risks and side effects of ketamine and implications for the field will be presented and esketamine treatment and will be able to describe discussed followed by a roundtable discussion of them accurately and thoroughly to their patients; 4) technology and serious mental illness Understand the place of esketamine therapy among other neuromodulation approaches such as ECT and John Fryer, M.D. American Civil Rights Icon: How rTMS; 5) Articulate the limitations of ketamine the APA Bent the Arc of Justice treatment and controversies surrounding it. Introduction: Saul Levin, M.D., M.P.A. Presenter: Malcolm Lazin, J.D. SUMMARY: At least one third of patients with major depressive EDUCATIONAL OBJECTIVES: disorder do not experience adequate response to At the conclusion of this session, the participant several rounds of antidepressant therapy, and a core should be able to: 1) Apply quality improvement 20% fail to respond to available antidepressants and strategies to improve clinical care.; 2) Provide evidence-based psychotherapies. Advanced culturally competent care for diverse populations.; neuromodulation approaches have been developed 3) Describe the utility of psychotherapeutic and including repetitive transcranial magnetic pharmacological treatment options. stimulation and vagal nerve stimulation, but all have significant limitations. Ketamine, a dissociative SUMMARY: anesthetic that has been available in the US since Starting in 1952, DSM-I listed homosexuality as a 1970, has been developed as a novel antidepressant mental disorder. Treatments included electric shock for difficult to treat depression (DTD) and major therapy, mental institutionalization and lobotomies, depressive disorder with suicidal ideation (MDDSI) among others. The designation was used to buttress over the last 15 years. Following early studies by Drs. homophobic statutes and regulations. Most states Robert Berman and colleagues at Yale University and would not license a homosexual to practice Carlos Zarate and collaborators at the intramural medicine. Homosexual psychiatry residents feared program of the NIMH, evidence of the effectiveness disclosing their sexual orientation to their of IV ketamine and, later, an intranasal form of the psychoanalysts. The 1972 Annual Meeting included S(+)-enantiomer of ketamine called esketamine has “Should Homosexuality Be in the APA steadily accumulated. This culminated in the Nomenclature?”. This controversial and well approval of esketamine (SpravatoTM) for DTD in attended panel included John Fryer with the 2019 and MDDSI in 2020. Ketamine and esketamine have been among the most “rationally developed” making, language skills and social cognition each medications in Psychiatry, in that they target one of play important roles in patient care. As a result of the putative underlying pathophysiological professional, economic, and social forces, our mechanisms underlying depression, neuroplasticity. current physician work force now includes many This presentation will review the clinical data in professionals actively working into their 70’s and support of the effectiveness of ketamine and even 80’s. In several countries, public concern about esketamine for DTD and MDDSI; the limitations, the quality of care delivered by our oldest physicians adverse effects, and controversies surrounding their has led to the development and implementation of use; their hypothesized mechanisms of action and age-based “Late Career Physician” screening policies. how that relates to theoretical causal processes for Such policies are spreading, though not without depression. Participants should understand if and resistance, among US health care systems. The how they might use esketamine in their practice. evidence in favor of LCP screening includes both They should also be able to describe the theoretical general findings about cognitive and physical aging mechanisms, benefits and limitations of esketamine as well as specific associations found between age to their patients. This should help them make and various physician performance outcome rational decisions about choosing among the variables. Nonetheless, doubts about the validity of available advanced treatment options for neuropsychological tools as an indicator of clinical depression. performance, concern about professionals’ dignity and legal rights, and fear of succumbing to ageist Late Career Physician Cognitive Screening: Policies, bias have made LCP screening policies very Practice, and Perspectives controversial. Should we as psychiatrists, including Chair: James Ellison, M.D., M.P.H. our aging members, support or oppose such Presenters: Andrew White, M.D., Kelly Garrett, Ph.D., programs? In this session, we will examine the issue Karen A. Miotto, M.D. of LCP screening from several different angles. The respected and influential screening approach EDUCATIONAL OBJECTIVES: promulgated by the CPPPH will be discussed by a At the conclusion of this session, the participant psychiatrist who participated in its development. A should be able to: 1) Summarize the issues neuropsychologist actively involved in LCP screening underlying the spread of late career physician (LCP) will discuss the instruments used for this purpose cognitive screening programs.; 2) Describe the with a focus on their role in identifying performance ethical norms and stakeholder viewpoints that issues. Finally, a hospitalist who has explored influence the adoption of a late career health care stakeholder attitudes in focus groups will illustrate provider screening program; 3) Explain the practical the LCP perspective on age-based screening. and legal considerations and the process involved in Attendees will be invited to share their experiences, a physician wellbeing committee's response to the concerns, and suggestions through discussion of case referral of a late career physician for perform; 4) vignettes and open question and answer period. Differentiate instruments used for screening and evaluation of cognitive status in a LCP program and Measuring Quality and Equity of Mental Health appreciate their value and limitations.. Care: Existing Challenges and Future Opportunities Chair: Bonnie T. Zima, M.D., M.P.H. SUMMARY: Presenters: David Kroll, M.D., Juliet Beni Edgcomb, Among many factors relevant to the performance of M.D., Ph.D. clinical duties, the effects of cognitive ageing have Discussant: Grayson Norquist, M.D., M.P.H. become an important focus of public and professional interest. The delivery of health care EDUCATIONAL OBJECTIVES: demands a consistent, high level of cognitive At the conclusion of this session, the participant functioning, Learning and recall, complex attention should be able to: 1) Be aware of the health policy and multitasking, manipulation of familiar and novel context for mandated public reporting of statewide detailed information, abstract reasoning, decision adherence to national quality measures by Medicaid in 2024; 2) Be familiar with the basic specifications of be reviewed in light of the implications for data the national quality measures related to mental interpretation. The session will then pivot towards health in the 2021 National Core Set; 3) Understand the future by providing examples of potential how type of data source (e.g., screening tool, survey, selection bias of measures in the 2024 Core Set that claims, electronic healthcare records) impacts utility may negatively influence measures utilizing and data interpretation of quality measures; 4) screening tools or patient experience surveys. The Recommend how advances in clinical informatics can remaining presentations will introduce advances in be adapted to examine the quality and equity of federated electronic health care record systems with psychiatric care; 5) Provide one example of a how a common data elements. Participants will be recommended care process for psychiatric care can introduced to the Accural to Clinical Trials Network or cannot be easily captured in a quality measure or (ACT) and PCORNet®, and how these resources may assessed using an existing administrative data be applied to track quality of care and disparities. To sources. counter balance, overview of these innovations will be followed by a brief critical assessment of SUMMARY: advances made and challenges ahead for utilizing Under the auspices of the Agency for Healthcare large-scale common element data sources to report Research and Quality, an initial core set of 24 quality quality of care and disparities over time. Together, measures was submitted to the Secretary of our session will engage participants through Department of Health and Human Services on interspersed questions that stimulate self-inquiry on January 1, 2010. Every year starting in 2013, the how quality measures for mental health can be National Core Set is reviewed and measures are improved, how reporting on quality measure considered for addition or removal. Currently, state adherence should be refined to interpret results Medicaid agencies voluntarily report adherence within clinically relevant contexts (i.e., social rates on 33 adult quality measures of which 12 are in determinants), and how data infrastructure can be the behavioral health domain, and 24 child quality improved to build greater capacity to measure and measures that include four related to behavioral report quality of care and disparities that is health. Beginning in 2024, state reporting of all meaningful. quality measures from the Core Set will be mandatory, as stipulated by the 2018 Bipartisan Medical Mimics of Psychiatric Disorders After TBI Budget Act. Nevertheless, statewide capacity to Chair: Gregory John O'Shanick, M.D. report adherence rates widely varies and of the behavioral health quality measures, only one related EDUCATIONAL OBJECTIVES: to follow-up mental health care after a At the conclusion of this session, the participant hospitalization for mental illness is frequently should be able to: 1) Identify questions and exam reported. Criteria for removal include significant procedures to differentiate agoraphobia from challenges in accessing an available data source that vestibular disorders;; 2) Identify questions and exam contains all the data elements necessary to calculate procedures to differentiate social phobia from the measure, including an identifier for Medicaid oculomotor and vergence disorders;; 3) Identify and Child Health Insurance Program (CHIP) questions and exam procedures to differentiate beneficiaries. Criteria for addition include a high bar; attention deficit disorder from auditory processing namely, at least half the states should be able to disorder;; 4) Identify questions and exam procedures produce the measure for FFY 2021 or FFY 2022, and to differentiate post-traumatic neuroendocrine all the states should be able to produce the measure disorders from primary affective disorders;; 5) by FFY 2024. Within this context, our session will Identify vulnerabilities of psychometric instruments engage participants by introducing a brief health (eg. MMPI) in misdiagnosing psychopathology after policy context underlying the urgency to be aware of TBI.. the need to interpret publicly reported rates of mental health quality cautiously. The basic SUMMARY: specifications of the national quality measures will While psychiatrists are licensed as Doctors of Medicine or Osteopathy, conducting any form of SUMMARY: physical or neurological examination on one’s The year 2020 saw simultaneous nationwide crises patient is unfortunately not a common practice. This that posed significant threats to mental health. The oversight results in the possibility of critical combined effects of an unprecedented pandemic, misdiagnosis and engagement in unnecessary mitigation measures and economic distress, and a treatment especially when one is evaluating an national crisis and reckoning over racism, had individual who has sustained a concussion or any widespread effects on our economy and society. It is other form of traumatic brain injury. This lecture will crucial that we understand the mental health provide essential training and clinical tips for impacts of these events, and implement mitigation identifying neurosensory abnormalities that can measures to help reduce these impacts. I will detail imitate commonly encountered anxiety, mood and the research approach taken by the National attentional disorders using a combination of case Institute of Mental Health, in collaboration with material, audience participation and didactics. The other NIH institutes, in response to the events of origins of balance dysfunction and the interplay of 2020 that will inform the mental health response environment and conditioning will be discussed as it over the coming months. pertains to post-TBI behaviors. Impairments of binocularity and near point convergence will be Psychotherapeutic Approaches to Sexual Problems discussed as triggers of interpersonal anxiety. Chair: Stephen B. Levine, M.D. Auditory processing and sound localization abnormalities similarly may present as distractibility EDUCATIONAL OBJECTIVES: and attentional deficiencies, only to fail when At the conclusion of this session, the participant treated with standard courses of stimulant should be able to: 1) Increase clinical interest in medications. Impairments in interhemispheric learning about patients' sexual lives/concerns; 2) transfer of spoken communication will be reviewed Encourage clinicians in their ability to assist patients as distinct from those defects in global attention. with their problems; 3) Appreciate the differences Post-traumatic neuroendocrine disorders will be between DSM-5 sexual diagnoses and what patient reviewed with specific attention to those involving present with; 4) Recognize the abilities and the anterior pituitary and mimicking primary limitations of prosexual medications; 5) Perceive the depressive disorders. Finally, the challenge of two-way relationships between anxiety/depression overreliance on traditional psychometric and sexual dilemmas. instruments in the assessment of those with TBI will be addressed with reference to those instruments SUMMARY: that may falsely identify psychopathology rather There is no single therapy for the broad range of than neurological dysfunction sexual problems. Instead, psychiatrists are challenged to develop comfort with and interest in Mental Health Research in the Era of Competing the diverse symptomatic ways that satisfying sexual Crises lives are thwarted. Some of these sex/love Chair: Joshua A. Gordon, M.D., Ph.D. predicaments are helped by our knowledge of personality development, interpersonal EDUCATIONAL OBJECTIVES: relationships, and mental and physical disorders and At the conclusion of this session, the participant their medication treatments. It is our should be able to: 1) Describe what is known from psychotherapeutic skills, however, that enable some prior research on disasters, racism, and economic patients to overcome their obstacles to more distress on mental health;; 2) Detail research satisfying sexual experiences, more relationship findings on the mental health impacts of the events stability, and better mental health. This session will of 2020;; 3) Compare and contrast alternative provide an overview of the forms of suffering interventions to reduce the mental health impacts of mediated through sexual identity issues and sexual disasters, and economic distress. dysfunction. These problems are very private, subjective, and interpersonal matters that patients tenure as chairman from 1979 till 2013, will be want to discuss in a safe psychotherapeutic presented. context. The psychiatrists' ideology, from behavior therapy through psychoanalysis, ethnicity, Scope of Practice: The Evolution of Physician-Only or gender are far less important than the Paradigm in Psychiatry professionals' comfort, knowledge, and integrity. A Chair: Michelle Riba, M.D., M.S. new interest in clinical sexuality can reinvigorate Presenters: Kamalika Roy, M.D., Varma Penumetcha, psychiatrists who are growing tired what they have M.D., Vishal Madaan, M.D. been doing and who wish to continue developing their psychotherapeutic means of helping. EDUCATIONAL OBJECTIVES: At the conclusion of this session, the participant Religion, Psychiatry, and Mental Health: Past, should be able to: 1) Explore the status of non- Present, Future physicians' practice authority across the states; 2) Chair: Driss Moussaoui, M.D. Understand the differences in education and training among physicians and advanced practice nurse EDUCATIONAL OBJECTIVES: practitioners; 3) Explore the differences in practice At the conclusion of this session, the participant pattern among physicians and nurse practitioners; 4) should be able to: 1) Recognize the importance of Understand and balance the needs and effects of Religion in Psychiatry and Mental Health by all non-physicians' practice privileges. mental health professionals; 2) Recognize and implement ‘Religion sensitivity’ within cultural SUMMARY: sensitivity every psychiatrist should have; 3) Use for Expanding advanced practice nurses’ (APRN) scope diagnosis and psychotherapeutic techniques that of practice has been proposed to solve many deficits take into account the socio-religious background, in the current healthcare delivery system. The initial but adapt them to each individual. argument was that the mid-level providers could help the stark discrepancy in primary care SUMMARY: physicians’ geographical distribution across the There is no human society without religion. Belief underserved and urban areas. The expanded scope systems seem to be universal to respond to all kind of practice was proposed to be helpful in better cost- of anxieties, especially the one of death, and the effectiveness in medical care. In this workshop, inextinguishable search for meanings of life. Directly speakers will dissect some of the effects of this or indirectly, every human being deals with some expansion of independent practice scope. Speaker form of relationship with religious beliefs and one will discuss the current status of the scope of practices. This is also the case when the person is practice in different states in the US. At least 28 physically or mentally ill. In “Western” countries, states allow the statutory authority to APRNs to mental health workers have great difficulties practice independently without any physician addressing this domain, as it is considered to be the oversight or collaboration. It is unclear whether all intimate intimacy of the person’s life. It is not the the APRNs are actually practicing independently in case in other parts of the world, and traditional these states, as there is no method to track their practices contain part of the religious beliefs of a employment information. The availability and the community. In this presentation, historical, social extent of supervision varies. Speaker will describe and anthropological aspects of the main religions in specific authorities in different states in terms of the world will be addressed, with a psychological independent diagnosis, treatment planning, and and/or psychiatric perspective. The work of various prescribing. He will also inform the audience of committees on religion and psychiatry will be resources for county-specific data on APRN practice. mentioned, included the one of the WPA Section on Speaker two will discuss the differences in training Religion and Psychiatry. Personal experience of the and education, highlighting the duration, rigor, and speaker and research studies conducted in his the nature of knowledge and clinical exposure in department in Casablanca, Morocco, during his training between physicians and APRNs, including psychiatry specific comparison in training. The post- counteract current practices and policies created by training licensing requirements and continuing structural racism. education requirements will be discussed, as well. These requirements vary from state-to-state. The SUMMARY: implications of the lack of a national board Despite advances in understanding the mind and requirement will also be explored. Speaker three will brain structural racism has historically impact compare the expected outcomes and evidence- psychiatry and continues to influence psychiatric based realities between physicians and APRNs practice and policy. In turn the larger public is practice. Though APRNs were expected to relieve the impacted by implicit racism that affects the healthcare workforce shortage in rural and knowledge base of mental disorders for the general underserved areas, only 18% of them practice in public. Historically African Americans have been those places. A recent Graduate Nursing Education misdiagnosed, are less likely to receive optimal report revealed a $179 million grant funded project treatment if they are treated at all and more likely to yielded 75% of APRN graduates practicing in already be impacted by incarceration, homelessness, and adequately served places. This section will include a other punitive outcomes. Despite extensive research rapid review of available data comparing opioid on diagnostic development, African Americans prescription patterns between physicians and continue to be misdiagnosed. Despite evidence to APRNs. Though opioid overdose is associated with the contrary substance abuse is thought to be more overprescription, the difference in prescribing common than other ethnic groups. Violence is patterns is strikingly unexplored. Despite the Centers thought to be more common, while suicide is for Disease Control and Prevention (CDC) published thought to be rare. As a consequence, specialized a guideline on the use of opioid medications for non- mental health services is less available and when cancer pain, a significant number of Medicare Part D provided tends to be inpatient and involuntary. patients continue receiving a higher dose than More punitive approaches such as incarceration and recommended for non-cancer indications. The the consequence of lack of treatment such as association between independent practice authority homelessness is more likely. We will explore how and overprescription of opioid medication is shown structural racism contribute to these disparities and in a recent study. In the end, the Chair will invite the how the historical treatment of African Americans audience to an interactive poll regarding benefits vs. promotes the persistence of beliefs reinforced by risks of expanding the scope of practice for APRNs. scientific racism. Historically African Americans After the survey, there is a question-answer session during the antebellum period were thought to lack for 20 minutes, moderated by the Chair. the affective and cognitive apparatus for genuine feelings and intellect and were thought to be Structural Racism in Psychiatry: The Past Is Driving impulse driven, intellectually incapable, and tend to the Present be violent to others but not to self. This session will Chair: William Bradford Lawson, M.D., Ph.D. explore how such beliefs persist and impact current Presenters: King Davis, Ph.D., Cynthia Turner- psychiatric research, treatment, and mental health Graham policy. We will explore the extent to which these Discussant: John McIntyre misconceptions still persist, impact the research literature and contribute to present day disparities in EDUCATIONAL OBJECTIVES: care. We will also explore strategies that may At the conclusion of this session, the participant minimize disparities and reduce implicit bias. should be able to: 1) Gain knowledge about racist practices that emerged in early America dictated The #MeToo Movement: Implications for present policies and directions that persist today; 2) Psychiatrists Understand how historical beliefs about African Chair: Renee M. Sorrentino, M.D. Americans continue to persist through scientific Presenters: Ryan Hall, Susan Joy Hatters-Friedman, racism; 3) Learn to develop strategies that M.D., Michelle Riba, M.D., M.S.

EDUCATIONAL OBJECTIVES: and administrative career opportunities.; 2) At the conclusion of this session, the participant Demonstrate an understanding of the benefits and should be able to: 1) Identify the influence of the challenges of assuming leadership roles within #MeToo movement in the psychiatric setting as well organizations; 3) Synthesize this information with as describe a novel approach to discussing #MeToo their own personal goals and values in assessing issues; 2) Identify resources for policies and training potential career opportunities. to address gender bias and harassment; 3) Become familiar with some of the barriers to the #MeToo SUMMARY: movement in medicine. As new psychiatrists enter the workforce, they are frequently offered leadership opportunities within SUMMARY: clinical institutions shortly out of training. However, Despite the well-documented prevalence of sexual many lack the knowledge and tools to assess the misconduct by physicians and sexual harassment in value of such leadership opportunities in academic medicine, the #MeToo Movement has not administrative and academic roles in the context of permeated the medical profession. The absence of their professional and personal goals. Further, few complaints and training to address such behaviors, are prepared for the benefits and challenges of as seen in other settings which appear to have assuming such roles within complex organizations. In responded to the #MeToo era of no tolerance, this interactive workshop, the presenters will first suggest the medical profession is immune to such introduce components of career opportunities in behaviors. Renewed attention to the issue of sexual leadership/administrative roles that are important to misconduct presents an opportunity to address consider. They will also engage in a conversation problematic sexual behaviors and attitudes in about when in the career path should someone seek physicians. In the first segment, panelists will review out leadership opportunities and how to approach the prevalence of sexual harassment and misconduct administration about these opportunities. Further, in medicine, identifying strategies to address such presenters will provide nationally representative behaviors and attitudes. In the second segment, data about salary, productivity, and other relevant panelists will discuss the related consequences and metrics. Presenters will then describe several role of the #MeToo Movement in psychiatric care. hypothetical career options which incorporate Has the #MeToo Movement validated patients’ leadership roles. In small groups, participants will perspectives? Pressured others to report harassment identify personally salient career considerations and or abuse? As psychiatrists integrate the #MeToo determine what additional information they would movement into their clinical care, it is imperative require to assess each option and how this that professionals and institutions consider what information would influence their decision-making. roles best serve our patients. The panel will conclude Finally, the presenters will discuss various benefits with a novel approach that addresses these timely, and challenges of assuming leadership roles, politically fraught topics with broad psychiatric particularly early in one’s career. implications. The Caravan Moves on: From Solomon Carter Fuller The Benefits and Challenges of Assuming to Psychiatry in the 21st Century Leadership Roles: A Workshop for Residents, Presenter: Altha J. Stewart, M.D. Fellows and Early Career Psychiatrists Chair: Tobias Diamond Wasser, M.D. EDUCATIONAL OBJECTIVES: Presenters: Luming Li, M.D., James Rachal, Victor J.A. At the conclusion of this session, the participant Buwalda, M.D., Ph.D., Manish Sapra should be able to: 1) Apply quality improvement strategies to improve clinical care.; 2) Provide EDUCATIONAL OBJECTIVES: culturally competent care for diverse populations.; At the conclusion of this session, the participant 3) Integrate knowledge of current psychiatry into should be able to: 1) Identify relevant variables to discussions with patients.. consider when assessing potential leadership roles SUMMARY: clinical care; 4) Integrate knowledge of current When Solomon Carter Fuller was born in 1872, psychiatry into discussions with patients. America was recovering from the Civil War and entering a period of racial oppression that extended SUMMARY: slavery without the obvious chains, but with real What are political determinants of health? How have consequences for generations of African Americans they driven inequities in the U.S. health care system? to come. His entry into medicine and later psychiatry Daniel Dawes, JD, director of the Satcher Health is a story of an accomplished man who achieved in Leadership Institute Morehouse School of Medicine, the face of adversity and hoped for better for and Rueben C. Warren, DDS, director of the generations to come. We know little of much of his Tuskegee University National Center for Bioethics in work life in his early years, although he conducted Research and Health Care, in conversation with Dr. some of the seminal work that went on to make the Rebecca Brendel and Dr. Regina James, share an man he worked with a household name. His life and inclusive approach to addressing health issues achievements have been discussed recently in the impacting the most vulnerable populations in an context of recent conversations on structural racism increasingly complex health care system and political in psychiatry and a new recognition for his environment. contributions to medicine and psychiatry is being acknowledged. The Mary Kaplan biography, “Where The Time for Justice Is Always Now! Engaging in My Caravan Has Rested” chronicles the life of a man Advocacy as an Early Career Psychiatrist of excellence in his profession as well as in his Chairs: Mary C. Vance, M.D., M.Sc., Katherine personal life. Many of the challenges he faced in the Gershman Kennedy, M.D. early 20th century as a Black psychiatrist are still Presenters: Ilse R. Wiechers, M.D., M.H.S., M.P.P., faced by Black psychiatrists today. Where Fuller Uchenna Barbara Okoye, M.D., M.P.H., J. Corey sometimes had to remain silent in the face of Williams, M.D. obvious racists acts, in his work and actions he often acted in a manner of “protest” against the mores of EDUCATIONAL OBJECTIVES: the day. His professional trajectory will be reviewed At the conclusion of this session, the participant to demonstrate some of these acts. And today’s should be able to: 1) Understand physician advocacy psychiatrists may recognize a type of protest as a core professional responsibility, distinct from behavior that is reminiscent of more contemporary activism, and essential for advancing social justice in psychiatrists, including Pierce, Greer, and Bell. A the context of a structurally oppressive healthcare review of his life and work and comparison to issues system; 2) Describe how advocacy helps patients, occurring today will be a focus of this lecture and the especially those from under-represented and presenter will articulate how his tactics might serve marginalized groups, to equitably access care, today’s Black psychiatrists well. improve health outcomes, and mitigate social determinants of health; 3) Recognize a framework The Politics of Health Policy: Integrating Racial for advocacy that psychiatrists can use to address a Justice Into Health Care and Clinical Research range of issues across diverse patient populations, Chair: Rebecca Brendel, M.D., J.D. especially at the intersection of social justice and Presenters: Daniel Dawes, J.D., Rueben C. Warren, mental health; 4) Identify types and levels of D.D.S., D.P.H., M.P.H. physician advocacy and provide specific examples; 5) Describe the specific rewards and challenges of EDUCATIONAL OBJECTIVES: advocacy as an early career psychiatrist. At the conclusion of this session, the participant should be able to: 1) Provide culturally competent SUMMARY: care for diverse populations; 2) Identify barriers to The healthcare disparities laid bare by COVID-19 care, including health service delivery issues; 3) have solidified the notion that, for physicians Apply quality improvement strategies to improve especially, advocacy is a core professional responsibility. Many physicians act as advocates routinely during their day-to-day work, including at psychiatrists, early in their careers, can incorporate the patient level (e.g., calling an insurer for social justice advocacy into their professional lives. authorization of care that has been unfairly denied Principles and strategies that underlie successful to a patient) and the organizational level (e.g., advocacy efforts will be highlighted. joining a hospital task force focused on improving equitable access to health services). Some physicians Unprecedented Access to Psychiatry: Expand Your take even greater steps to engage in advocacy Impact to Infinity and Beyond! Collaborative Care, outside of the clinical arena--for example, through eConsults, and ECHO Models legislative advocacy (e.g., interfacing with state or Chair: Shannon Kinnan, M.D. federal policymakers on bills that impact social Presenters: Lori Raney, M.D., Mark Duncan, determinants of health) and by engaging the popular Christopher Benitez, M.D. media (e.g., writing an op-ed about the impact of racism on mental health). Psychiatry is especially in EDUCATIONAL OBJECTIVES: need of physician-advocates to address major social At the conclusion of this session, the participant justice problems facing our patients and our society, should be able to: 1) Describe solutions to access to including structural and systemic racism, the stigma care in psychiatry; 2) Summarize strategies to associated with seeking mental health care, and the support productive interaction between primary lack of parity enforcement for mental health services care and psychiatric consultants; 3) Formulate a across the US. Recently, COVID-19 has further helpful response to an electronic question about exacerbated the need for advocacy in psychiatry, as patient care from a primary care provider; 4) Identify individuals with mental health and substance use shortcomings and reasons for underutilization of diagnoses, especially those from under-represented these indirect consultation methods; 5) Locate and marginalized groups, are often “left behind” as resources to support the ongoing education of our fragmented health care system strains under the integrated care for primary care and mental health weight of the pandemic. Despite its importance, providers. advocacy skills are not traditionally taught during either undergraduate or graduate medical SUMMARY: education. Current as well as aspiring physician- The shortage of psychiatrists in the US is well advocates often find a lack of resources, support, documented and contributes to limitations in access and mentorship to aid their advocacy work. This is to care, poor outcomes, increased cost of overall particularly true for early career psychiatrists, who care, as well as continued suffering. As a result, have recently left the structure of training and have several alternative models that leverage psychiatric yet to become established in their careers and expertise across larger populations have been professional networks. A Psychiatrist’s Guide to developed. These models require psychiatrists to Advocacy is the first book on physician advocacy rely on different skill sets in the management of geared specifically for psychiatrists. This book patients and communication with referring provides a comprehensive, step-by-step guide to providers. The Collaborative Care model of advocacy in psychiatry, across multiple levels and integrated care is an approach to extending across a variety of patient populations. In this psychiatric expertise by incorporating psychiatric workshop, the editors of the guide (Dr. Vance, Dr. consultation through a weekly systematic caseload Kennedy, and Dr. Wiechers) as well as early-career review. Project ECHO Psych uses a hub and spoke advocates (Dr. Okoye, Dr. Williams, and Dr. Vance) model to provide consultation in adult, child, will walk participants through the nuts and bolts of addictions, geriatrics, and other areas. E-consult is engaging in advocacy as psychiatrists, especially as it an approach that offers “remote,” rapid access to pertains to advancing social justice for marginalized psychiatric consultation for primary care providers communities. They will describe ways to advocate (PCPs). These in-direct care models have through clinical care, teaching, research, community tremendous promise to improve health equity by engagement, and communications via the popular expanding psychiatric expertise to geographically media. Case examples will be provided for how remote regions and larger groups of people. Psychiatrists engaged in these programs have of a patient distressed by anxiety who was found to learned to rely on specific principles to maximize be most appropriately diagnosed with mixed their impact, including providing quick access to features of a bipolar II disorder. She will review the affirm support for referring providers, cultivating overlap between uncomplicated anxiety and mixed personal relationships to develop trust, and features, and clinical pearlsfor distinguishing structuring consultation to facilitate case-based between the two. She will also discuss medication learning during practice. This session will include choices for treatment of a mixed episode. Dr. Nettles national experts in each approach who will discuss will discuss a case of a patient with Generalized the promise and shortcomings of these models Anxiety Disorder and Panic Disorder who had been followed by a discussion of real-world strategies and managed long term with increasingly high dose lessons learned. Participants will have the benzodiazepines. She will review clinical pearls and opportunity to practice consultations during the challenges of managing this complicated patient and presentation. safely tapering high dose benzodiazepines while still managing anxiety. Lastly, Dr. Gonzalez will discuss We’re So Anxious!! Challenges Faced and Lessons the pharmacologic management of anxiety in a Learned in the Management of Anxiety in Older patient in a nursing home with co-morbid major Adults neurocognitive disorder. Specifically, he will highlight Chair: Tawny Smith, Pharm.D. the challenges of utilizing medications that address Presenters: Alba Lara, Nicole Scott, Victoria Nettles, anxiety and underlying PTSD symptoms, while being Victor Gonzalez, Erica C. Garcia-Pittman, M.D. mindful of medication side effects that can worsen neurocognitive symptoms. Dr. Smith will review EDUCATIONAL OBJECTIVES: clinical pearls related to the cases presented. In At the conclusion of this session, the participant addition, we will share knowledge regarding should be able to: 1) Explore the similarities and literature updates, as well as guidelines for differences between uncomplicated anxiety and a treatment of the aging patient with anxiety. mixed episode of bipolar disorder.; 2) Review options for safely tapering benzodiazepines in What to Do With the Rest of My Life? Career Tips geriatric patients while still managing anxiety; 3) for Launching Psychiatrists Discuss complications and subsequent Chair: Jessica L.W. Mayer, M.D. pharmacological management of anxiety and PTSD Presenters: Margo Christiane Funk, M.D., M.A., symptoms in older adults with major neurocognitive James Shore, Eric Williams, Maryland Pao disorder.; 4) Review and recognize a presentation of major depressive disorder mimicking new-onset EDUCATIONAL OBJECTIVES: anxiety disorder.. At the conclusion of this session, the participant should be able to: 1) Describe a diverse range of SUMMARY: psychiatric career options to consider.; 2) This session will highlight several challenging and Understand the importance of when, how, and why complicated cases of anxiety treated in an to consider transitions between positions.; 3) interdisciplinary geriatric outpatient clinic and Appreciate the pros and cons and opportunities for nursing home settings. We will share our lessons maintaining a healthy work-life balance in various learned from these clinical encounters with the psychiatric careers and positions.. assistance of Dr. Tawny Smith, a clinical psychiatric pharmacist. Dr. Lara will discuss a case of a patient SUMMARY: with major depressive disorder with psychosis which Early career psychiatrists completing training can be mimicked new onset anxiety disorder. She will at a loss for knowing the range of career review the diagnostic challenges associated with opportunities available to them. Nationally anxiety disorders masking and exacerbating major prominent psychiatrists with a diverse range of depressive disorder and the treatment approach for backgrounds and career paths will gather to share this patient. In addition, Dr. Scott will discuss a case their insights, experiences, and perspectives on career choices today and the paths they took along as a “critical ingredient” in these tragedies (Shabad, the way. They will share "what I would advise my 2017). However, a closer inspection of the data younger self today if I were just starting out again." reveals that mass shootings by mentally ill By sharing their journey, speakers will share the individuals accounts for less than 1% of gun-related hardest lessons learned, mentoring tidbits including homicides. Moreover, only 3% of violent crime where and how to look for a job, when to consider a involves those who suffer from a serious mental transition between positions, and three take-home illness (Fazel, 2006). In fact, in the U.S., a person is pearls. fifteen times more likely to be struck by lightning than to be killed by someone with a chronic mental Why Blaming Violence on Mental Illness Is illness (Knoll, 2016). Apart from mental illness Misleading: A Call for Multifaceted and Evidence- though, other sociocultural factors have also been Based Strategies to Reduce Gun Violence implicated in explaining “mass shootings.” Among Chair: Ahmar Mannan Butt, M.D. these are: history of violent behavior (including Presenters: Dhruv R. Gupta, M.D., Alisa R. Gutman, domestic violence), gender expectations for males in M.D., Ph.D., Muhammad Hassan Majeed, M.D., society that emphasize aggressive pride, perceived Jessica S. Bayner, M.D. injustice, a general pathological sense of self (narcissism), deterioration of spirituality, isolation, EDUCATIONAL OBJECTIVES: difficulty achieving success, breaking down of family At the conclusion of this session, the participant system, revenge fantasies and violence in the should be able to: 1) Discuss the risk factors for self- entertainment industry, insecurities, easy availability directed, interpersonal, and community violence and of intoxicants and access to firearms, and motivations leading to escalating mass shootings glamorization of mass killing by the press, among over the past decade.; 2) Identify prevalent others. Nonetheless, mental illness continues to be misconceptions relating to mental illness and gun used as a scapegoat for increased gun violence. This violence while understanding the consequences of obfuscates the problem and distracts policy makers further stigmatizing an already vulnerable from addressing the etiology of mass shootings. For population.; 3) Understand the history of gun our patients already struggling with symptoms of legislation, red flag laws and proposed interventions serious mental illness, this adds state-level stigma to for psychiatrists to avert such incidents with some an already cumbersome burden. Prevention of clinical scenarios pertaining to gun laws.. violence is multifactorial and needs to begin in childhood by helping parents, schools, and SUMMARY: communities raise emotionally healthy beings. The The United States has one of the highest rates of role of a clinician in asking about access to firearms deaths from firearms (Schultz, 2013). In 2018 alone, for means reduction, counseling, and taking legal there were almost 40,000 fatalities due to gun action vary on a state-to-state basis, and gun violence in the United States (CDC, 2020). The legislation, too, plays an important role in this majority of these deaths (almost 60%) were by regard. Prohibition of firearms for high-risk suicide, which have been increasing for several individuals through a legal framework may reduce years. As described by the Centers for Disease gun violence. However, interventions through Control and Prevention, a “mass shooting” occurs education, community, health systems, and when three or more shooting victims (not ultimately clinical judgment are still required. necessarily fatalities), not including the shooter, are Increasing access to data and resources will help find involved. These tragedies are marked by a national evidence-based solutions to keep our communities public response of emotions, debate, and safe. resolutions. Examples of such reactions were seen with the shootings that occurred in El Paso, Dayton “Why Can’t They Just Go to Psychiatry?” Changing and West Texas, which were followed by media Attitudes Toward Patients With Challenging commentaries on gun violence and mental health. Behaviors on an Inpatient Pediatrics Unit Both the media and politicians portray mental health Chair: Hannah Marie Gamble, M.D. Presenters: Danica Kozek, M.D., Fariya Ali, M.D., Participants will be divided into pairs to create an Megan Zappitelli, M.D. actionable plan with group discussion following to facilitate creative thought and peer-directed EDUCATIONAL OBJECTIVES: learning. Following the SWOT exercise, participants At the conclusion of this session, the participant will perform a role play demonstration of should be able to: 1) Identify essential elements developmentally sensitive, trauma-informed de- required to develop a Challenging Behaviors Action escalation techniques. Participants will be divided Team (CBAT); 2) Conduct a SWOT analysis of their into groups of 2-3 and provided a case-based home institution to develop a personalized strategy scenario for technique practice. We will also review for building a multi-disciplinary challenging methods for communicating and teaching such behaviors team; 3) Discuss methods for measuring techniques to other multi-disciplinary team meaningful change within the institution; 4) Describe members. Finally, the session will conclude with and demonstrate developmentally sensitive and time set aside for questions and answers. We are trauma-informed de-escalation techniques for hopeful that this session will allow participants to patients of all ages. learn how to identify essential elements required to build a multi-disciplinary team for safely treating SUMMARY: patients with challenging and dangerous behaviors. In many hospitals, more psychiatric patients with We also hope that participants will have developed challenging and dangerous behaviors are being an individualized plan of action to help improve admitted to the general pediatric or adult inpatient treatment outcomes and safety within their home wards while awaiting placement in a psychiatric institutions. Additionally, we hope that participants facility. Perceived distress amongst hospital staff will be able to demonstrate developmentally treating these patients has correspondingly sensitive and trauma-informed de-escalation increased. Though caring for patients with techniques for patients of all ages. In summary, we challenging or dangerous behaviors is often high risk, hope that participants will leave our session with the resulting in frequent staff and patient injuries, tools to implement simple, affordable, and hospital damage, and staff burnout, there is a generalizable solutions to providing safe, equitable paucity of literature on this topic (Malas et al, 2017). care for the treatment of one of our most vulnerable Through our work on the child and adolescent and challenging patient populations. psychiatry consultation-liaison service, we have addressed the treatment complexities surrounding Window to the Mind: Clinical Implications of Visual these challenging and vulnerable patients by System Impairment in Psychosis implementing a new task force called the Chair: Steven Silverstein, Ph.D. Challenging Behavior Action Team (CBAT). During Presenters: Halide Bilge Turkozer, M.D., Paulo Leonel this session, we will discuss the development of the Lizano, M.D., Ph.D., Deepthi Bannai, M.Sc., Steven CBAT at Prisma Health Children’s Hospital, review Silverstein, Ph.D. our process for identifying essential elements required to construct a multi-disciplinary team, and EDUCATIONAL OBJECTIVES: provide an overview of the results of this initiative. At the conclusion of this session, the participant This could include results from our survey designed should be able to: 1) Identify changes in various to assess changes in pediatric providers’ job visual perceptual functions in psychosis and their satisfaction, perception of the workplace potential contribution to the formation of psychotic environment, and attitudes toward caring for experiences; 2) Identify retinal changes in psychosis patients with challenging behaviors. Participants will and its potential clinical applications; 3) Identify be guided through a Strengths, Weaknesses, brain structural changes in the visual system in Opportunities, and Threats (SWOT) analysis exercise psychosis; 4) Recognize the potential clinical use of that will allow them to design a plan for building a visual assessments as biomarkers of psychosis multi-disciplinary team to improve the treatment of vulnerability in individuals at high risk for psychosis; challenging behaviors within their home institutions. 5) Recognize the potential clinical use of visual A Simple Method to Ensure Creative Problem remediation in psychosis and their clinical benefits. Solving in Healthcare Service Delivery Chair: Erik Rudolph Vanderlip, M.D., M.P.H. SUMMARY: The visual system is recognized as an important site EDUCATIONAL OBJECTIVES: of pathology in psychotic disorders. The At the conclusion of this session, the participant abnormalities in the visual system range from basic should be able to: 1) Employ a simple method to visual symptoms, to visual perceptual impairments, develop and test creative solutions to healthcare retinal and structural abnormalities, and service design.; 2) Recite the process of design electrophysiological changes. Recent studies suggest thinking and apply it to healthcare service delivery.; that these changes precede the emergence of 3) Increase their organizational focus on the; 4) psychotic symptoms and may be predictors of future Crosswalk recovery models of mental health with development of psychosis. Furthermore, studies design-thinking.. suggest that impairments in the visual system may contribute to the formation of psychotic experiences SUMMARY: by providing higher cognitive processing streams Healthcare is confused. Too often we are designing with inaccurate or ambiguous sensory information. systems and services that serve the provider in order In this workshop, our goal is to introduce this critical, to serve the population in need, but the problems of but under-discussed site of pathology in psychotic the provider are not always synonymous with the disorders to clinicians and trainees using an problems of the person seeking help. As a result, the interactive teaching approach. Our session will start system is opaque, not patient-centered (though we with a vignette on an individual who presents with claim it may be) and full of awkward policies and paranoid delusions, disorganization, basic visual procedures that stand in the way of efficiency, add symptoms, and visual hallucinations. There will be costs and reduce the chances of a full recovery and interactive small-group discussions of the potential sustained improvement in health outcomes. In this sites of pathology that may lead to the symptoms. session, workshop participants will review a case After discussion, the second part of the vignette will study of design thinking applied to clinical service be distributed, where the character in the vignette delivery. They will then be divided into small groups participates in a research study and undergoes and tasked with rapidly ideating solutions to real or several biomarker assessments including retinal hypothetical healthcare service delivery imaging, structural MRI, and visual perceptual problems. Afterwards, they will share their assessments. The results of the assessments will be proposed solutions with the other attendees and a shared with the participants and there will be small- small panel of judges will award the winner candy. group discussions on the results and their relationship with the clinical presentation. This part Advocacy for Health Equity in Diverse Populations will be followed by brief presentations on visual Chair: Patrice A. Harris, M.D. perceptual, structural, and retinal abnormalities in Presenters: Steven Starks, M.D., Altha J. Stewart, psychotic disorders and their potential role in the M.D. formation of psychotic experiences. The last part of the workshop will include an interactive discussion EDUCATIONAL OBJECTIVES: on the potential clinical use of assessments of the At the conclusion of this session, the participant visual system, followed by a presentation on the should be able to: 1) Understand factors underlying current state of evidence on visual biomarkers as risk social determinants of health from both an historical indicators for psychosis and clinical benefits of visual and contemporary perspective; 2) Identify racial and perceptual remediation in patients with psychosis. ethnic disparities as they exist in health care and society and the dangers they pose; 3) Assess the Sunday, May 02, 2021 efforts underway by the American Medical Association and other institutions to fight disparities and create greater health equity for diverse upstream (including into medical education) to populations. address all determinants of health. 5) Create pathways for truth, reconciliation, and healing. In SUMMARY: carrying out this work, the AMA Center for Health There is a national movement underway to better Equity envisions a nation in which all people live in understand and recognize how systems of power thriving communities where resources work well, and oppression, including bias, racism, sexism and systems are equitable and create no harm, and other forms of discrimination, result in devastating everyone has the power, resources, and health consequences for Black, Brown and opportunities to achieve optimal health. Indigenous communities. Too often and for too long, our health system has failed to recognize these root Asian American Mental Health and Racism During causes, with many physicians feeling ill-equipped to and Post COVID-19 tackle the structural and social drivers of health in Chair: Edmond H. Pi, M.D. the communities they serve. As we have witnessed Presenters: Geetha Jayaram, M.D., M.B.A., Joan Han, throughout the COVID-19 pandemic, without D.O., Francis Sanchez, M.D., Dora-Linda Wang, M.D., system-level and structural change, health inequities M.A., Clayton Chau, M.D., Ph.D. will persist, marginalized communities will be disproportionately impacted, and the health of our EDUCATIONAL OBJECTIVES: nation will continue to suffer. Through advocacy, At the conclusion of this session, the participant partnership and action, the American Medical should be able to: 1) Discuss the COVID-19 impact on Association is committed to ensuring that all people Asian Americans: anticipated and experienced and all communities have the opportunities, discrimination. Recognize unique set of challenges in conditions, resources, and power to reach their full patient care facing Asian American mental health health potential. To advance this goal, AMA is providers; 2) Promote understanding and empathy leading an aggressive effort to eliminate for Asian Americans in a nation with a long history of longstanding inequities within our health system, anti-Asian laws and attitudes. Put the epidemic of remove barriers to care, and improve outcomes for anti-Asian activity amid the pandemic in historical historically marginalized and minoritized context; 3) Recognize Asian American under-testing populations. As the physicians’ powerful ally in for COVID-19 is a real problem across the States and patient care and a leading national voice on health identify some of the reasons including stigma toward policy, the AMA has placed equity at the center of its COVID-19 and anti-Asian discrimination; 4) work to shape the future of medicine. This includes Understand the Filipino American’s development of equipping physicians with the consciousness, tools, identity and promotes rapport building including a and resources to confront health inequities and humanistic approach to establishing an alliance as advance equity in their communities and across our well as acclimate to the “new abnormal”; 5) health system. It also includes proactive steps such Acknowledge the importance of engaging trainees in as speaking out against police brutality, raising conversations of social justice, racial equality, awareness about the detrimental effects of racism, diversity and inclusion and discuss why this is and calling for systemic changes in our criminal important as a trainee. justice and health systems. In 2019, the AMA established a Center for Health Equity to elevate and SUMMARY: sustain our equity efforts to address system level The Covid-19 pandemic has fundamentally changed changes that can improve health and well-being. nearly all aspects of individuals’ personal and Through this work, we strive to: 1) Embed health professional lives. Since March 2020, work, equity in practice, process, action, innovation, and movement in social arenas, daily schedules, and outcomes. 2) Build alliances and share power via communication with others have been impacted in meaningful engagement. 3) Ensure equitable unprecedented ways. As of October 2020, data opportunities and conditions in innovation for showed COVID-19 had a disproportionate effect on marginalized people and communities. 4) Push the mortality rate among Asian Americans: From January to July 2020, deaths increased 35 percent care to Asian Americans and dismantling anti-Asian over the 2015-19 average, compared to a nine discrimination during and post COVID-19 era. percent rise for whites. However, COVID-19 positivity rate for Asian Americans remains low. Cannabis: Clearing the Smoke on Cannabis Use Asian American under-testing for COVID-19 is a real Disorder problem across the States. Some of the reasons Chair: Smita Das, M.D., Ph.D., M.P.H. includes stigma towards COVID-19 and also anti- Presenters: Anees Bahji, M.D., Oscar Gary Bukstein, Asian discrimination fostering distrust of reporting M.D., Thomas J. Riordan, M.D., Andrew John Saxon, and contact tracing. Moreover, racial discrimination M.D. has shown to correlate with an increase stress, anxiety and depression. There are many faces of EDUCATIONAL OBJECTIVES: stigma during COVID-19, stigmatization surrounding At the conclusion of this session, the participant the pandemic has presented extreme challenges for should be able to: 1) Learners will understand the frontline workers as for those suffering from COVID- impacts and implications of cannabis as it relates to 19 infection. High proportions of Asian Americans children/adolescents; 2) Learners will be introduced have been working in essential healthcare roles but to cannabis use disorder and the DSMV criteria; 3) have been vilified. Challenging times like this also Learners will be introduced to novel treatment highlights the importance of psychiatric residency methods for cannabis use disorder; 4) Learners will education on understanding racial inequality, quantify how state laws on cannabis affect use and diversity and inclusion but structured training on this other substance use disorders; 5) Learners will topic varies across the country. This presentation will access APA position statements on cannabis which focus on the Asian American experience of both review the current evidence base for cannabis use as anticipated and experienced discrimination in it relates to psychiatry. personal and social encounters, cultural adaptation to COVID-19, and the positive attributes of the Asian SUMMARY: culture helping to work through obstacles during and With more states legalizing cannabis and changing post COVID-19 pandemic. The blaming of Asians for public perception of cannabis, there is considerable the pandemic will be discussed in historical context. confusion around its safety and uses as it relates to A review of anti-Asian activity will be presented, psychiatry. Psychiatrists are not sure how to assess including the slavery of Asian women in California, for cannabis use, what sort of information to give the Chinese Exclusion Act of 1882, laws excluding their patients or the clinical implications of cannabis Asians from owning land, hate-ful portrayals in use. This is also very relevant for child and Hollywood films, and the current epidemic of anti- adolescent psychiatrists. Furthermore, there is Asian violence during the COVID-19 pandemic. confusion on what cannabis is, versus components Ethnic discrimination towards Filipinos in the US has including cannabidiol or tetrahydrocannabinol. a long tumultuous history dating back centuries. Finally, there is limited understanding of cannabis How to identify the specific microaggressions to and the risks of addiction; many psychiatrists are form strong therapeutic relationships to properly surprised to learn that in research, 9-30% of those address various mental and physical health concerns who use marijuana develop some degree of will be discussed. How a County has created the marijuana use disorder. There has also been recent COVID-19 Testing Strike Team led by a collaborative conflicting evidence on whether cannabis of community-based organizations to provide testing legalization affects other timely topics such as opioid and other services for Asian American at non- use and overdose. This expert panel will present traditional community venues will be presented. The brief presentations on these topics and following the importance of engaging trainees in conversations of presentations, the audience will be able to social justice, racial equality, diversity and inclusion participate in what we anticipate will be a lively will also be presented. Presenters and participants question and answer session. We also hope to will culminate the session by determining future provide the audience with resources such as APA strategies and activities to provide mental health position statements and resource documents that Discussant: Rachid Bennegadi they can use in practice. EDUCATIONAL OBJECTIVES: Collision of the Opioid Crisis and the COVID-19 At the conclusion of this session, the participant Pandemic should be able to: 1) To understand how the Covid- Chair: Nora D. Volkow, M.D. 19 has affected the social life of the communities across the world; 2) To understand the impact of EDUCATIONAL OBJECTIVES: Covid-19 pandemic on mental health; 3) To At the conclusion of this session, the participant understand the strategies used across the world to should be able to: 1) Describe the current state of deal with the psychosocial consequences of the the opioid crisis in the U.S.; 2) Appreciate the added Covid19 pandemic; 4) To understand how to plan an social challenges facing those with substance use effective approach in dealing with psychosocial disorders during the COVID-19 pandemic; 3) Better consequences of a pandemic in future. understand some of the unique structural challenges facing those with substance use disorders during the SUMMARY: COVID-19 pandemic. Covid-19 pandemic had had an unprecedented social impact on all over the world and has affected SUMMARY: developed, developing and underdeveloped The misuse of and addiction to opioids—including countries without any distinction. The pandemic has prescription pain relievers, heroin, and synthetic been associated with very high infectivity and opioids such as fentanyl—has resulted in a national varying mortality across the world with a widespread crisis of overdose deaths that we have not been able community fear of infection. A large number of to control. In parallel, an alarming resurgence in countries had to declare countrywide lockdowns to stimulant use--including cocaine and prevent the spread of infection, which had methamphetamine—is further contributing to the widespread economic consequences because to a rise in overdose fatalities. This crisis is now large population put into unemployment and exacerbated by the COVID-19 pandemic which has economic hardships. Closure of educational resulted in increased drug use and relapse of those institutions has affected the academic careers of a in treatment and highlights the urgency to large population of school and college going characterize the unique social and structural students, though online classes have been started at challenges faced by those with substance use most of the places. Economy of the most of the disorders and to develop strategies to overcome countries including those in the high-income them. This presentation will highlight how NIH countries has been affected. Covid-19 due to its researchers are using scientific advances to address highly infectious nature and lack of an effective the opioid crisis amidst the COVID pandemic, which treatment and vaccine has been associated with high includes the development of new medications and levels of fear of infection in the community, mental formulations to help treat opioid use disorders and health problems and social stigma. Industrial overdoses; prevention strategies to mitigate an shutdown, economic hardships, unemployment, individual’s vulnerability to addiction; and closure of social and cultural events, closure of implementation science to guide optimal various avenues of entertainments and outdoor deployment of therapeutic interventions including sports, all have their effect on mental health. Social the use of telehealth in diverse settings (healthcare, distancing has led to lack of emotional warmth in the justice setting, rural communities). relationships. In this background, social psychiatry can have an important role to play in instituting COVID-19 Pandemic and After: What Social strategies of reducing stigma, psychosocial Psychiatry Can Offer? interventions for common mental health problems, Chair: Eliot Sorel, M.D. and group approaches at helping the communities in Presenters: Rakesh Kumar Chadda, M.D., Roy coming back to the pre Covid era. The World Abraham Kallivayalil, M.D., Andrew Molodynski Association of Social Psychiatry (WASP) issued a position statement in May 2020 expressing concerns cover such advances with subject matter experts at the worldwide psychosocial consequences of the focused on expanding the skill set of those in the pandemic and suggesting need for a multicountry, audience! This talk will focus on not only the multisectoral and multimodal approach. Faculty rationale behind these innovations but also the comprises of leaders in social psychiatry from history of the metrics and outcomes that benefit this different parts of the world, who would share their relationship. To best educate on this topic includes experiences at dealing with the psychosocial issues, the need to examine both the medical stakeholders and reach a consensus to how to deal with such in these processes (health systems, physicians, situations in future. emergency rooms, patients) as well as the non- medical stakeholders (law enforcement, advocates, Crisis Coordination With Law Enforcement: To CIT family members, peer support, payors, policy and Beyond! makers). Once covering current state, the presenters Chair: Tony Thrasher, D.O. will then speak to future plans on this topic including Presenters: Debra A. Pinals, M.D., Charles Browning, grassroots change, educational curriculum, and M.D., Christina Terrell, M.D. policy initiation. These advancements will be covered at the state, federal, and local governmental EDUCATIONAL OBJECTIVES: levels. Additionally, there will be discussion of how At the conclusion of this session, the participant this topic (and its synergy between mental health should be able to: 1) Process the need for psychiatric and law enforcement) can assist in germane items as leadership/involvement with law enforcement of late focused on police adverse outcomes with collaboratives.; 2) Discuss how the field of psychiatry patients as well as advocacy to benefit the patients, can assist not only patients in crisis but also with the their families, and those that provide care for them law enforcement officers tasked to care for them in (both medical and otherwise). A notable strength of the community; 3) Educate upon how the field in the program will be the diverse backgrounds of the question has evolved over time, including early presenters. While all four physicians have led CIT expansions into what is now known as CIT.; 4) programs and developed training curricula, each Proffer unique new programming that builds upon individual also practices in a different area of the CIT tenets while also showing more adherence to the country facing their own unique challenges.……. thus evidence base of trauma informed care and recovery the need to process items at the programmatic level models.; 5) Examine how the slate of presenters are as well as larger products via SAMSHA and Crisis handling this in unique geographical settings (all four Now. Hence, we look forward to presenting on this practicing in different venues across the country).. complex, yet very germane topic in today’s society. The audience will be actively engaged in discussions SUMMARY: and case examples looking at both current and Patients with mental illness often find themselves at future state. Additionally, the diversity of the an intersection with law enforcement due to a presenters’ respective backgrounds will allow any myriad of reasons. These include but are not limited participant to find information of relevance to their to: geography of the crisis, local civil commitment practice………whether that be at the local level or for laws, lack of mental health community capacity, those looking to collaborate on larger projects. The acuity of illness, and/or the ideas behind specific more that physicians are active with the law modes of access or crisis resolution. Improving enforcement community, the greater the positive these interactions have been a long-standing goal of outcomes for our patients and our communities. mental health professionals, as noted by differing approaches and curricula, manifesting with Crisis Delivering HIV Prevention and Care to Transgender Intervention Training (CIT) and similar modules. People: An Update While this modality has proven to be of assistance to Chair: Kenneth Bryan Ashley, M.D. both patients and community stakeholders, there Presenters: Carmen Casasnovas, Kenneth Bryan has been a great deal of evolution of these Ashley, M.D., Luis Filipe Gomes Pereira, M.D., M.S., processes. Hence, this discussion is intended to Max Lichtenstein, M.D. health outcomes and increase morbidity and EDUCATIONAL OBJECTIVES: mortality. Dr. Ashley will review the indications for At the conclusion of this session, the participant the use of PrEP and its role in HIV prevention in the should be able to: 1) understand the prevalence of transgender community, including potential barriers. HIV in the transgender population; 2) identify Finally, Dr. Pereira will discuss recent data pertaining transgender individuals at high risk of HIV infection; possible risk compensation behavior in PrEP users, 3) identify how stigma can affect both HIV and uptake, and future pharmacological preventive psychiatric treatment adherence; 4) understand the methods. use of PrEP in the transgender population. Depression in Families: Clinical Opportunities for SUMMARY: Breaking the Cycle of Transmission Worldwide, according to UNAIDS, individuals Presenter: Myrna Weissman, Ph.D. identifying as transgender remain among the most heavily affected by HIV and are considered a key EDUCATIONAL OBJECTIVES: population. Within this group, transgender women At the conclusion of this session, the participant are the most vulnerable. In 2018, the risk of should be able to: 1) To understand the long-term contracting HIV was 12 times higher for transgender risks on functioning of major depression that is women than for adults aged 15 to 49. Risk factors for familial; 2) To understand the critical ages of onset HIV infection include engaging in condomless sex, of major depression for early interventions; 3) To lower perceived risk of HIV, multiple sex partners, understand potential targets of interventions for the and sharing equipment to inject hormones or drugs. individual and the family member to break the cycle Stigma may be the largest barrier to access to care of transmission; 4) To learn the status of one brief for HIV+ transgender people. Transgender people evidence-based psychotherapy: interpersonal face discrimination from both their HIV status and psychotherapy; 5) At the conclusion of this session, gender identity/expression, but also are more likely participants will understand the potential of to be involved in the underground economy (sex screening and interventions for persons at high work, illegal drug dealing), which presents unique depression risk.. challenges in risk management. This population is also more likely to have mood and anxiety disorders, SUMMARY: substance use and trauma. Taking a trauma I will use the honor of this award to give clinical informed approach to treat this population will be highlights of my research that may be of interest to key to rapport building, good therapy outcomes, as those who treated depressed patients and who look well as to identify root causes of what is often seen for opportunities to intervene early. I will begin with as problematic patient behavior. Pre-Exposure a summary of 38 years studying the offspring at high Prophylaxis with FDA approved medication is a risk for depression but virtue of having a parent with valuable HIV prevention tool in this population with moderate or severe depression. These offspring will increased risk for HIV infection. Overall knowledge of be compared to those with a parent who has never risk for HIV infection, stigma and its effect on health been depressed (low risk). These findings show a outcomes, as well as the use PrEP when taking care long-term increased risk of depression, anxiety, of patients identifying as transgender is a necessary substance abuse in the high-risk offspring, an early step in reducing the incidence of new HIV infections. age of onset, poor functioning over the years, and an Dr. Casasnovas will start this session by reviewing astonishingly high rate of deaths for unnatural the epidemiologic data and risk of HIV infection in causes of suicides and overdoses. In a second line of individuals identifying as transgender, including research looking for interventions, we showed that individual perceived risk and its effect on health by successfully treating the depressed parent to outcomes Using the stigma-sickness slope theory, remission, we could reduce the symptoms of the Dr. Lichtenstein will explore issues of stigma, access untreated child, and these symptoms remained in to care, and discrimination. He will discuss how remission for at least a year. Our two studies used compounding layers of stigma adversely affect medication to treat the mother, a third study by another group had similar effects using interpersonal The COVID-19 pandemic is covering the world with a psychotherapy with the mother. The final part of my cloud of uncertainty. Not surprisingly, anxiety, talk will touch on psychotherapy. I will briefly depression, irritation, and anger is increasing describe interpersonal psychotherapy (IPT), an especially in individuals who are intolerant of evidence-based treatment with over 130 clinical uncertainty and emotional distress. The need for trials recommended in a number of guidelines, most effective emotional regulation strategies and recently the US Preventative Task Forces for methods to promote psychological flexibility is treatment of depression during pregnancy. IPT is not undeniable. Fortunately, Dialectical Behavior the only good treatment for depression or the only Therapy (DBT) is an empirically supported evidence-based psychotherapy. I talk about IPT psychosocial intervention for adolescents challenged because I invented it with my late husband, Gerald by multiple psychiatric challenges. Characterized by Klerman, M.D., a psychiatrist. I know it well, and a synergistic combination of the biopsychosocial some features of its global reach are relevant for the model, behaviorism, and the notion of dialectics, current treatment of depression, especially the need DBT surfaced at the crest of the third wave of for brief effective treatment with the COVID behavioral therapies. Currently, the approach is epidemic. IPT has helped with the eruption of practiced in outpatient settings, inpatient units, depressive symptoms in the context of interpersonal partial hospitalization programs/IOPs, forensic problems of grief, life changes, disputes, and centers, and integrated pediatric clinics. DBT loneliness and isolation. These are problems highly balances acceptance and change strategies that associated with depression and now the COVID. increase motivation, distress tolerance skills, Globally, hundreds of community health workers in mindfulness, psychological flexibility, and adaptive primary care have been trained to carry out IPT perspective taking. The Ninja mindset is marked by individually and in groups providing a large and acknowledging the wisdom of patience, the trained workforce to treat mild to moderate necessity of challenging one's fears, choosing a path depression. These efforts are relevant today in the of justice for the self and others, delaying U.S. gratification and resisting impulses, tolerating emotional distress, and maintaining equilibrium in Dialectical Behavioral Therapy With Adolescents: life. Achieving a Ninja mindset and DBT's clinical Fostering a Ninja Mindset objectives are well-matched. This clinician-friendly Chair: Robert D. Friedberg, Ph.D. presentation brings together five experts (Drs. Presenters: Erica Rozmid, Ph.D., Micaela A. Rozmid, Thordarson, La Prade, Atasuntseva, and Thordarson, Ph.D., Rebecca La Prade, Ph.D., Anaid Miller) working in different settings (outpatient, Atasuntseva, Ph.D. inpatient, IOPs, etc) that deliver DBT via various Discussant: Alec Miller, Ph.D. platforms (live, remote, phone, etc). Each presentation highlights the ways DBT fosters a EDUCATIONAL OBJECTIVES: nimble Ninja mindset. Rozmid (UCLA) will explain the At the conclusion of this session, the participant rudiments involved in delivering DBT via telehealth should be able to: 1) Understand the elements of a platforms in order to facilitate the Ninja mindset. La Ninja mindset and the ways DBT can facilitate this Prade (McLean Hospital/Harvard SOM) will present perspective; 2) Learn how DBT may be delivered via how DBT skills are taught in a family context to help telehealth platforms to develop flexibility and individuals walk the middle path and practice adaptive coping; 3) Recognize how to optimize DBT emotional regulation. Atasuntseva (Stanford phone coaching with adolescents; 4) Identify the SOM) will discuss ways to integrate mindfulness way adolescents can walk the middle path and practices into DBT with adolescents. Thordarson practice emotional regulation regulation strategies (Children's Hospital of Orange County) will highlight through family based DBT; 5) Appreciate the role of the role of phone coaching in DBT with young mindfulness in DBT with adolescents. patients. The noted DBT expert and pioneer in applying the approach to adolescents, Dr .Alec Miller SUMMARY: (Cognitive Behavioral Consultants), the pioneer in applying DBT to adolescents, serves as the suicide risk; 4) review extant evidence-based discussant and will add remarks that synthesize the treatment approaches and 5) review Dialectical four presentations. In sum, this presentation is Behavior Therapy (DBT) with adolescents. DBT is precisely aligned with the 2021 APA convention currently the only "well-established" evidence-based theme, by providing clinical portable information to treatment for reducing self-harm in youth. In order practitioners so they can equitably care for a diverse to provide audience members with practical tools for population. utilizing the techniques we describe in their clinical practices, we will include didactic presentation as Evidence-Based Treatment Approaches for Suicidal well as experiential techniques, such as role plays, Adolescents demonstrations and case examples. Chair: Michele Berk, Ph.D. Presenter: Claudia Avina Excited Delirium Syndrome: An Excuse or a Diagnosis? EDUCATIONAL OBJECTIVES: Chair: Julie Owen, M.D., M.B.A. At the conclusion of this session, the participant Presenter: Sarah Elizabeth Slocum, M.D. should be able to: 1) Learn evidence-based safety Discussants: Leslie Zun, M.D., M.B.A., Thom Dunn, practices for youth at risk for suicide.; 2) Become Ph.D. familiar with existing evidence-based treatment approaches for youth at risk for suicide.; 3) Learn the EDUCATIONAL OBJECTIVES: basic components and interventions used in At the conclusion of this session, the participant Dialectical Behavior Therapy with adolescents at risk should be able to: 1) Highlight the existing literature for suicide.; 4) Understanding the difference surrounding “excited delirium syndrome” (ExDS) and between non-suicidal self-injury and suicide patient morbidity/mortality; 2) Propose a centralized attempts in youth.. criterion for a diagnosis of “excited delirium”; 3) Identify the challenges with making this diagnosis in SUMMARY: field settings; 4) Identify the overlap of this diagnosis Suicide is the 2nd leading cause of death among 10- with other disorders, including substance 34 year-olds in the United States (CDC, 2017). intoxication; 5) Review the evidence on According to the Youth Risk Behavior Survey, a pharmacological treatment approaches, including biannual national survey of high school students in ketamine. the United States, just under 1 in 5 high school students have reported seriously considering SUMMARY: attempting suicide (17.7%) and just under 1 in 10 As our country and our world have become more reported attempting suicide in the past year (8.6%; reliant on daily technologies, the ability of Kann et al. 2016). Suicide rates have continued to bystanders to record people’s behaviors has cast a rise across age groups in the United States over the critical eye on public events. In particular, the recent last 15 years, with females aged 10–14 showing the murders of George Floyd and Elijah McClain while in greatest increase (200%; Curtin, Warner, and police custody share concern for a diagnosis of Hedegaard 2016). Given the magnitude of the excited delirium in the popular media, with available problem, it is critical that mental health recordings for review. However, there is no formal professionals who treat adolescents are familiar with criteria-based consensus for "excited delirium” as a evidence-based strategies for reducing suicide risk in diagnosis, nor universal protocols for what youth. In this general session focusing on evidence- treatment is indicated. Additionally, little is reported based approaches for working with youth at risk for regarding the fact that it is often diagnosed and suicide, we will provide 1) an overview of the treated “in the field,” sometimes by police officers epidemiology of suicidal and self-harm behavior in with minimal medical training. We assembled a adolescents; 2) review known predictors and risk panel of physicians (representing Emergency factors for suicidal behavior in youth; 3) review Medicine and Psychiatry) and a clinical psychologist evidence-based safety interventions for reducing who is also a paramedic to discuss excited delirium. We will present a brief didactic (approximately 30 care with economic, patient, and clinician burdens. minutes) focusing on the most commonly accepted Of note, MBC is a core aspect of non-behavioral features of the syndrome of excited delirium, the health medical care (e.g. use of blood pressure to overlap of this diagnosis with other conditions manage hypertension) and has long been (especially substance intoxication), challenges with understood as a critical driver of improved management in the field and within emergency outcomes. Implementation of behavioral health medicine, currently utilized treatments (focusing MBC with regular use of standardized assessment both on Project BETA as well as the current literature tools is linked to improved outcomes, such as on ketamine) in the field and the acute care setting, improved symptoms, lower readmission rates and and use of the diagnosis as a cause of death. We better quality of life. The known variations in intend to further discuss recent instances in the depression treatment outcomes are evidenced by news, including what has been released regarding poor performance on quality measures and are the presentation, attempted management, and basis for existing depression measures used in aftermath. We will analyze various EMS protocols for national programs such as the CMS Quality Payment management of excited delirium, including what is Program and HEDIS. Recentlythe Joint Commission recommended for restraint and sedation for safety. and URAC have implemented new elements in A pre-hospital patient scenario will be presented and accreditation programs that focus on use of MBC in discussed. Lastly, our panel will provide their own care for behavioral health disorders. Despite the experiences with excited delirium, as well as their customary use of MBC in medical disease opinions on the particular complications of this management and recent increase in implementation diagnosis from a variety of professional lenses. We of MBC in the mental health field, only 17.9% of will then allow a Q&A for audience participation. psychiatrists and 11.1% of psychologists routinely administer standardized tools for assessing Expanding Access to Measurement Based Care: symptoms. Even fewer clinicians routinely use these Evidence and Policy Initiatives That Incentivize tools for assessing functioning or recovery. Further, Quality Care and Health Equity although the use of standardized assessments has Chair: Carol L. Alter, M.D. been shown to significantly improve outcomes Presenters: Henry T. Harbin, M.D., Michael compared to usual care, are feasible to implement Schoenbaum, Glenda Louise Wrenn Gordon, M.D., on a large scale, and are highly acceptable to Shawn Griffin, M.D. patients there is still low and variable implementation of MBC among behavioral EDUCATIONAL OBJECTIVES: healthcare clinicians and across settings. At the conclusion of this session, the participant Importantly, use of MBC provides an opportunity to should be able to: 1) Understand the policy address health equity, by allowing for greater landscape and opportunities encouraging objectivity of assessments that MBC allows. Finally, measurement based care (MBC); 2) Understand the while there is compelling clinical evidence to support evidence for managing care at the population level use by providers, recent changes in accreditation using MBC; 3) Understand the role MBC plays in standards and performance payments that are tied addressing care equity; 4) Understand accreditation to use of MBC create important incentives for organizations recognition of the value of MBC that is providers to deliver MBC. Presenters will provide an routinely used in clinical care settings. overview of ongoing policy objectives, highlight the evidence supporting the use of the Measurement SUMMARY: Based Care and the positive impact this evidence- Measurement Based Care (MBC) is a set of standard based process has on outcomes across patient processes used to support engagement, diagnosis, populations. The session will include information on condition monitoring, treatment adjustment, and recent actions of standard setting organizations to the evaluation of outcomes. MBC is considered a encourage adoption of MBC. core component of numerous evidence-based practices and seeks to balance the optimization of Getting Animated in a Queer New World: Steven nonexistent in popular media. Gathering a large, Universe as a Socially Conscious Cartoon for cult-like following of youth and adults alike, the Exploring and Understanding Sexuality and Gender show has earned an Emmy and a GLAAD nomination, Diversity with growth into spin-off shows and a feature-length Chairs: Diana M. Mujalli, M.D., Amy Elizabeth Curtis, film. Steven Universe is also the first major animated M.D. series created by an individual who does not identify Presenter: Mamatha Challa, M.D. as male, Rebecca Sugar, who has more recently Discussants: Myo Thwin Myint, M.D., Christy Duan, come out as a bisexual non-binary woman. The show M.D. itself is a humorous, whimsical, sci-fi adventure series using colorful storyboards and catchy musical EDUCATIONAL OBJECTIVES: numbers to explore both the comedy and the At the conclusion of this session, the participant complexity inherent to exploring our unique should be able to: 1) Discover the groundbreaking identities. In contrast to cartoons from earlier series Steven Universe, a socially conscious cartoon decades where less than one third of all characters that explores themes of social justice, gender & were female and of those characters nearly all had sexual diversity, mental health, and complex family underdeveloped narratives, Steven Universe depicts dynamics; 2) Demonstrate understanding of the a cast of feminoid, gender-ambiguous characters psychosocial impact of queer-affirming media, with diverse in sound, appearance, age, and personality. emphasis on use of animated formats to serve the The series has been celebrated for its representation needs of the LGBTQ community and others with of LGBTQ themes and identities, with inclusion of diverse identities; 3) Examine intersecting themes queer and nonbinary characters helping to embrace related to mental health, gender, and sexuality, universal emotions and individuality. The clinical using active engagement techniques such as live utility of introducing media elements to facilitate participation and interactive audience discussion; 4) discussion and skill-building has been well- Incorporate relevant themes into clinical practice established, as recently highlighted with use of the with focus on supporting the mental health and animated film Inside Out to enhance emotional wellbeing of gender and sexual minority patients. intelligence in youth therapy settings. The selected episode will be screened to provide insight into the SUMMARY: show and spark discussion surrounding mental Steven Universe, an animated television series which health and diversity. Several active engagement aired on Cartoon Network, has stood out as a show techniques will be used throughout. Presenters will that pushes the boundaries of queer representation synopsize commentary during the episode airing. in the media. The session will highlight the Selected themes from viewer commentary will be significance of representative television for minority highlighted after the episode is viewed, culminating groups, with emphasis on the ability of animated in a discussant-facilitated, audience-driven dialogue. media to uniquely serve the needs of LGBTQ youth. Using active engagement tools, presenters will Health Policy and LGBTQ Mental Health facilitate discussion on the intersections between Chair: Amir Ahuja, M.D. mental health, media, and diverse identities with use Presenters: Amir Ahuja, M.D., Cathy Renna, Jack of screening a carefully selected episode of the Drescher, M.D. show, projection of live audience commentary in the Discussant: Saul Levin, M.D., M.P.A. Zoom chat, and interactive audience dialogue. Viewers will gain familiarity with relevant pop EDUCATIONAL OBJECTIVES: culture and be inspired to incorporate diverse At the conclusion of this session, the participant themes into clinical practice to better meet the should be able to: 1) By the end of this Symposium, mental health needs of individuals with diverse the audience will be able to identify policies and identities. By creatively depicting narratives on laws that affect LGBTQ mental health.; 2) By the end gender, race, and diverse relationships, the show of this Symposium, the audience will be able to explores important themes that were previously define conversion therapy and identify its negative impact on LGBTQ people.; 3) By the end of this effort to have laws based on science, and not Symposium, the audience will be able to identify opinion or religious belief. Finally, Dr. Amir Ahuja will three ways religious liberty laws could impact the be presenting on Marriage Equality. This was lives of LGBTQ Americans.; 4) By the end of this decided with a Supreme Court case in 2015, but Symposium, the audience will be able to identify there are continual challenges to that ruling. The Section 1557 of the Affordable Care Act and discuss importance of these equal rights cannot be mental health parity's impact on LGBTQ mental overstated, as marriage in the USA comes with over health.; 5) By the end of this Symposium, the 1,000 legal rights. These include hospital visitation audience will be able to discuss the marriage quality and inheritance rights, and in many ways, marriage timeline and its impact on LGBTQ mental health.. for LGBTQ people has improved and sustained better mental health outcomes. All of these connected SUMMARY: issues will be dissected from a health perspective, It feels like there has never been as much focus on legal perspective, and civil rights perspective. This health policy as there is now. We are in a very symposium will inform the audience of the latest fraught political state, with uncertainty in our courts, developments with this, and how the law can a dangerous rise in mental health symptoms, and a influence mental health more generally. It will pandemic raging throughout the country (and the conclude with a discussion about the role of world). This symposium addresses multiple areas Psychiatry in policy. where health policy and the law intersect with mental health in general, and specifcally, the mental Here’s Your Hat, What’s Your Hurry: Career health of LGBTQ people. It is well known that there Transitions in Academic Psychiatry are health disparities for LGBTQ people, and that is Chair: Philip R. Muskin, M.D., M.A. very true with mental health. This is partly due to Presenters: Sherry P. Katz-Bearnot, M.D., Linda Minority Stress, and is greatly influenced by laws and Worley, M.D. institutions in a society. We will begin this symposium discussing Religious Liberty Laws. There EDUCATIONAL OBJECTIVES: has been a lot of movement in the past few decades At the conclusion of this session, the participant to assert religious liberty in various aspects of life in should be able to: 1) Review career paths of America. Increasingly, this issue is being fought in clinician/educators; 2) Understand sought after and the courts. There are various ways of looking at this, involuntary career transitions; 3) Experience how though for LGBTQ people, this can be dangerous and work-life balance can be disrupted by career limit the ability of this group to live their lives fully transitions; 4) Explore how COVID has caused career and openly. Dr. Jack Drescher will discuss the transitions for psychiatrists. impacts of these laws on LGBTQ mental health, which include increased stress, but also encompass SUMMARY: limits in ability to get health care and equal access to The twists and turns of an academic career can bring providers and procedures. After this, Dr. Saul Levin great joy, adventure and opportunity as well as will discuss the Affordable Care Act. In particular, he crushing anguish, frustration and misery. Three will focus on the Mental Health Parity and Sexual clinician/educator psychiatrists with experience in Orientation and Gender Identity protections within senior management positions, including leadership the Act. These have greatly aided LGBTQ people in in national psychiatric organizations come together obtaining quality mental healthcare and better to offer personal perspectives, insights and lessons mental health outcomes. It has also lifted the learned. The session will include an interactive importance and coverage for mental health in discussion period for participants to seek informal general. Cathy Renna, Communications Director for mentoring and feedback from the group. The goals the National LGBTQ+ Task Force, will discuss how of the session are to engage participants in the religion is being used to promote anti-LGBTQ process of discovering what gives them the greatest legislation and the efforts being taken to counter satisfaction professionally and how that satisfaction this message. She will emphasize the Task Force's can be preserved, albeit modified, through the lifespan of the physician. Career transitions are At the conclusion of this session, the participant important and complicated. A perfect position is rare should be able to: 1) Recognize that sexual assault in and knowing when it is time to move on isn’t always inpatient psychiatric facilities is a widespread and straight forward. What is most important is honoring likely underreported problem presenting unique one’s values and contributing to the field in medical, ethical, and legal challenges for providers; meaningful ways. Each speaker will share “lessons I 2) Identify factors placing patients at greater risk for wish I could have told my younger self” with 3 take sexual assault during inpatient psychiatric home truths: · You can love an institution, but it hospitalization; 3) Understand the importance of won’t love you back. · Negotiate & ask for help implementing a clearly defined policy for addressing before you’re barely hanging on for dear life. · Have allegations of sexually inappropriate behaviors in the courage to set out for new seas when the one inpatient psychiatric facilities; 4) Describe strategies you’re in is filled with pirates. The world may be for managing sexual assault allegations in inpatient calling for you! · Your value is NOT your position. · psychiatric facilities. Your friends and national colleagues are your life- line to survive the rough times. · Some institutional SUMMARY: decisions aren’t personal. · Festering anger and Sexual assault is a widespread and underrecognized resentment saps your energy. Forgiveness and issue that has been subject to increasing national letting go to move on is empowering. · The best attention in recent years. Despite growing dialogue revenge is thriving, living your values and being surrounding this issue and calls to action throughout genuinely happy. What are the risk factors for American society, research on sexual violence in anger/sense of helplessness/depression when career inpatient psychiatric facilities and discussions about changes are caused by decisions not under the it are surprisingly scarce in the psychiatric literature. control of the individual? How can we be alert to This is unfortunate, since sexual assault is a serious signals that such things are likely to occur, even patient safety issue with detrimental and lasting though they cannot be avoided? How can consequences for both patients and psychiatrists in academic settings “take stock,” i.e., providers. Existing data indicate that, as in the figure out what you are really good at, what you community, the prevalence of inappropriate sexual really like to do? How does a clinician/educator behaviors in inpatient psychiatric settings is likely cobble that together with what might already be underreported. As providers, it is our responsibility available programmatically (rather than having to to not only educate and prepare ourselves to invent a place for yourself)? What are the respond when these scenarios arise, but to also mechanisms to decide how much responsibility you facilitate much needed conversation in our field want to carry and how does one align all of that with about identifying and addressing barriers to both financial needs and goals and personal needs/goals preventing and detecting inappropriate sexual for travel and time off? No one likes to become behaviors in inpatient facilities. During this superannuated, but in psychiatry in particular there presentation, we will review relevant are the terrible stories of teachers who have stayed epidemiological data, with particular emphasis on too long at the fair. How do we remain self-aware to factors that may place some patients at increased allow ourselves to make changes when they are risk of experiencing sexual victimization and others necessary? at higher risk of perpetrating it. We will also discuss policies and procedures for managing sexually Improving Sexual Safety in Inpatient Psychiatric inappropriate behaviors in inpatient psychiatric Facilities settings. In doing so, we hope to educate and Chair: Holly Betterly, M.D. empower audience members to implement Presenters: Divya Patel, M.D., Jamie Karasin, M.D., strategies within their own facilities to reduce the Brian Scott Barnett, M.D., Meghan Musselman, M.D. occurrence of sexual violence and effectively respond to the physical and psychological needs of EDUCATIONAL OBJECTIVES: survivors when it cannot be prevented. Examples of actual patient sexual assault cases will be used to provide perspective into the consequences of such either sympathetic over activation or dorsal vagal incidents, particularly their legal despair. ACEs including physical, emotional or sexual ramifications. Audience members will be abuse; domestic violence; parental severe mental encouraged to participate via a case-based illness or substance use disorder, and divorce. discussion centered around brief clinical vignettes Current ACEs include forced separation of families at representative of scenarios that providers may the border, unaccompanied minors, increased encounter in their practice. This open-ended parental incarceration, childhood medical trauma discussion aims to engage participants in applying and hospitalization, and the stress of Covid-19. the strategies and skills presented throughout the Evolving ACEs call for new models of care. Parents’ workshop, as well as elicit perspectives from stress profoundly impacts fetal and infant providers around the country. development (prematurity, low birth-weight, immune and metabolic functions, In an Insecure World Breath-Based Practices cognitive/language/psychomotor development). Promote Secure Attachment, Social/Emotional Teaching parents to use breathing practices helps Development, and Stress Resilience them feel competent in calming their babies. Parents Chair: Patricia Lynn Gerbarg, M.D. observe that babies are better able to feed (stop Presenter: Marilyn R. Sanders, M.D. regurgitating). They watch monitors showing (increased oxygen saturation) as their baby EDUCATIONAL OBJECTIVES: becomes calmer, less agitated. Breathing At the conclusion of this session, the participant methods help parents feel calm and confident with should be able to: 1) List three biologic/physiologic their baby, supporting attachment and healthy processes modulated by social connectedness.; 2) development. A case of breath work with a high-risk List three evolutionarily determined mammalian mother is presented. Dr. Gerbarg will discuss autonomic states based on perception of neurophysiological mechanisms thought to environmental safety or threat.; 3) Describe two underlie the effects of voluntarily regulated effects of Coherent Breathing on the autonomic breathing practices (VRBPs) on psychophysiological nervous system.; 4) Identify populations that could states. Changing the pattern of breathing, changes benefit from using voluntarily controlled breathing the messages sent to the brain from the respiratory practices to reduce adverse effects of stress.. system, messages that have widespread, effects on thoughts, emotions, perceptions, and SUMMARY: behaviors. Slow gentle breathing (4-6 bpm), such as Stress from the COVID-19 pandemic exacerbates Coherent (Resonant) Breathing shifts autonomic health inequities and compounds adverse childhood balance, reducing defensive reactions (fear, anger, events (ACEs). Stress-reducing breath-based mind- mistrust) and supporting activation of the social body treatments that decrease sympathetic engagement network, necessary for healthy overactivity and increase parasympathetic communication, cooperation, compassion, and underactivity characteristic of chronic stress states, empathy. These practices can be taught in-person or could play a major role in prevention and recovery. online. Neonatologist, Dr. Sanders discusses Polyvagal theory, emotion co-regulation and self-regulation Individual and Community Trauma: Impact, Risk, within close relationships. When babies and young and Interventions children are connected to loving, attuned caregivers, Chair: Joshua C. Morganstein, M.D. their autonomic nervous system sends signals of Presenter: Gary H. Wynn, M.D. safety and security reflecting enhanced parasympathetic ventral vagal tone. Over time, safe EDUCATIONAL OBJECTIVES: dyadic relationships lead to secure attachment with At the conclusion of this session, the participant improved physical and social-emotional well-being. should be able to: 1) Review the adverse However, if disruptions of connectedness become psychological and behavioral responses to trauma chronic, the infant or child senses danger, leading to for individuals and communities.; 2) Describe individuals and event-related characteristics of At the conclusion of this session, the participant trauma that influence risk for adverse outcomes.; 3) should be able to: 1) Acknowledge the power of Understand the neurobiology underpinning the international collaborations among colleagues to development of trauma response.; 4) Discuss the conduct research in relevant topics of global framework for early interventions developed to psychiatry and mental health.; 2) Realize the mitigate negative effects of trauma.; 5) List the importance of cultural humility when seeking to existing and emerging treatments for trauma and understand mental health and psychiatric practice stressor disorders.. across disparate and diverse countries.; 3) Be motivated to foster collaborations in psychiatry SUMMARY: practice and research with international colleagues, Trauma affects millions of people every acknowledging the challenges and opportunities of year. Whether from interpersonal violence or far- such online-based, transcultural endeavors.. reaching disasters, the impacts of violence can ripple across a community. Our presentation, “Individual SUMMARY: and Community Trauma: Impact, Risk, and Around the time when COVID-19 was declared a Interventions” seeks to provide an overview of this global pandemic, a group of early career important topic. This presentation will draw heavily psychiatrists (ECPs) across the world, connected from the vast experience of the Center for the Study through the World Psychiatric Association (WPA) of Traumatic Stress, one of the nation’s oldest and ECP section, joined forces with other colleagues and most highly regarded academic-based organizations eventually established a global research ‘think tank’ dedicated to advancing trauma-informed to understand the effects of COVID-19 on public knowledge, leadership and mental health worldwide and propose new methodologies. Beginning with the psychological perspectives and solutions. The group, connected and behavioral responses to trauma, the audience through the internet, brought to its members not will be provided with a review of the adverse effects only co-authorship of scientific publications, but also of individual and community trauma followed by a a borderless space for friendship and further description of factors that influence overall risk for collaboration. It also eventually expanded its negative outcomes. Beyond these fundamental research scope beyond COVID-19. This session, concepts, this presentation will cover the current chaired by two members of the APA Global Mental understanding of the neurobiological underpinnings Health Caucus, and with its support, will count on of trauma response. After this review of the impact five ECPs and trainees involved in this endeavor. Our and risk of trauma we will discuss principles of early goal is to show an example of international interventions to mitigate adverse effects of trauma collaborations in psychiatric research to address as well as existing and emerging treatments for questions of current concern from a global trauma and stressor related disorders. Throughout perspective, presenting our published and ongoing this review we will strive to provide key scientific work. The session will be chaired by Dr. Pereira- findings as well as ensure clinical relevance for Sanchez, a psychiatrist in New York. He joined the attendees providing direct care to those who have group of ECPs during its early formation and helped suffered from trauma. it expand to a large and open ‘think tank’, which he coordinates. He has been encouraging members to International Research Collaborations in Global bring new ideas and transform them into successful Psychiatry and Mental Health: The World Early research collaborations. Dr. Essam, neuropsychiatry Career Psychiatrists’ Think Tank resident at the General Secretariat of Mental Health Chairs: Zargham Abbass, M.D., Victor Pereira- & Addiction Treatment of the Ministry Of Health & Sanchez, M.D. Population in Egypt, and international member of Presenters: Laura Orsolini, M.D., Lamiaa Essam APA and WPA, will present on our original study Hamed Ahmad, Ruta Karaliuniene, M.D. assessing the phenomenon of psychosis-like episodes in adolescents and older adults during the EDUCATIONAL OBJECTIVES: pandemic. Dr. Orsolini is a clinical researcher and early career addiction and forensic psychiatrist American (20.4%), and Asian-American (19.1%) working in Ancona, Italy, secretary of the section on adults (p<0.001); which is increasingly recognized as Telemental Health of the European Psychiatric a risk factor for major mental illness, such as Association (EPA) and ECP Committee regional schizophrenia, depression, and dementia. It is also coordinator of the Italian Society of Psychiatry (SIP). well established that Latinx hold a lower educational She will talk about multifaceted aspects of COVID-19 level in the US compared to other ethnic groups. As outbreak on mental health, discussing the topics of per the US Census, in 2019, 40.1% of non-Hispanic telepsychiatry, the emergence of addictive disorders whites age 25 and older had a bachelor’s degree or and COVID-19-related stigma behaviors. Dr. higher, up from 33.2% in 2010. During the same Karaliuniene, PhD student and resident in adult periods, the percentage of African-Americans age 25 psychiatry at the Academic Hospital - Technical and older with a bachelor’s degree or higher scaled University Dresden, will talk about the global impact from 19.8% to 26.1%; Asians from 52.4% to 58.1%; of COVID-19 on the practice, training and research of and Hispanics from 13.9% to 18.8%. ECPs. Dr. Abbass, a resident psychiatrist in Kansas Disproportionate effects during the COVID-19 City, MO, will co-chair the session. He joined the pandemic, have not been the exception. While ‘think tank’ during the spring of 2020 and has led the Latinx counties, defined as those with over 17.8% of first project beyond COVID-19, bringing global their population represented by Latinos, only perspectives on the effects of systemic racism on the account for 11% of counties in the Northeast, 4% of mental health of children and adolescents from counties in the Midwest, and 33% of counties in the ethnic minorities worldwide. A discussion with the West, there has been a dissimilar proportion of audience will follow. We seek to attract a wide COVID-19 cases in each region with 63.4% of cases audience, especially inviting younger and senior and 66.1% of deaths in the Northeast, 31.9% of cases colleagues with expertise or interest in international and 22.6% of deaths in the Midwest, and 75.4% of psychiatry and global mental health research. cases and 73.7% of deaths in the in the West. Such disproportion was greater in counties with more Latinx 2021: Solving the Dilemma monolingual Spanish speakers, higher employment, Chair: Bernardo Ng, M.D. heart disease deaths, and less social distancing. This Presenters: Eugenio M. Rothe, M.D., Renato Daniel presentation will discuss how these factors impact Alarcon, M.D., Theresa M. Miskimen, M.D. the mental health of migrant and non-migrant Latinx, their idioms of distress during the current EDUCATIONAL OBJECTIVES: disaster and beyond, and the areas of opportunity to At the conclusion of this session, the participant enhance health literacy, adherence to preventive should be able to: 1) • Recognize the phenomenon measures, and early access to treatment. During this of migration and race in the US; 2) • Appreciate the presentation, these adverse and persistent features disproportionate rates of disease among Latinos in will be contrasted with efforts to increase the the US; 3) • Understand cultural aspects behind opportunities of Latinx professionals to join the these Latinx disparities; 4) • Realize how mentorship ranks of researchers and leaders in our field. programs have contributed to the presence of Latinx Programs to mentor and recruit minority medical in leadership positions. students and residents, will be presented, in the attempt to understand why we have not been able SUMMARY: to solve the dilemma of being the largest minority, Latinx represent the largest minority in the US since yet remain underrepresented among the 2003, and after almost two decades, continue to be stakeholders in mental health policy and planning. underrepresented in the academic, corporate, and political environments. Latinx represent the highest Physician Well-Being: ‘Good Stuff’ During COVID-19 group of all immigrants into the US (25-30%). This Chair: Peter M. Yellowlees, M.D. ethnic group, also has the highest prevalence (22.1%) of type 2 diabetes mellitus in the country, EDUCATIONAL OBJECTIVES: compared to non-Hispanic white (12.1%), African- At the conclusion of this session, the participant be given several exercises in brief writing and should be able to: 1) 1. Describe the role of a messaging during the session that will be reviewed psychiatrist as a Chief Wellness Officer and change by the group, and compared with messages sent out agent; 2) 2. Be aware of a number of preventive and by the presenter during Covid-19. educational approaches that enable physicians to maintain their health and avoid burnout; 3) 3. Prediction of Disease Vulnerability and Treatment Understand the importance of messaging and Response in Mood Disorders and PTSD: communication on physician wellbeing as Personalized Medicine in Psychiatry exemplified by weekly “Good Stuff” during Covid-19. Introduction: Saul Levin, M.D., M.P.A. Presenter: Charles Barnet Nemeroff, M.D., Ph.D. SUMMARY: The profession of medicine is historically exemplified EDUCATIONAL OBJECTIVES: by denial of the personal needs of physicians, and At the conclusion of this session, the participant self-sacrifice to the greater good of patients. This is should be able to: 1) To understand the principles of shown in the Hippocratic Oath, where there is no personalized medicine as applied to mood and mention of the importance of physicians maintaining anxiety disorders; 2) To understand the role of their own well-being. The author of this invited Genome Wide Association Studies, candidate gene session will summarize and discuss the rationale for approaches, transcriptomics, epigenetics, and writing two books on physician health, “Physician proteomics in predicting disease treatment response Well-being: Cases and Solutions” and “Physician in mood and anxiety; 3) To understand the role of Suicide: Cases and Commentaries” and will broadly gene-environment interactions, particularly early life discuss their content, and relevance in changing and trauma, in predicting treatment response in mood improving the culture of medicine, especially during disorders. a pandemic. The books are used as core texts for a six month Fellowship in Clinician Well-being which SUMMARY: has been taught to a total of 45 Fellows (including 40 Over the last quarter century, remarkable advances physicians) in the first two cohorts, and cover much have been accomplished in biology and medicine in of the essential curriculum in physician well- general and in neuroscience in particular. These being.The second cohort during Covid ( April – Oct landmark findings, particularly in molecular biology, 2020) was entirely virtual. He will then review the genomics and brain imaging have not yet been role of Chief Wellness Officer which he occupies at translated into breakthroughs in either diagnosis or UC Davis, a role that is becoming increasingly treatment of the major psychiatric disorders. This popular in US health systems, and argue that the presentation will focus on several of the major main objective of the role is to be a change agent, neuroscientific advances that have occurred and focused on improving the culture of medicine, and how they will very likely result in the attainment of healthcare more generally. The position description the “holy grail” in psychiatry, namely the realization for his role starts with the following statemement: of true personalized or precision medicine. More “The CWO’s main responsibility is to develop a work specifically, how advances in neuroscience and culture in which physicians have the opportunity to genomics will help identify the “at risk” population not only show up and perform, but to thrive.” There and moreover will help identify the optimal are many possible approaches to this role, and the treatment for an individual patient will be described. seminar will focus specifically on one of the “cases” The interaction of genetic vulnerability and used at UC Davis during Covid-19. These are “Good environmental stressors as exemplified by the Stuff” messages written by the presenter sent effects of childhood maltreatment on the diathesis weekly, and sometimes bi-weekly, to all physicians, for mood disorders and PTSD will be described. The and weekly or monthly to all staff. The messages will role of genetic variability and epigenetic mechanisms be the focus of this presentation, demonstrating the in predicting vulnerability vs resilience in response to importance of continuous honest and open trauma will be explored with a focus on recent communications and messaging. The audience will GWAS studies. The emerging role of non-coding RNA in regulation of gene expression will be discussed. effectiveness of these compounds. This panel, The extant data on prediction of treatment response designed to engage researchers, clinicians and policy in major depression will be described in detail makers, features Robert Koffman, M.D., CAPT, USN including the currently available pharmacogenomic (Ret), first Senior Consultant for Integrative Medicine tools which have not lived up to their claims. & Behavioral Health at the National Intrepid Center However the future of pharmacogenomics is likely of Excellence, Mark Bates, PhD, LtCol, USAF (Ret), quite bright in predicting treatment response, as is former branch chief, Psychological Health other biomarkers that characterize significant Promotion, DoD Psychological Health Center of subtypes of depression. The role of inflammation in Excellence, Rachel Yehuda, PhD, Director, Center for the pathophysiology of a sizeable minority of Psychedelic Psychotherapy and Trauma at the Icahn depressed patients and its treatment implications School of Medicine, Mount Sinai, and Harold Kudler, will be discussed. Clearly a far better understanding M.D., past Mental Health policy lead, U.S. of the underlying pathogenesis/pathophysiology of Department of Veterans Affairs, who will review the psychiatric disorders is required to develop validated pharmacological and psychological evidence base for biomarkers and most importantly novel treatments. psychedelic-assisted psychotherapy for PTSD, With 100 million neurons and countless more glial describe its clinical application and consider the role cells and innumerable cell types, the human brain is which altered states (sweat lodges, Mesmerism, far more biologically complex than any other organ. hypnosis, sodium amytal and psychedelics) have No wonder its secrets are so much harder to uncover played over the centuries in clinical and cultural than, for example, those of the liver with its two cell efforts to transcend psychological trauma. types. Psychotherapy for Psychosis: Perspectives on Psychedelic-Assisted Psychotherapy for PTSD: Current Interventions and Future Directions Theory, Technique and Context Chair: Robert Osterman Cotes, M.D. Chair: Harold Stephen Kudler, M.D. Presenters: Sarah Kopelovich, Michael Garrett, Kim Presenters: Robert Koffman, M.D., Mark Bates, Mueser, Eric Granholm Rachel Yehuda, Ph.D. 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) Recall and describe three should be able to: 1) Identify the leading forms of evidence-based psychosocial interventions for psychedelic-assisted psychotherapy currently under people with psychosis.; 2) Identify a common theme study and describe their technical application.; 2) of how different psychotherapeutic interventions Assess the evidence for the relative contributions of advance recovery for people with psychotic biological and psychological aspects of psychedelic- disorders.; 3) List two ways the current evidence- assisted psychotherapy for PTSD.; 3) Assess the role based interventions could be more widely deployed which psychedelic-assisted psychotherapy may play throughout community mental health.. within your own theoretical approach to psychological trauma and your clinical practice.. SUMMARY: The needs of people who experience psychosis SUMMARY: extend beyond medication alone. The recently Psychedelics have long been employed by traditional updated American Psychiatric Association practice healers to promote physical and mental recovery. guidelines for the treatment of patients with The US Food and Drug Administration recently schizophrenia recommends or suggests that patients granted MDMA and psilocybin Breakthrough with schizophrenia receive the following Therapy designation to accelerate study of their psychosocial interventions: cognitive behavioral efficacy in psychiatric disorders while ketamine therapy for psychosis, psychoeducation, supportive clinics multiply apace. Less obvious is the role which psychotherapy, illness self-management skills, psychotherapy plays in the application and cognitive remediation, social skills training, supported employment services, and family enhancing our understanding of small molecule interventions. Other beneficial approaches include target engagement with brain pathophysiology in psychodynamic therapy, and third wave cognitive persons with neurodevelopmental disability. To do behavioral therapies like acceptance and this, our lab and collaborators around the country commitment therapy, dialectical behavior therapy, have focused on evaluating brain function and compassion focused therapy, and dialogic activity in ways that are amenable to use in clinical practice. These interventions can play a key role in trial treatment development settings. This includes helping people rebuild their lives after an episode of focus on modalities including, but not limited to, psychosis and can help individuals to accomplish high density research EEG, computer based their interpersonal, educational, and vocational performance based testing, and quantitative goals. Even if not practicing them directly, measure of eye gaze and pupil response. In doing psychiatrists should view these treatments as this we have also careful worked to synchronize our standard of care, rather than ancillary to care. Yet human measures with preclinical animal measures the field faces challenges, as many evidence-based to heighten the chance of translational medicine psychotherapeutic options are not widely available success by using evaluations that in sync across in community settings. Coordination of care with the species. This journey has allowed our lab to various disciplines of treaters in a busy clinic setting appreciate significant variation in even single gene can also be difficult. This session brings together a disorders such as fragile X syndrome (FXS). In FXS we group of distinguished practitioners from different are defining molecular and neurophysiologic theoretical orientations to discuss their perspectives variation across individuals in a way that allows for on the state of the science for psychotherapy for subgroup selection and treatment matching in ways psychosis, as well as future directions. previously not utilized in our field. We are hopeful that our ability to better parse variation even in Refining Translational Medicine Efforts in single gene neurodevelopmental disorders will Neurodevelopmental Disorders results in the personalization of medicine in this field Presenter: Craig Erickson, M.D. leading to success in treatment development.

EDUCATIONAL OBJECTIVES: Supporting ECPs and RFMs in Their Careers and At the conclusion of this session, the participant Beyond should be able to: 1) Understand the presentation of Chair: Saul Levin, M.D., M.P.A. and targets of treatments in fragile X syndrome.; 2) Presenters: Tristan Gorrindo, M.D., Nitin Gogtay, Describe new non invasive means to characterize M.D., Regina James, M.D. brain physiology utilized in clinical trial settings.; 3) Understand how as a field we need to parse EDUCATIONAL OBJECTIVES: heterogeneity even in single gene At the conclusion of this session, the participant neurodevelopmental disorders to enhance should be able to: 1) Apply quality improvement treatment development.. strategies to improve clinical care.; 2) Provide culturally competent care for diverse populations.; SUMMARY: 3) Describe the utility of psychotherapeutic and Over the last 20 years significant efforts have pharmacological treatment options.. focused on targeted treatment development in neurodevelopmental disorders. While this followed SUMMARY: successful approvals of aripiprazole and risperidone This session is open to APA members who are as treatments of irritability in youth with autism, residents or early career psychiatrists. In a small success has not followed from these early group discussion with APA CEO and Medical Director accomplishments. I will review how translational Saul Levin, attendees will have an opportunity to treatment development in neurodevelopmental discuss challenges faced by residents and early disorders has re-tooled and learned from many past career psychiatrists in their clinical setting and to clinical trial failures. These developments include brainstorm ways in which the APA might be able to assist. Topics for discussion include the future of analysis in our laboratory showed that this was psychiatric care, challenges related to career mainly related to the citalopram’s. The 5-HTTLPR advancement, workforce development, and polymorphism was found to influence leadership development. antidepressant and amygdalar response. The apparent effect of age on CYP3A4-metabolized The Challenge of Clinical Pharmacology and medications is through reduction of hepatic blood Pharmacogenetics in Later Life flow. Additional methods assessing serum Presenter: Bruce Godfrey Pollock, M.D., Ph.D. anticholinergicity and population pharmacokinetics were employed to help understand and improve EDUCATIONAL OBJECTIVES: individual drug response. For example, population At the conclusion of this session, the participant pharmacokinetics determined that higher 9-hydroxy should be able to: 1) At the conclusion of this risperidone concentrations led to diminished session, the participant will have a greater effectiveness in older patients in the CATIE trial. understanding of the complex pharmacokinetic and Population pharmacokinetics and CYP2C19 pharmacodynamic factors that may affect drug genotyping were able to identify additional variables response and predisposition to adve; 2) The affecting escitalopram clearance. A newly developed participant will be able to identify the major P450 serum anticholinergic assay based on cultured M1 drug metabolizing polymorphisms and their role in receptor cells was recently deployed in a study of drug-drug interactions.; 3) The participant will have 311 subjects with Mild Cognitive Impairment and an improved understanding of findings relevant to was related to impairment in executive function. the safety of antidepressants and antipsychotics in Older subjects have generally been excluded from older patients.. regulatory trials for new medications. Following the release of the SSRIs, the author was amongst the SUMMARY: first to discover their effect on platelet aggregation, Psychotropics have been identified as the major inhibition of nitric oxide synthase, hyponatremia and class of medications causing drug-induced adverse impairment of postural sway. In a trial of patients events in older patients. The susceptibility of older recovered from depression with residual cognitive patients to adverse events may be a result of impairment, donepezil, contrary to expectations, did pharmacokinetic and pharmacodynamic changes not improve cognition but significantly increased the associated with aging, such as diminished glomerular likelihood of depression recurrence. The author has filtration, reduced hepatic blood flow, and changes also worked for many years to reduce the in neurotransmitter activity. Illnesses affecting many prescription of antipsychotics to patients suffering elderly persons leads to polypharmacy adding from dementia accompanied by agitation. In the another level of complexity to course of this talk the major drug metabolizing psychopharmacological treatment. In this lecture, polymorphisms will be reviewed, emphasizing their thirty years of the author’s work in applying first, potential for understanding drug-drug interactions drug metabolic phenotyping with debrisoquine and and inter-individual pharmacokinetics. mephenytoin for CYP2D6 and CYP2C19, respectively (prior to the advent of genotyping) and then The Clinical High Risk Syndrome for Psychosis: Past, genotyping for these two major polymorphisms as Present, and Future well as for 5-HTTLPR and CYP3A4 will be discussed. Presenter: Scott W. Woods, M.D. The author found an age-associated impact on the CYP2C19 polymorphism but not on CYP2D6. EDUCATIONAL OBJECTIVES: Polymorphism of CYP2D6 was demonstrated to be At the conclusion of this session, the participant important in prospectively identifying poor should be able to: 1) At the conclusion of this metabolizers of nortriptyline and perphenazine. The session, the participant will be able to recognize CYP2C19 polymorphism and age effect on clearance typical clinical features of the Clinical High Risk (CHR) subsequently was shown to be of consequence for syndrome for psychosis.; 2) At the conclusion of this citalopram induced QTc prolongation. Further session, the participant will be able to consider the balance of benefits and risks to diagnose a patient various practical strategies for programs to foster a with CHR.; 3) At the conclusion of this session, the culturally diverse and IMG friendly training and participant will be able to develop an informed teaching environment. opinion as yo whether CHR should be included in DSM/ICD.. SUMMARY: International Medical Graduates (IMGs) constitute a SUMMARY: significant proportion of both trainee residents and The Clinical High Risk (CHR) syndrome for psychosis practicing faculty in Psychiatry across the United offers hope for preventing schizophrenia and other States. Recent data suggests that IMGs are 24.3% of psychotic illnesses, among the most disabling practicing physicians, 30 % of practicing disorders in psychiatry and over the past 25 years psychiatrists, and 33% of psychiatry residents in the may have stood the test of time. This presentation U.S. Historically, IMGs constitute a substantial will touch upon the past, present, and future of CHR. percentage of the practicing psychiatrists’ workforce Topics will include precursor movements to for the in various practice settings, which range from the prevention of psychosis before CHR, the origins of private sector to practicing in underserved areas, the CHR concept, and the accumulating public sector and academic settings. IMGs thus play epidemiologic, clinical, biological, and therapeutic a critical role in the delivery of psychiatric care to an evidence for the syndrome’s validity. A number of increasingly diverse patient population. Despite controversies surrounding CHR will be discussed as being an indispensable aspect of the American well: What should the entity be called? Should it healthcare system, IMGs commencing psychiatry emphasize risk or current illness? Is it a state or a residency training can struggle with overcoming syndrome? A diagnosis or an arbitrary point on a cultural barriers, understanding aspects of the continuum? Are its outcomes pluripotential? Does it psychosocial framework, verbal and non-verbal precede all cases of psychosis? Is there effective communication skills and understanding treatment? Should antipsychotics be used? Are psychotherapy from an American perspective. This is patients harmfully stigmatized by the CHR ‘label?’ further complicated by their attempts at Should it be listed in DSM/ICD? and If these patients acculturation which may continue to hinder their are so important, why is it so hard to find them? academic progress even beyond the initial training Recent developments in the expansion of clinical years. The IMG Early Career Psychiatrists (ECPs) practice in CHR and in the development process for similarly face unique dilemmas in their career novel safe and specific treatments will also be trajectory which range from lack of federal research discussed. funding opportunities, to establishing a niche for themselves with the local population, if practicing in The IMG Journey: Snapshots Across the the community. As senior faculty, the IMG Professional Lifespan psychiatrists may similarly encounter challenges Chair: Muhammad Zeshan, M.D. related to obtaining leadership positions. In this Presenters: Ahmad Hameed, M.D., Manal Farrukh unique workshop, we will explore the challenges Khan, M.D., Souparno Mitra, M.D. that IMGs face at various stages of their professional Discussant: Vishal Madaan, M.D. development, identify potential corrective strategies, and discuss innovative measures to EDUCATIONAL OBJECTIVES: consolidate strengths while addressing areas of At the conclusion of this session, the participant growth. The speakers will also highlight successful should be able to: 1) Recognize the challenges faced strategies to facilitate supervision and mentorship of by international medical graduates (IMGs) during IMG trainees and early career psychiatrists, improve both residency training and professional interviewing skills, approaching psychotherapy from advancement in their practice of psychiatry.; 2) an IMG perspective, and providing resources to Identify successful strategies to overcome obstacles access research and career opportunities. We will that may prevent IMGs from realizing their optimal accomplish this by interacting with the audience, potential in their careers in psychiatry.; 3) Discuss using real-life case scenarios and presentations by speakers ranging from a resident to a senior Tool (SMART) to facilitate organizational change in professor. The workshop will also be useful to the community mental health setting. colleagues and supervisors of IMGs. SUMMARY: The Physician Leadership Journey: Roadmaps and In response to a reinvigorated national dialogue Potholes around structural racism, the American Association Presenter: Kenneth C. Nash, M.D. for Community Psychiatry (AACP) aimed to create a tool or roadmap for community behavioral health EDUCATIONAL OBJECTIVES: providers that would (1) provide metrics specific to At the conclusion of this session, the participant disparity and inequity issues in community should be able to: 1) Establish their informal behavioral health; (2) extend beyond culture network; 2) Apply guidance to their own career competency and linguistic appropriateness to trajectory; 3) Avoid various barriers to being an incorporate structural inequity; and (3) promote a effective physician leader. stepwise, concrete quality improvement process than could be adapted for self-directed use in SUMMARY: community behavioral health settings. There are Not only is the role of “physician leader” attractive, multiple prior examples of organizing principles and but it’s also imperative in the field of medicine. frameworks to address inequity and racism in Physicians need to take active, administrative healthcare (Spitzer-Shohat & Chin, 2019; Metzl & leadership roles to better serve their patients, their Hansen, 2014; Gomez et al, 2016). Despite the rich colleagues, and their health system. Unlike array of content to draw from in guiding equity- medicine, leadership does not come with a degree focused, anti-racist work in health care, none of and therefore the path to leadership can be these existing resources fully address the three key convoluted, unique, and just flat out tricky. elements relevant to the AACP’s goal. Here, we Participants should be interested in growing their introduce the Self-assessment for Modification of role from “physician” to “physician leader”. Dr. Nash Anti-Racism Tool (SMART), a quality improvement will present on his own unique journey while tool that aims to meet the AACP’s needs in offering guidance, hindsight, and discussing potential facilitating organizational change in community pitfalls for current and future physician leaders. behavioral healthcare. In this session, we will review previously described health inequity frameworks, The Self-Assessment for Modification of Anti- highlighting their strengths and their limitations as Racism Tool (SMART): Addressing Structural Racism relates to addressing structural racism in community in Community Mental Health behavioral health practice. We will then introduce Chair: Rachel Melissa Talley, M.D. the key components of the SMART, describing our Presenters: Kenneth Minkoff, M.D., Sosunmolu process in developing this organizational tool based Shoyinka on key inequity issues that are most relevant to community mental health practice. Lastly, we will EDUCATIONAL OBJECTIVES: use a case example to illustrate the process for using At the conclusion of this session, the participant the SMART, and describe future directions for should be able to: 1) Describe how the Self- piloting this framework. Assessment for Modification of Anti-Racism Tool (SMART) builds on prior existing health inequity The Suicidal Physician: Narratives From a Physician frameworks; 2) Describe the components of the Self- Who Survived and the Physician Widow of One Assessment for Modification of Anti-Racism Tool Who Did Not (SMART) and the key issues of mental health Chair: Michael Myers, M.D. inequity that it aims to address in using these Presenters: William Lynes, M.D., Linda Seaman, M.D. components; 3) Understand the process for using the Self-Assessment for Modification of Anti-Racism EDUCATIONAL OBJECTIVES: At the conclusion of this session, the participant course for medical students.; 2) Describe the should be able to: 1) 1. Appreciate the diversity of challenges and opportunities in interdisciplinary biopsychosocial factors that drive suicidal behavior medical education.; 3) Appreciate the application of in physicians.; 2) 2. Know how to conduct a suicide theories of human motivation and of adult learning risk assessment when your patient is a physician.; 3) to medical education.; 4) Reflect on the challenges 3. Gain tips and insights from physicians who have and opportunities for the future of medical “been there.”. education..

SUMMARY: SUMMARY: Research is murky (or dated) on how many Modern psychiatric education must balance physicians die by suicide each year in the United longstanding values and pedagogical principles with States. There are even fewer data on physicians who remarkably shifting curricular and societal contexts. attempt suicide, in part rooted in non-disclosure, The presenter will offer perspectives and insights shame and denial. In this session, Dr Michael Myers, drawing on over 30 years of experience teaching a specialist in physician health will give a brief across the continuum of medical education and overview of what we know and don’t know about professional development. Using his co-leadership of suicide in physicians. Dr William Lynes, board- a nationally-recognized “Mind/Brain/Behavior” certified urologist, will give a brief history of how his medical student course as an extended example, the professional and personal life was upended when he presenter will consider topics including: (1) suffered two traumatic medical events that plunged educational collaborations with neurologists and him into a devastating depression. Struggling with basic scientists; (2) the use of digital audiovisual hopelessness and burdensomeness he made several media to enhance learning and engagement; (3) suicide attempts before receiving life-saving care. He fostering autonomous motivation in learners; (4) has now retired and become a tireless advocate general principles of adult learning as conceptualized lecturing and writing about the importance of from ancient times to the present; and (5) recent personal wellness and psychiatric treatment. Dr trends in medical student curricula, shaped by larger Linda Wrede-Seaman, a primary care and palliative societal concerns including growing emphases on care physician and former emergency medicine equity, justice, and social determinants of health. physician, is a survivor of her husband Dr Matthew The presentation will frame discussion about the Seaman’s suicide. She will discuss the issues substantial challenges and equally considerable associated with the mental health deterioration of opportunities for psychiatrists in medical education her emergency medicine husband from the ‘insults over the coming years. (And for those curious, yes, and assaults’ of the licensing board and the legal the presentation will explain the relevance of the system at a vulnerable high-risk time, the first year cultural references in the presentation title!) after retirement. She will also address the barriers from insurance and substandard care given by the Therapeutic Misconception in Clinical Research: A mental health care system for Matthew as he Psychiatrist’s 40-Year Journey progressed into a refractory depression, including Presenter: Paul S. Appelbaum, M.D. valuable lessons to help all of us be more sensitive and supportive of our hurting physician colleagues. EDUCATIONAL OBJECTIVES: At the conclusion of this session, the participant Thelonious Monk, Pepé Le Pew, and Me: should be able to: 1) To describe the manifestations Adventures in Medical Education of therapeutic misconception (TM).; 2) To identify Presenter: Jeffrey M. Lyness, M.D. the threat of TM to informed consent to research participation.; 3) To outline an approach to reducing EDUCATIONAL OBJECTIVES: or eliminating TM in clinical psychiatric research.. At the conclusion of this session, the participant should be able to: 1) Understand the curricular SUMMARY: context of an integrated “Mind/Brain/Behavior” Therapeutic misconception (TM) was first described TM remains a problem in much clinical research and by me and my colleagues in 1981, when we noticed a threat to the validity of informed consent, but that some psychiatric research participants failed to means exist to address the issue without impairing appreciate the distinction between the imperatives the conduct of clinical research in psychiatry and the of clinical research and of ordinary treatment. rest of medicine. Despite having undergone a standard informed consent process, they assumed that the selection of Toward Personalized Psychiatry: Individual Risk of an intervention in the research study would be Developing and Having Recurrent Manic Episodes – based on their personal needs and that their doctor 20-Year Prospective Studies would be making that decision—even when Presenter: Boris Birmaher, M.D. treatment assignment was randomized, placebos were being used, and their physicians were blind to EDUCATIONAL OBJECTIVES: whether they were in an active treatment or control At the conclusion of this session, the participant group. Research participants who manifested TM should be able to: 1) Describe the prodromal often expressed incorrect beliefs, not just about the symptoms and risk factors associated with the onset degree to which the study intervention would be of Bipolar Disorder; 2) Describe the course and risk individualized to meet their specific needs, but also factors associated with poor outcome in youth with about the likelihood of benefit from participation in bipolar disorder; 3) Describe the personalized risk for the study and the goals of the researchers onset of bipolar disorder and mood recurrences. conducting the project. These beliefs may have been attributable to participants’ failure to distinguish the SUMMARY: research setting from their previous experiences Bipolar disorder (BD) is a recurrent illness that receiving medical treatment, or to comments made usually onsets during adolescence and is by the research team or on the consent form that accompanied by significant psychosocial impairment, fostered the conflation of treatment with research. high risk for suicidal behaviors, substance abuse and We subsequently demonstrated, in a multi-site legal problems. Thus, it is important to identify the study, that TM by no means is limited to psychiatric prodromal symptoms of this disorder early and to research, but affects clinical research, especially provide interventions that will delay its onset or in clinical trials, more broadly. Over the years following the best of the cases, prevent its onset. Also, since our initial publications, many studies from around each recurrence is associated with worse prognosis, the world confirmed the ubiquity of the it is important to identify BD youth who are at risk phenomenon, with 50-70% of research participants for recurrences. Studies have identified risk factors displaying evidence of TM. This is of concern for the risk of development of BD and the risk for because TM undercuts the process of obtaining recurrences. These factors, while important at the meaningful consent to clinical research participation group level, do not answer a crucial clinical question: by distorting participants’ beliefs about the nature What is the risk of developing BD and the risk of and consequences of the process into which they are recurrences for an individual youth? This information entering. Finding a means of reducing or eliminating may be utilized to tailor treatments for each specific TM in the consent process therefore seemed to be a individual. This presentation will present 20-years of priority. Thus, we turned next to the development of ongoing longitudinal studies of offspring of parents a reliable and valid scale for assessment of TM, the have BD and youths who already were diagnosed first step to developing effective interventions. With with BD that address the above issues. that accomplished, we then showed, in a controlled study using a hypothetical research project, that Treating Invisible Wounds: Psychiatry Meets Pain helping participants grasp the reasons for the use of Management methods such as randomization, double-blinds, and Chair: Taranjeet Singh Jolly, M.D. placebos effectively reduced the prevalence of TM Presenters: Taranjeet Singh Jolly, M.D., Zeeshan without adversely affecting expressed willingness to Nisarahmed Mansuri, M.D., M.P.H., Christa Coleman, enroll. Today, 40 years after our initial publication, Psy.D. Discussant: To-Nhu Vu, M.D. billion annual sales. Starting in 2014 in the US, drug overdose deaths surpassed car accidents as the EDUCATIONAL OBJECTIVES: number one cause of accidental death. The Covid-19 At the conclusion of this session, the participant pandemic has accelerated the opioid overdose should be able to: 1) Participants will learn about death. Interdisciplinary treatment and even definition of chronic pain, its effect and correlation collaborative multidisciplinary care are achievable with mental health issues, epidemiology of chronic and effective with the right combination and dose. pain and mental health co-morbidities.; 2) Many times, individuals referred for behavioral pain Participants will learn about treatment modalities treatment may have exhausted all of their options, for chronic pain and overlapping mental health leaving them feeling hopeless and at time defensive. issues, primarily psychopharmacological options.; 3) Interdisciplinary treatment and even collaborative Participants will learn from Pain Medicine physician multidisciplinary care are achievable and effective about abuse potential of opioids, identify with the right combination. In the first session, mechanisms of abuse-deterrent opioids and presenter will talk about introduction and continuing search for low abuse potential opioids.; epidemiology of chronic pain and co-morbid 4) Learn about tips to implement behavioral pain psychiatric conditions to understand the prevalence management with patients, including assessing and overlap between mental health and chronic problems amenable to behavioral treatment, pain. Next session would focus on various treatment introducing the idea of non-medication pain modalities to treat chronic pain and focus on non- manage. opioid psychopharmacological/medication management of chronic pain and mental health SUMMARY: issues in context of chronic pain. This would be Chronic pain is defined as persistent or intermittent followed by update on the topic of opioid safety by pain lasting for more than three months. Pain Medicine Physician with a focus on the abuse Epidemiological studies report that more than one- potential of opioids, identify mechanisms of abuse- fifth of the general population is affected by chronic deterrent opioids and continuing search for low pain in the USA and Europe. Pain affects nearly 100 abuse potential opioids. The last session will focus million people and is one of the most common on tips to implement behavioral pain management complaints made to primary care physicians (PCPs) with your patients, including assessing problems by their patients with total costs of chronic pain in amenable to behavioral treatment, introducing the the United States estimated to be between $150 idea of non-medication pain management, and billion and $260 billion annually. Compared with the modalities to consider. There will be a panel general population up to 85% of patients with discussion at the end to address participant chronic pain are affected by severe depression, and questions. over 85% of chronic pain patients said they had difficulty sleeping. As such chronic pain is a complex Treatment of Severe Obsessive-Compulsive and issue that truly requires multi-disciplinary Related Disorders: What Do You Do If First-Line collaboration and effort, starting from primary care, Treatments Don’t Work? to pain medicine physician, psychiatrist, Chair: Katharine A. Phillips, M.D. psychologist, PT/OT to name a few. The opioid Presenters: Christopher Pittenger, M.D., Carolyn epidemic, cultural factors, stigma, affordability, and Rodriguez, M.D., Ph.D., Jon Grant, M.D. lack of access to specialized pain care for many Discussant: Michele Pato, M.D. Americans create challenges in caring for this population. In addition, chronic pain is associated EDUCATIONAL OBJECTIVES: with higher rates of psychiatric issues, disability, as At the conclusion of this session, the participant well as reduced quality of life. Opioid prescription should be able to: 1) Describe first-line treatments, context of chronic pain is a huge public health issue; both medication and psychosocial, for the obsessive- Oxycontin received FDA approval in 1995, by 2010, it compulsive and related disorders; 2) Discuss made up 30% of total analgesic market with 3.1 evidence-based pharmacologic treatments for severe obsessive-compulsive and related disorders trichotillomania and excoriation (skin-picking) when first-line treatments fail; 3) Discuss evidence- disorder. All of the presenters are both researchers based psychosocial treatments for severe obsessive- and clinicians with expertise in both pharmacologic compulsive and related disorders when first-line and psychosocial treatment for the OCRDs. Dr. Pato, treatments fail; 4) Discuss device-based treatments our discussant, has expertise in all treatment for severe obsessive-compulsive disorder when first- modalities across the full spectrum of OCRDs. The line treatments fail; 5) Discuss potentially helpful audience will be able to interact by chat with the adjunctive approaches to challenges that commonly presenters during their presentations, and 15 arise with more severely ill patients. minutes at the end will be reserved for Q and A. Knowledge about the OCRDs has advanced in recent SUMMARY: years, and these disorders are of increasing interest The obsessive-compulsive and related disorders to the field. This session will enable participants to (OCRDs) – OCD, body dysmorphic disorder (BDD), more effectively treat patients with these hoarding disorder, trichotillomania, and excoriation conditions, especially those who are more severely (skin-picking) disorder--are a new chapter of ill and who may not fully improve with first-line disorders in both DSM-5 and ICD-11. They are treatments. common conditions that typically impair psychosocial functioning and quality of life, Understanding and Transforming the Current sometimes to a debilitating degree. Several of them Competence to Stand Trial System are associated with elevated rates of suicidality. Presenters: Debra A. Pinals, M.D., Lisa Callahan, Although these disorders are genetically related to Ph.D. one another and have some overlapping treatment elements, their treatments meaningfully differ and EDUCATIONAL OBJECTIVES: must be tailored to each disorder. This proposal’s At the conclusion of this session, the participant topic – treatment of severe OCRDs -- is important should be able to: 1) Identify at least two sources of and timely for several reasons. First, the OCRDs can waitlists for defendants in the competence to stand be challenging to treat. Although first-line trial process.; 2) Identify at least two intercepts treatments are often effective, a substantial where individuals in the competence system could proportion of patients do not respond fully and be diverted into treatment.; 3) Describe the require additional treatment. Furthermore, patients importance of data in improving the competence with more severe symptoms often require multiple system.; 4) Describe how cross-systems treatment modalities concurrently. In addition – collaboration can improve competence system perhaps with the exception of OCD -- clinicians may waitlists, enhance treatment and reduce criminal be less familiar with the treatment of OCRDs than recidivism. with treatments for other psychiatric disorders. Finally, in recent years there have been meaningful SUMMARY: advances in our understanding of optimized The competence to stand trial (CST) and competence treatment for patients with these challenging restoration (CR) processes are in crisis in many conditions. The presenters will first describe first-line states. The demand for competence evaluations and treatments – pharmacologic and psychosocial – for restoration services strains both local and state the OCRDs. A substantial portion of the didactic mental health and local justice resources. The legal presentations will then focus on recommended and treatment systems both play a role in the approaches when first-line treatments fail, including problems and the solutions for what can be viewed for patients with severe symptoms. The presenters as an overstressed system of care. Forensic will also discuss adjunctive approaches to challenges psychiatric beds, typically managed by the state that often arise with more severely ill patients (for mental health authority, are historically and example, for suicidality in patients with BDD). Dr. presently the default for competency restoration in Pittenger will present on OCD, Dr. Phillips on BDD, most states, so when a court orders an inpatient Dr. Rodriguez on hoarding disorder, and Dr. Grant on competence evaluation or restoration, the defendant is on a waitlist and detained in the local “Will You Let Me Die?”: Terminality and Treatment jail. There are multiple waitlists for a single arrest Futility in Psychiatry event: waitlist for competence evaluation; waitlist Chair: Dominic Sisti, Ph.D. for competence restoration; and waitlist for criminal Presenters: Yingcheng Xu, M.D., Rocksheng Zhong, charges to proceed if restored or waitlist for M.D., M.H.S. placement if deemed non-restorable. Because the competence question pauses the speedy trial clock, EDUCATIONAL OBJECTIVES: wait times accumulate, and often with the At the conclusion of this session, the participant defendant detained in a local jail. The defendant is in should be able to: 1) Recognize the pressing need for treatment and legal limbo between the local court a clearer delineation of terminal illness and futility in order and mental health needs. More states are psychiatry; 2) Apply the concept of parity to moving toward outpatient, or community-based psychiatric conditions; 3) Identify two methods of competence services. Moving to community-based defining treatment futility; 4) Discuss current services is one pathway to reducing the demand for limitations in psychiatric end-of-life care; 5) Describe forensic state hospital beds. Cross-system planning possible roles of palliative psychiatry. can reduce the delays and further penetration of persons with severe mental illness, substance use SUMMARY: disorder, intellectual development disabilities, and Over the past 20 years, an increasing number of neurocognitive challenges into the criminal justice jurisdictions have legalized medically-assisted dying system. The Sequential Intercept Model (SIM) is a (MAD). The American Medical Association and framework that identifies six decision points – or American Psychiatric Association state that a intercepts – in criminal justice processing where physician should not facilitate the assisted death of a diversion from the justice system and into treatment patient. However, the debate continues, and with can be considered. The SIM can identify suitable that has followed the demand for MAD for treatment and diversion options for CST defendants mental illnesses. Currently, MAD for mental illness is and amplify gaps where communities can enhance legal in four countries and is actively being debated options without reducing public safety. By in Canada. A key argument supporting MAD for identifying the target population at each intercept, mental illness is conceptual parity: mental illnesses systems can divert people into treatment. At and physical illnesses are equally valid and thus both Intercepts 0 and 1, law enforcement and/or deserve equal consideration for MAD. However, if community-led crisis teams respond to calls for MAD is available for terminal physical illnesses, what assistance where the best outcome is for the defines a terminal mental illness? One necessary individual in crisis to be connected to treatment not part of terminal illness is treatment futility, which arrested, sometimes referred to as “deflection.” has previously been understood as falling into two Intercepts 2 and 3 include many diversion options broad categories: quantitative futility and qualitative such as specialized pretrial services, competence futility. Our session will review these issues and dockets, community-based restoration, and specialty present an argument for qualitative futility as the courts. Finally, Intercepts 4 and 5 are jail-based more useful and appropriate lens for understanding programs such as improved in-jail treatment terminal mental illness. We will propose palliative services, specialized discharge planning, and in-reach psychiatry as a treatment option for terminal mental re-entry planning. The SIM is a demonstrated illness and identify additional key limitations in strategic planning activity that examines the gaps psychiatry that require clarification before MAD for and opportunities for diversion and can be used to mental illness can reasonably be considered. We plan for and implement diversion to treatment for anticipate that these topics will spur a lively individuals in the competence system who have discussion and so will leave all remaining time for among most significant mental health needs in our attendee comments, as well as Q&A. communities.

Zooming Through COVID-19: Achievements and of telehealth for continued mental health treatment Challenges in Telemental Health Services and expand beyond its use during COVID-19. This session Patient-Centered Treatment will focus on the doctor-patient collaboration, Chair: Victor J.A. Buwalda, M.D., Ph.D. highlight the strengths and weaknesses of using Presenters: Rogena Abdelrahman, B.S., William E. telehealth and video conferencing, and address the Narrow, M.D., M.P.H., Renee Cookson, Eve K. impact of telehealth capabilities on the doctor- Moscicki, Sc.D., M.P.H. patient experience. We will discuss the benefits of and barriers to this modality for diverse patient EDUCATIONAL OBJECTIVES: populations. Participants will learn how to effectively At the conclusion of this session, the participant provide treatment in partnership with patients’ should be able to: 1) Articulate how telemental needs in a rapidly-changing digital world. Offering a health can impact the doctor-patient relationship.; personalized and hybrid treatment plan, inclusive of 2) Understand patients’ perceptions of their role as both in-person sessions and telehealth, will meet the partners in the doctor-patient relationship during overall goal of providing patients more control over the digital era.; 3) Recognize challenges clinicians their treatment and making mental health care face in their role as partners in the doctor-patient accessible and more cost-effective. relationship during the digital era.; 4) Implement psychiatric treatment modalities based on patients Monday, May 03, 2021 preferences and needs. Avoid Burnout and Improve Outcomes Through SUMMARY: Motivational Interviewing as a Core Recent years have witnessed a growing focus on Communication Style patient-centered outcomes and important changes Chair: Michael A. Flaum, M.D. in the doctor-patient relationship. The past role of Presenters: Carla Marienfeld, Florence Chanut, Brian the doctor as a paternalistic authority has evolved to Hurley, M.D., M.B.A. that of a coach to help meet their patients’ treatment needs. At the same time, patients sought EDUCATIONAL OBJECTIVES: greater involvement and participation in assessing At the conclusion of this session, the participant treatment outcomes that are important to them. should be able to: 1) Participants will be able to With the introduction of outcome assessment explain the meaning of the “paradoxical effect of systems in routine clinical practice, however, coercion” and describe how this may relate to involving patients as full partners in the process burnout; 2) Participants will be able to discuss the presented challenges, as both clinicians and patients core components of the spirit of MI and how struggled with differing expectations. For example, incorporating these into clinical practice may reduce patients largely favored implementing outcome burnout; 3) Participants will improve their capacity assessment in their treatment process while to make simple and complex reflective listening clinicians were less favorable and faced technical statements. hurdles. In the digital era, implementing digital health technology (DHT) in combination with e- SUMMARY: health modules in routine clinical practice faces the Physician burnout is increasingly identified as a same issues. With the digitization of society, patients threat to optimal healthcare. Rates of clinically have already embraced and are using DHT in their significant burnout symptoms are > 50% across all daily lives. The COVID-19 outbreak has made this physicians and increasing over the past decade. transformation process even more urgent. Doctors (Shanafelt, et al, 2015). Rates vary across specialties, and patients are learning to adapt to abrupt changes with rates for psychiatrists estimated to be 48%. A in all aspects of life, including availability of mental recent white paper on the topic has gone so far as to health treatment. Telehealth is a key tool that allows call physician burnout a “public health crisis,” doctors to stay connected to their patients via a because of its potential effects on reducing the platform that will not spread the virus. The benefits physician workforce in the future and on decreasing quality of patient care. This is especially important in the mental health field, as the transmission of EDUCATIONAL OBJECTIVES: hopefulness has an especially prominent impact on At the conclusion of this session, the participant patient outcomes. Much work has been done over should be able to: 1) Identify the evidence for a the past few years to develop and disseminate causal relationship of cannabis exposure and onset approaches to reduce burnout and enhance of psychosis.; 2) Understand current data on the resilience among physicians (including many overlapping neurobiology of cannabis psychosis.; 3) resources from the APA’s committee on physician Identify current practices to minimize the risks of wellness and Burnout, APA 2018). These include cannabis use by persons with psychosis. both individual level solutions, such as various self- care and wellness practices, as well as organization- SUMMARY: level solutions that focus on things like optimizing Over 127 million persons in the U.S. had used workflows and promoting a culture of wellness in cannabis at some time in their lives and over 3.5 the workplace. To our knowledge, little attention to million used cannabis for the first time in 2019, date has focused on aspects of the doctor-patient according to recent national data. International data interaction that may impact burnout. Motivational show that cannabis is the world’s most commonly Interviewing (MI) is an evidence-based used ‘illicit’ drug, and data from population studies communication style for those in helping roles and treatment systems document strong (Miller and Rollnick, 2012). In this session, we will associations between cannabis use and psychosis, introduce and demonstrate the clinical practice of including schizophrenia. Some studies suggest a motivational interviewing (MI) as a promising particular relationship between more potent forms strategy to reduce physician burnout. Specifically, of cannabis and synthetic cannabinoids (e.g., Spice we will suggest that incorporating the spirit and and K2), and psychosis. Thus, increasing potency of technique of MI as a core communication style may cannabis products (both plant forms and extracts) be an effective way to lessen burnout and enhance may confer increasing population risk. In examining physician resilience. We will discuss the rationale for the relationship between cannabis and psychosis, it this both from a theoretical basis and from the is important to consider both acute exposure presenters’ experiences. Each of the presenters will outcomes as well as longer term risks associated draw upon their own clinical experience both before with early exposure. Acute exposure can result in and after incorporating MI into clinical practice. Each anxiety, positive symptoms (e.g., paranoia and presenter incorporated MI into their clinical practice disorganization), negative symptoms (e.g., with the goal of improving patient outcomes, with amotivation) and cognitive deficits (e.g., memory no expectation for personal benefit. And each of us, and attentional impairments). Whether cannabis when teaching MI to others, always include the itself can trigger onset of chronic psychosis is not as remarkable, unexpected decrease in feeling burned clear. Cannabis use in early teens is associated with out at the end of a busy clinical day, since we have increased rates of psychosis by early adulthood. In made this transition. In this session, we will addition, this increased risk appears to be linked to introduce the basic concepts of MI and practice specific genetic and psychosocial factors, and it may some skills to introduce participants to how and why be mediated by family risk for psychotic disorders. this approach can be helpful both to your patients Data from epidemiological, family and cohort studies and yourselves, with a focus on MI as a burnout are consistent with cannabis as a risk factor for the mitigation strategy. onset, but whether this represents an uncovering of incipient cases or represents an increase in the Cannabis and Psychosis: Population, overall rate of psychosis remains uncertain. In Neurobiological, and Treatment Services addition to potentially increasing onset of psychosis, Perspectives cannabis can also complicate treatment. Cannabis Chair: Wilson M. Compton, M.D., M.P.E. can increase severity of symptoms, cause relapses of Presenters: Deepak Cyril D'Souza, M.D., M.B.B.S., psychosis, and exacerbate negative symptoms. Yet, Marc Manseau, M.D., M.P.H. many outpatients with chronic psychosis use cannabis, motivated by desire for both positive and the treatment of choice for TRS. Despite its proven negative rewards. That is, the motivation may be the efficacy and guidelines recommending its’ use, high/intoxication and/or relief of symptoms, or to actual rates of prescribing have remained low. While ameliorate side effects of medications. In response, 20-30% of patients with schizophrenia meet health systems need to incorporate interventions to clozapine use criteria, only a fraction of these provide integrated, evidence-informed treatment to patients end up receiving a clozapine trial. Although individuals with cannabis use and psychosis, clozapine has proven to be highly efficacious, its use especially at a time when cannabis laws are has steadily declined in the U.S. Investigation into evolving. For this panel, three speakers will provide the origins of the reduced use have implicated overviews of current evidence, including a panel prescriber’s fear of using clozapine, citing concerns discussion with the audience: Dr. Wilson Compton, centered on side effects and comorbidities, Deputy Director, National Institute on Drug Abuse, increased frequency of clinic visits, and reluctance to will present “Epidemiology of cannabis use and enter patients into the weekly blood monitoring psychosis”; Dr. Deepak Cyril D’Souza, Professor of program. However, studies have shown clozapine Psychiatry, Yale University School of Medicine, will actually reduces mortality, possibly secondary to present “Translational perspectives on the reducing the risk of suicide with the reduction overlapping neurobiology of cannabis and reaching 85%. In the CATIE study clozapine, treated psychosis”, and Dr. Marc Manseau, Chief of Medical subjects continued treatment longer then several Services, New York State Office of Addiction Services comparators. Lastly, treatment with clozapine is and Supports, will present “Implications of cannabis cost-effective, and the significant decrease in suicide use by persons with psychosis for the planning and risk far outweighs the low risk of mortality from implementation of health services”. agranulocytosis. To foster effective use of clozapine, recent studies have highlighted the importance of Clozapine Clinic: The Need of the Hour developing clozapine clinics, which could expand Chair: James L. Roerig, Pharm.D. access and include experienced clinicians that would Presenters: Balwinder Singh, M.D., M.S., Lori Esprit, effectively manage adverse events. Clozapine clinics M.D., Robert J. Olson, M.D. could provide the opportunity for focused, supplementary training for psychiatric residents and EDUCATIONAL OBJECTIVES: other health professionals. The integration of this At the conclusion of this session, the participant type of clinic into psychiatry residency programs should be able to: 1) Better understand the evidence would result in the graduation of experienced base for the use of clozapine treatment for clinicians that could promote future clozapine use. schizophrenia spectrum disorders and This symposium would provide clinical insights into epidemiological trends in clozapine prescribing; 2) a) The clinical efficacy of clozapine, b) barriers to Through presentation and audience Q&A, review clozapine prescriptions among the psychiatrist, clinical pearls and potential barriers to clozapine advanced practice providers, and psychiatry prescribing among psychiatrists, advanced practice residents/trainees, and c) share a model to initiate a providers, and Psychiatry residency trainees; 3) To clozapine clinic into a psychiatric residency program. present a successful model on how to integrate a Dr. James Roerig (Introduction to clozapine, efficacy Clozapine Clinic into a residency training program and data on clozapine under prescribing, how to and address the related challenges.. design a clozapine clinic), Dr. Balwinder Singh (barriers to clozapine prescription), Dr. Lori Esprit SUMMARY: (state mental health clinic perspective) and Dr. The United States Food and Drug Administration Robert Olson (administrative challenges) (FDA) indications for clozapine use include treatment-resistant schizophrenia (TRS) and Cognitive Behavior Therapy for Personality reducing suicidal behavior in patients with Disorders schizophrenia or schizoaffective add disorder. Chair: Judith Beck, Ph.D. Clozapine is accepted by the clinical community as EDUCATIONAL OBJECTIVES: At the conclusion of this session, the participant SUMMARY: should be able to: 1) Specify and conceptualize In this session, we address current day examples of difficulties in treating personality disorder patients; colonization in medicine and think about ways to 2) Engage personality disorder patients in treatment; decolonize psychiatry in medical schools. 3) Use the therapeutic alliance to achieve treatment Colonization of medicine will be defined more goals. specifically from oxford dictionary definition of colonization as, the action of appropriating a place SUMMARY: for one's settling among and establishing control A number of studies have demonstrated the efficacy over the indigenous people. Looking into the mirror of Cognitive Behavior Therapy in the treatment of of our mental health system, we must acknowledge patients with personality disorders. The the patriarchy, hierarchy, oppression, and conceptualization and treatment for these patients devaluation of patients, trainees, and faculty of is far more complex than for patients with acute color. In order to move forward, we must truly disorders such as depression and anxiety. Therapists listen, recognize and name inequalities, and need to understand the cognitive formulation for challenge individuals and systems that get in the way each of the personality disorders. They need to be of inclusivity. The work ahead requires a safe spaces, able to take the data patients present to develop united perseverance, and careful attention. individualized conceptualizations, including the role Participants will learn background terminology, hear of adverse childhood experiences in the cases, reflect on powerful images, and discuss development and maintenance of patients' core content in small groups. In the cases lead by third beliefs and compensatory strategies. This and fourth year medical student conceptualization guides the clinician in planning presenters, personal case scenarios that highlight treatment within and across sessions and in the challenges faced by black indigenous person of effectively dealing with problems in the therapeutic color (BIPOC) in medicine. In our discussion groups, alliance. Experiential strategies are often required we will de-brief the case examples and open for patients to change their core beliefs of discussion to question our “mainstream” medical themselves, their worlds, and other people not only culture, medical curricula, framework, and the at the intellectual level but also at the emotional systems we were raised not to question. We will level. review the themes of the discussion and emphasize steps in the direction forward. Participants will leave Decolonizing Psychiatry: Listening to and Learning the session with practical strategies to recognize and From Case Discussions respond to practices of colonization in medicine in Chairs: Alicia Barnes, D.O., Desiree Nicolette Shapiro, order to promote inclusivity in the clinical learning M.D. environment. Presenters: Courtney Cosby, Dewonna Ferguson Discussant: Matthew N. Goldenberg, M.D., M.Sc. Disaster Mental Health Epidemiology and Nosology: Perspectives From Three Decades of EDUCATIONAL OBJECTIVES: Research At the conclusion of this session, the participant Chair: Carol S. North, M.D. should be able to: 1) Define colonization in medical school training and further recognize the problem of EDUCATIONAL OBJECTIVES: racism in academic psychiatry; 2) Present case At the conclusion of this session, the participant examples illustrating how disparities are fostered should be able to: 1) List the types and prevalence of through creating spaces for discussion in small specific psychiatric disorders reported in major break-out groups; 3) Learn strategies to recognize studies of survivors of disasters; 2) Critically examine practices of colonization of medicine and address it elements of diagnostic criteria for PTSD and the in real time to foster more inclusive educational significance of trauma exposure and symptom types environments. in predicting mental health sequelae of disasters; 3) Differentiate symptoms and distress from mental health response to be offered in this psychopathology in response to disasters; 4) Discuss presentation. appropriate approaches disaster mental health response in a framework of emergency and medical Double Jeopardy, Muslim Mental Health Provider: response based on epidemiologic findings and Facing Xenophobia, Navigating Burnout and Focus nosological principles. on Wellness Chair: Batool Kazim, M.D. SUMMARY: Presenter: Farha Zaman Abbasi, M.D. Disasters are increasing in frequency and severity throughout the world. Mental health consequences EDUCATIONAL OBJECTIVES: of disasters are profound, making disaster mental At the conclusion of this session, the participant health a vital area of psychiatric interest. Accurate should be able to: 1) Recognize and understand the knowledge of mental health effects of disasters is mental and physical health impact of exposure to essential for effective disaster response. The existing persistent stress in form of growing xenophobia body of disaster research mental health research, current; 2) Have acquired coping strategies when however, has inherent methodological difficulties facing xenophobia and micro-aggressions; 3) that have limited the understanding of mental Become aware of growing xenophobia in the country health consequences of disasters. This presentation and its detrimental effect on health outcomes. will present and interpret disaster mental health research findings in the context of research SUMMARY: methodology, providing expert analysis of the We are seeing an unprecedented increase in the current body of disaster mental health research and intense irrational fear and disdain of immigrants in direction on interpretation of many conflicting and our country. This is being translated as toxic confusing findings in the literature. The presenter persistent stress which is disproportionately has more than 3 decades of experience in impacting the minorities and especially faith based conducting federally-funded studies of disaster communities. This has acute and long term adverse mental health, providing epidemiologically and impact on the physical and mental health of these nosologically informed interpretations of the results vulnerable populations. Muslims are also feeling the of these studies and conclusions on the findings of pressure of this growing xenophobia in the form of the research literature in general. The research Islamophobia. Islamophobia is a form of identity conducted by the presenter includes studies of more based bias towards Islam and its adherent Muslims. than 3,500 survivors of 15 different disasters of all Roughly 1% population of America identifies as disaster typologies, including natural disasters, Muslims and are currently facing discrimination and technological accidents, and intentional human acts overt acts of aggression against not only Muslims, of destruction including major terrorist events and but anyone who “appears” or “sounds” Muslims. mass shooting episodes. The presenter’s research The hate crimes nearly tripled from 34-101 in 2016 studies have generated original findings relating to (Southern Poverty Law Center). The rate of bullying the role of disaster typology on mental health is twice as high the national rate for Muslim youth. consequences, important elements of disaster This sense of persecution is impacting their self- trauma exposure and posttraumatic stress esteem, identity and ability to integrate in the host responses, the course of mental health responses culture. Being Muslim and a mental health provider over time, and functional and symptomatic recovery. doubles this allosteric load, can lead to high burn out Findings from these studies will be presented in the rates and detrimental health consequences. Muslims context of the broader disaster mental health comprise approx. 10 % of current physicians in the literature, with in-depth discussion of the meaning country. The lack of awareness and dearth of of the findings from this literature in the context of research is creating a silent epidemic that needs to the research methodology. Finally, the findings of be addressed immediately. these studies inform general principles of disaster Dynamic Supportive Psychotherapy: Strategies and confrontation, encouragement, providing hope, Techniques for Psychiatric Practice using metaphor, coping skills development, self- Presenter: John Battaglia, M.D. soothing techniques, and use of humor. Transference and countertransference core concepts EDUCATIONAL OBJECTIVES: will be discussed, including a model of four stages of At the conclusion of this session, the participant countertransference development in the therapist. should be able to: 1) Outline the history and Supportive psychotherapy techniques for working research on supportive psychotherapy validating it with trauma associated psychiatric conditions will be as an efficacious psychiatric treatment.; 2) Develop a outlined. Specialized supportive psychotherapy psychodynamic formulation as a platform for strategies for working with borderline personality supportive psychotherapy treatment.; 3) Describe disorder, schizophrenia, and substance use disorders common supportive psychotherapy strategies and will be discussed. A brief discussion of termination techniques.; 4) Describe key components of the issues in supportive psychotherapy will end the therapeutic alliance and its relationship to successful session. psychiatric treatment.; 5) Outlined specialized supportive psychotherapy techniques for borderline Ethnicity, Culture, and Psychopharmacology personality disorder, schizophrenia, and substance Presenter: Edmond H. Pi, M.D. use disorders.. EDUCATIONAL OBJECTIVES: SUMMARY: At the conclusion of this session, the participant This presentation will include how the field of should be able to: 1) Understand the supportive psychotherapy grew out of necessity interrelationship between ethnicity, culture, and from psychoanalytic therapy and how it has evolved psychopharmacology; 2) Recognize the clinical significantly over the past 50 years. Initially implications of ethnicity and culture in supportive psychotherapy was used in research only psychopharmacology among the diverse as a "control" or "treatment as usual" condition. populations; 3) Understand the role of the Despite this disadvantage, supportive psychotherapy pharmacokinetic, pharmacodynamic, and showed at least equal efficacy to the popular pharmacogenetics mechanisms in treatment under study, time and time again. psychopharmacological approaches in treating Eventually research on supportive psychotherapy ethnically and culturally diverse groups. itself as a bone fide treatment showed it was not only equal to other therapy modalities, but the SUMMARY: treatment of choice for some. The idea of the During the past five decades, great progress in the corrective emotional experience will be examined as diagnosis and treatment of mental disorders has the cornerstone for how supportive psychotherapy been made. The discovery and use of effective works. The development of the psychodynamic psychotropic medications, advancement in formulation will be reviewed, and how it provides neuroscience, establishment of community mental the platform for successful supportive health system, and utilization of psychosocial psychotherapy. Methods for developing the rehabilitation have significantly impacted the psychodynamic formulation will include bio-psycho- treatment outcome of mental disorders. Coincide social-cultural considerations. Development of the with increased mobility of population and migration therapeutic alliance will be presented, including of people to different discussion of how developing a good therapeutic continents/countries/locations, the societies have alliance is strongly correlated with successful become much more diverse in terms of ethnicity and psychiatric treatment (for not only supportive culture than ever before. As a result of these psychotherapy but also with psychiatric medication phenomena, the health and mental health system of management). Common supportive psychotherapy the United States have changed a great deal in techniques will be reviewed including active recent years. A better understanding of cross- listening, plussing, explaining behavior, normalizing, cultural perspective in psychiatry is no longer an option but an essence for psychiatrists who evaluate intervention in psychiatry in general and in psychotic and treat an increasing number of people from disorders in particular. Next, I will examine the different ethnic and divergent sociocultural existing treatment models for working with people backgrounds. The influence of ethnicity and culture with first episode psychosis, and describe the on psychotropic medications has become an evidence base behind them. This leads to discussion important clinical consideration. Cross-cultural of best practices in use of psychotropic medications, psychopharmacology seeks to determine whether team-based care, societal awareness of the there are differences in responses to psychotropic importance of early intervention, and the role of medications among various ethnic groups and the social determinants of health in first episode reason for such variations. This presentation will psychosis. In this section, I will highlight the special provide an overview on the existing information in challenge of substance use disorders in the context regard to cross-cultural perspective of of first episode psychosis. I will then review our psychopharmacology dealing with antipsychotics, growing understanding of neurobiological mood stabilizers, antidepressants, and mechanisms underlying symptom presentation in benzodiazepines. Clinical implications for the early psychosis as well as of the impact of treatment reported differences and the needs regarding how to interventions on the brain. Finally, I will consider the prescribe the most appropriate psychotropic racial/ethnic disparities in risk and resilience factors medications considering target symptoms and side as well as in treatment delivery and outcomes in first effects will be addressed. Recent advances and episode psychosis which worsen outcomes for Black future directions with respect to cross-cultural issues and Hispanic Americans. Throughout the talk, I will of psychopharmacology will be presented. highlight similarities and differences in how we think about first episode affective vs. nonaffective First Episode Psychosis disorder and argue for a transdiagnostic approach to Presenter: Dost Öngür, M.D., Ph.D. early psychosis care. I will conclude by weaving the themes of biological, psychological, and social EDUCATIONAL OBJECTIVES: aspects of the complex and unfolding phenomenon At the conclusion of this session, the participant of an emerging severe mental illness - and leave the should be able to: 1) Describe the importance of audience with a hopeful message that this is one of early detection and intervention in psychotic the domains in psychiatry where we have greatest disorders; 2) List therapeutic options available to ability to improve outcomes in the coming decade. practitioners for early intervention; 3) Describe the similarities and differences between first episode Focus Is the Secret Sauce in Effective affectice and non-affective psychosis; 4) Provide one Psychodynamic Therapy: A Pragmatic Clinician’s example of a controversial area in early psychosis Workshop practice; 5) Describe the RAISE study funded by Chair: Richard Fredric Summers, M.D. NIMH. Presenter: Jacques P. Barber, Ph.D.

SUMMARY: EDUCATIONAL OBJECTIVES: In this Distinguished Psychiatrist presentation I will At the conclusion of this session, the participant present multiple aspects of a rapidly evolving field in should be able to: 1) Accurately diagnose core psychiatry - first episode psychosis. The onset of a psychodynamic problems; 2) Develop a major psychotic illness is a confusing and psychodynamic formulation for appropriate destabilizing time for many patients and their patients.; 3) Become proficient at using the core families but it does not have to be. With proper psychodynamic problem to focus psychodynamic recognition and intervention, this period can be therapy.. handled in a way that improves long-term outcomes and there is a growing evidence base for what that SUMMARY: recognition and intervention should be. I will start Effective psychodynamic therapy requires focusing by reviewing the importance of early detection and on the core psychodynamic problem. By diagnosing the core psychodynamic problem, the pragmatic #JusticeForGeorge, and #BlackoutTuesday are just psychodynamic therapist can facilitate the kind of some of the hashtags that have predominated social deep, intimate and personal exploration that is media. Just two hours after a photo of Mike Brown’s needed to allow for change. Focus avoids the body lying in a pool of blood in the street circulated, concern that psychodynamic therapy is meandering, there were over 3.5 million tweets about Ferguson unstructured, and only vaguely addressing with the majority of tweets coming from black users. symptoms. Focus is a guiding principle for the The main themes in these tweets were institutional therapist and a reassuring and structuring racism, disparities, devaluation and self worth. More experience for the patient. This workshop uses video recently, social media has been used to organize clips and examples to challenge participants to thousands of protests against systemic racism and identify the core problem in case examples. The six police brutality in light of the deaths of George Floyd core psychodynamic problems – depression, and Breonna Taylor. While social media can be a obsessionality, fear of abandonment, low self- powerful tool for advocacy and rapid dissemination esteem, panic anxiety and trauma – will be of information, there may also be some discussed, along with the criteria and method for disadvantages. Recent studies in race and social choosing the best problem for each patient. This media have found that social media viewers can be conceptual approach and method are described in exposed to high volumes of discriminatory content detail in Summers and Barber, Psychodynamic which may lead to trauma, stress and internalized Therapy: A Guide to Evidence Based Practice, 2009, racism. Given what we know about the ability of and are widely used in training programs in social media to spread the effects of collective psychiatry, psychology and social work. trauma, we must consider what effect repeatedly viewing these murders or scrolling passed Friend, Frenemy, or Foe: The Role of Adolescent discriminatory devaluing content may have. This is Social Media Use in Race Based Trauma especially important when we consider black youth Chairs: Stephanie Alexis Garayalde, M.D., Asha D. who are high social media utilizers and may identify Martin, M.D. with the victims. Is there a possibility for repetitive Presenters: Tresha Gibbs, Gabrielle Shapiro, M.D., trauma via social media and how can this be Caitlin Costello recognized? Our session will introduce participants to themes of systemic racism, social media activism EDUCATIONAL OBJECTIVES: and collective and vicarious trauma. We will describe At the conclusion of this session, the participant a framework for the risk-benefits-analysis of should be able to: 1) Outline the role of social media adolescent social media use during a trauma fueled during periods with heightened attention to police race based pandemic. We will provide information shootings of unarmed black males; 2) Describe regarding potential risk and protective factors and healthy, developmentally appropriate social media through case examples we will outline adaptive and use by adolescents and their families in the setting maladaptive social media use. Finally, we will of collective trauma; 3) Identify features of consolidate the information in a skills based problematic social media use in adolescents which demonstration where discussants will model may increase trauma and other negative mental identifying healthy(friend), mixed (frenemy) or health impact; 4) Practice communicating with youth problematic (foe) social media use in race based and their families about patterns of use and identify trauma and delivering this information to parents. strategies to mitigate negative mental health impact. Integrating Clinical Practice and Research SUMMARY: Presenter: Carlos Blanco-Jerez, M.D., Ph.D. Over the last few years, social media has served as a major news source, powerful organizing tool and EDUCATIONAL OBJECTIVES: rapid means to show the grievances and collective At the conclusion of this session, the participant traumas of black in the United States. should be able to: 1) Describe the limitations of #BlackLivesMatter, #ICantBreathe, #SayHerName, traditional research models; 2) Present the need to integrate clinical research and practice; 3) Describe At the conclusion of this session, the participant learning healthcare systems as an alternative should be able to: 1) Identify treatment services for paradigm. Latinx/Hispanic Communities, gaps and opportunities; 2) Understand the importance of SUMMARY: evidence on access to mental health care for Despite considerable investments in research over Hispanics and on the quality of health care that they several decades, clinical care is often not evidence- receive.; 3) Recognize the importance of the use of based, fails to incorporate research findings and Artificial Intelligence to identify barriers for increasingly leads to dissatisfaction and burnout. At depression treatment in Latinx/Hispanic the same time, the health care underperforms in Communities. effectiveness, appropriateness, safety, cost and value. Undue treatment variation increases cost and SUMMARY: worsens outcomes. One reason for these problems The health of a population is influenced by both its at the clinician and system level is that clinical social and its economic circumstances and the health innovation is often seen as the exclusive purview of care services it receives. Latinx/Hispanic face a researchers, with limited input from the consumers variety of barriers to receiving mental health care of that research, including patients, clinicians and services. Some of these barriers result from their low system administrators. These approaches tend to socioeconomic status; others are due to specific follow a traditional view of innovation that cultural characteristics, degree of acculturation, seamlessly moves from inventors to early adopters, language, and immigration status. Identifying mainstream population, and late barriers to access psychiatric treatment among adopters. However, meaningful innovation rarely Hispanics is a critical task. How do Hispanic- follows a linear path. An alternative approach, American patients with mental disorders characteristic of learning healthcare systems, is to understand, reach out for help or respond to develop systems in which consumers (e.g., patients treatments? The presenters will shed light on and clinicians) generate the questions whose Hispanics’ unique cultural concepts what should answers could help improve clinical care and consider when evaluating patients, families and researchers provide the methods (i.e., research) to mental health services. Epidemiology, risk factors, systematically obtain those answers. This approach clinical characteristics of the patients with first is more collaborative and involves a circular process psychotic episode and the impact on the acute of question generation, experimentation, psychiatric care will be discussed by Dr. Tohen with implementation and evaluation, followed by emphasis on evidence base strategies that could be additional improvements. This presentation will implemented in this population. Dr. Ng will discuss contrast these two approaches and provide the emotional impact of the pandemic in Mexico examples of how learning healthcare methodologies with emphasis in the five phases for this pandemic: can be applied at different levels of clinical practice 1. Imported cases, 2. Community Spread; 3. Rapid ranging from solo practice to large systems of care. Spread 4. Second wave; and 5. End of the Pandemic. Dr. Castilla-Puentes will review the use of Artificial Latinx/Hispanic Communities and Mental Health: Intelligence to investigate digital conversations. Identifying Barriers to Access and Potential Hispanics commonly have a negative, resigned, and Solutions During Unsettled Times hopeless attitude towards depression and lack active Chairs: Ruby C. Castilla Puentes, M.D., Pamela involvement with its management, which contrasts Montano, M.D. with non-Hispanics. This information could be used Presenters: Mauricio Tohen, M.D., D.P.H., M.B.A., for formulating strategies for early engagement of Bernardo Ng, M.D. Hispanics with depression. Dr. Jimenez will present Discussant: Hector Colon-Rivera, M.D. information on the effects of health promotion interventions on indices of cardiometabolic risk in EDUCATIONAL OBJECTIVES: midlife and older Latinos living with HIV. In this symposium, we will review the evidence on access to health care for Hispanics and on the quality of health people without accountability - which has been care that they receive. We provide a summary of the compared to public lynchings. However, there are existing research and also present new data from polarized reactions resulting in some embracing the recent national surveys. We also focus on specific mantra “Black Lives Matter” and others responding features that are of particular importance to with the retort “All Lives Matter.” The death of Hispanics, including national origin, length of time in George Floyd led to over 2,000 protests around the the United States, language, and citizenship, and we globe during the Covid-19 pandemic. These protests assess how these features are associated with access shed light on what some consider to be law to and quality of mental health care during these enforcement’s perverse role in a form of Unsettled Times. Our discussant will examine the government that allows the terrorizing of members common threads to understand Hispanic needs and of the BIPOC communities while risking vicarious how to address them. This symposium is in trauma to those who witness such lethal use of force collaboration with the American Society for Hispanic increasingly via social media. Central to Psychiatry. understanding this phenomenon are several observations: 1) law enforcement has historically Law Enforcement and Qualified Immunity: A played a role in reinforcing hierarchical caste Psychoanalytic Exploration of State-Sanctioned systems in the US and around the globe; 2) at this Dehumanization and Its Effect on Self and Other point in our history, many whites in the US and Chair: Constance E. Dunlap, M.D. around the globe have frequently shifted into a Presenters: Ebony Dennis, Psy.D., Constance E. paranoid-schizoid position, perceiving an idealized Dunlap, M.D., Justin Hopkins, Psy.D., Jessica white dominant good self that is being threatened Elizabeth Isom, M.D., M.P.H. by a subjugated bad Black and brown other; and 3) something beyond implicit bias training is needed if EDUCATIONAL OBJECTIVES: we are to effectively interrupt this trend that is At the conclusion of this session, the participant likened to state-sanctioned dehumanization. should be able to: 1) Be knowledgeable about the origins of the qualified immunity doctrine and efforts LGBTQ+ Medical Students and Applying to to reform it; 2) Be knowledgeable about the history Psychiatry Residency of the evolution of law enforcement which has its Chair: Marshall Forstein, M.D. roots in slavery; 3) Be knowledgeable about the Presenters: Terrance William Embry, Allison Rhodes, range of physical (and psychological) injuries Teddy Gould Goetz, M.S., Matthew P. Abrams sustained during encounters with law enforcement; 4) Be knowledgeable about the public policies that EDUCATIONAL OBJECTIVES: promote criminality and result in dehumanization; 5) At the conclusion of this session, the participant Be knowledgeable about the psychoanalytic should be able to: 1) Understand the unique processes that contribute to a law enforcement challenges that LGBTQ+ students face in applying to officer’s identity development and response during residency; 2) Demonstrate various methods for critical incidents. identifying LGBTQ+ friendly residency programs; 3) Identify specific resources for finding and connecting SUMMARY: with LGBTQ+ mentors; 4) Identify strategies for It has been established that police killings of Black, developing and maintaining resilience as an LGBTQ+ Indigenous, and People of Color (BIPOC) have an medical student and future LGBTQ+ psychiatrist. adverse effect on the health of those who identify with or feel connected to these communities. The SUMMARY: qualified immunity doctrine has been used to Medical school is challenging, especially in this exonerate over 98% of law enforcement officers pandemic that changes the very experience of charged with these killings. The Black Lives Matter learning and training. For LGBTQ+ medical students, movement was established in 2013 to shed light on there are unique aspects of applying to medical this disturbing trend - the increasing killings of school, considering, and applying for residency. LGBTQ+ medical students often experience Medical Conditions Mimicking Psychiatric Disorders (increased) stressors such as overt or more subtle Versus Psychiatric Disorders Mimicking Medical forms of structural and institutional bias towards Conditions: Diagnostic and Treatment Challenges gender and sexual minorities. LGBTQ+ medical Chair: Catherine C. Crone, M.D. students often choose not to disclose their LGBTQ Presenters: Brenna Rosenberg, M.D., Nina T. Ballone, identities while in medical school, citing reasons M.D., Aisha Siddiqa, M.D., Rushi Hasmukh Vyas, from experiences or fears of non-acceptance, lack of M.D. institutional support, and overt hostility from peers Discussant: Ahmed Sherif Abdel Meguid, M.D. and/or faculty, in spite of improving societal awareness and acceptance of gender and sexual EDUCATIONAL OBJECTIVES: minorities in some areas of the U.S. Additionally, At the conclusion of this session, the participant although American Psychiatry has formally changed should be able to: 1) Promote greater awareness of the diagnostic perspective on homosexuality, bias the complicated overlap between medical and remains theoretically and practically amongst psychiatric comorbidities; 2) Provide a structural clinicians, evidenced by the continual antigay framework for differential diagnosis and work-up of pushback by many fundamenal religious groups, and psychiatric manifestations or sequelae of medical the continued practice of “conversion therapy” that disorders, with evidence-based recommendations is legal in most states. Specific to LGBTQ+ applicants for practice; 3) Discuss challenges and lessons in psychiatry is whether there will be a supportive learned through case examples in the work up and peer group, access to supervision by experienced management of these patients at the crossroads of teachers who understand the issues of coming out medical and psychiatric presentations. professionally, working with homophobic patients, and transference and countertransference issues SUMMARY: that arise in psychotherapy and supervision. This During the course of residency training, significant workshop was designed by medical students for efforts are made to instruct residents about the medical students. In a highly interactive format, recognition and treatment of primary psychiatric medical students will learn about applying to disorders such as major depression, bipolar disorder, psychiatry as an LGBTQ+ applicant. The panel of post-traumatic stress disorder, panic disorder, and recently-matched LGBTQ+ panelists will share schizophrenia. However, exposure to cases that experiences, lessons learned, and tips for other initially appear to be primary psychiatric disorders medical students. This workshop moves from an but are actually due to underlying medical overview of the challenges that LGBTQ+ students conditions is often lacking, despite their common face to a discussion of specific strategies that helped occurrence. Infections, hypoxia, electrolyte the LGBTQ+ panelists to navigate applying to imbalances, endocrine disorders, autoimmune psychiatry residency. Following this, the workshop disorders (e.g. lupus, sarcoidosis) neurologic will discuss ways to identify LGBTQ+ mentors and conditions (e.g. epilepsy, multiple sclerosis, delirium) ways to recognize and seek out LGBTQ+ friendly and medications are just some of the causes of residency programs. Medical students will then have patient presentations that can mimic primary the opportunity to practice using the tools and psychiatric disorders. Awareness of these “mimics” is resources that have been identified in small groups. needed as patients may otherwise appear to have Throughout the workshop, the panelists will elicit “treatment-resistant” psychiatric disorders or, of audience participation in a moderated question and greater concern, actually worsen when given answer format. The workshop will end with a psychotropic medications. This is necessary dedicated question and answer format to address information for both trainee and general psychiatrist unanswered questions from attendees. We aim for alike. An additional area of clinical knowledge that this panel to spark and continue this much-needed would benefit both residents and general conversation about the challenges that LGBTQ+ psychiatrists is the recognition and management of applicants face in applying to psychiatry residency. psychiatric disorders that mimic medical conditions. Limited exposure to consultation-liaison psychiatry during residency training may result in lack of illnesses. The requirements for certification in experience with conversion disorders, somatic psychiatry in the United States mandate a limited symptom disorders, and factitious disorders. These period of medical training in the first year of are patient populations that are often responsible residency, but do not specify knowledge objectives. for excessive utilization of medical resources and The traditional setting for this training has been the healthcare dollars as well as being sources of medical ward of a teaching hospital, where a vast mounting frustration and misunderstanding for majority of the patients have previously diagnosed medical colleagues. Requests for psychiatric life-threatening conditions (e.g., advanced involvement are not unusual, especially when malignancies, disabling cardiac or pulmonary medical work-ups are negative yet patients persist in conditions, sepsis). We lack data supporting the their requests for medical/surgical intervention. The value of this type of training in psychiatric settings in following workshop / session aims to provide which clinicians are often confronted with acute residents, fellows, and general psychiatrists with an changes in physiologic parameters, new symptoms, opportunity to learn more about secondary or asymptomatic laboratory abnormalities. This psychiatric disorders (psychiatric mimics) as well as session is designed to provide a common cognitive somatic symptom and related disorders (medical framework for dealing with medical issues mimics) in a case-based format with opportunities encountered in psychiatric practice, by teaching the for questions and discussion with residents, fellows, participants to ask themselves the following and attending physicians with experience and/or questions: a) is the patient at risk of dying in the next expertise in consultation-liaison psychiatry patient 24 hours; b) does the patient require immediate populations. transfer to an emergency medicine setting; c) does the patient need urgent laboratory or imaging Medicine in Psychiatry: What Do We Need to investigations; and d) are there any changes Know? required in the current medication regimen? This Chair: Peter Manu, M.D. framework will be used during the session to address 10 commonly encountered issues in EDUCATIONAL OBJECTIVES: psychiatric inpatient settings: abnormal vital signs At the conclusion of this session, the participant (fever, elevated blood pressure), common symptoms should be able to: 1) At the end of the session, the (agitation, seizures, falls, chest pain) and abnormal participants will be able to use an efficient laboratory findings (neutropenia, hyponatremia, framework for evlaution medical issues in the hyperglycemia). psychiatric setting; 2) At the end of the session, the participants will be familiar with the risk Mind, Brain and Culture: Toward an Ecosocial stratification of psychiatric patients with changes in Psychiatry vital signs, frequent symptoms, and prevalent Presenter: Laurence J. Kirmayer, M.D. laboratory findings; 3) At the end of the session the participants will be able to enhance the EDUCATIONAL OBJECTIVES: interdisciplinary cooperation with internal medicine At the conclusion of this session, the participant consultants. should be able to: 1) Recognize issues that arise from the limited attention to cultural and social structure SUMMARY: dimensions of experience in current frameworks for Somatic disorders are present in a least 50% of psychiatric research theory and practice; 2) Identify psychiatric inpatients and a consensus exists that the implications of recent work on the coevolution they are underrecognized, misdiagnosed, and of culture, mind and brain for models of suboptimally treated. Accelerated aging, social psychopathology, brain function and adaptation; 3) neglect, poverty, unhealthy lifestyle, complications Appreciate the central role of narrative and of psychiatric treatments and poor access to care are metaphor in illness experience, treatment major contributors to this substantial morbidity and negotiation, healing and recovery; 4) Identify decreased life-span of persons with severe mental strategies for integrating culture and social context in clinical practice; 5) Review evidence on the impact action in specific contexts has led to work on of considering culture and context in clinical enactivism that aims to show how cognition has its assessment and in mental health promotion. origins in interactions between the body and the world. Our self-understanding through narrative and SUMMARY: metaphor plays a pivotal role both in internal This talk will explore how recent work in cultural regulation and in our engagement with the social psychiatry, cognitive science and computational world. Through “looping effects”, the language we neuroscience can inform an ecosocial psychiatry that have available to articulate and express our understands mental health problems as embodied, experience changes the very nature of that socially embedded, and culturally elaborated. In this experience. This enlarged BPS-Cultural model can framework, brain mechanisms, narratives, and social inform a clinical approach to mental health problems interactions all contribute to multilevel explanations that is responsive to culture and context, engaging of experience that can be integrated in clinical individual experience, cultural identity, and assessment and intervention. The biopsychosocial structural violence. The practice of this ecosocial (BPS) approach offers a way to think about the many approach will be illustrated with examples from a dimensions of human experience in health and cultural consultation service and mental health illness drawing from hierarchical systems theory. promotion with Indigenous youth. Although it has become a mainstay of medical education, the BPS model has been criticized for Nutritional Interventions in Psychiatry: What Is the lacking substance and specificity. Research Evidence? frameworks like the NIMH Research Domain Criteria Chair: Jessica Lynne Principe, M.D. (RDoC) have embraced neuroscientific research as a Presenters: Glynis McGowan, M.D., Ann Felhofer, strategy to develop psychiatric science but give little M.D., Umadevi Naidoo, M.D. attention to culture and social context. Advances in cognitive science provide new insights into the co- EDUCATIONAL OBJECTIVES: construction of culture, mind and brain and point to At the conclusion of this session, the participant the need for a more thorough integration of culture should be able to: 1) 1) Describe evidence-based and context in psychiatry. On this view, human rationales and practical strategies of monitoring and biology is cultural biology: we have evolved and live repleting vitamin D, folate, and vitamin B12 in our lives in social worlds that we co-construct and patients with select psychiatric disorders.; 2) 2) that are animated and given meaning by culture. A Understand evidence-base and practical strategies framework based on 4E cognitive science offers us a for omega-3 supplementation in patients with select picture of thought and action as embodied, psychiatric disorders.; 3) 3) Describe current embedded, enacted and extended into the world in evidence and best practices for diet and lifestyle ways that make it deeply social and cultural. interventions as adjunctive treatment in general Embodiment reflects the ways that cognition, psychiatric practice.; 4) 4) Describe current evidence language and imagination emerge developmentally for diet and lifestyle interventions to manage and from basic bodily experiences and continue to be prevent antipsychotic induced metabolic syndrome.. elaborated through both internal physiological processes, and external physical engagements with SUMMARY: the environment. A rich experimental literature The interplay of nutrition and psychiatry is a broad shows the ways in which bodily processes both yet clinically relevant topic as evidence continuously structure and intrude on everyday thinking and even comes to light on the potential roles of nutritional abstract cognition. These bodily processes involve factors in the etiology of, recovery from, and actions in and on the environment and hence are potential resilience against psychiatric illness. always embedded in a particular context or niche Therefore, and practically, the importance of that provides cultural affordances and that monitoring and attending to the nutritional care of structures the process of cognition. The realization psychiatric patients is now more important than that the function of cognition is to guide adaptive ever, given the emerging evidence base for nutritional interventions that result in improved uncertainty about the future. The military outcomes including faster recovery, reduced population is unique compared to their civilian symptom burden, and reduced morbidity and counterparts. For example, they may not face the mortality in our patients at greatest risk. same economic uncertainty or unemployment Additionally, given relative explosion in primary during COVID-19. However, they face additional research, review articles, and meta-analyses on stressors: stress from work hours/shifts/mission these topics in recent years, with inevitably changes, misinformation/confusion from leadership conflicting results and opinions, distilling and who often dictate their daily routine, isolation and integrating the current data into everyday practice boredom in barracks rooms, limited food access due can be quite challenging for the general clinical to mandatory dining at centralized facilities, and fear practitioner. This session will comprise a balanced of infection due to the nature of their occupation presentation and overview of the topics outlined, which relies on group training. Additionally, the and specific, low-cost, monitoring and intervention return to work after social distancing ended was strategies applicable to general and specialized expected to heighten mental health distress for psychiatric practice will be reviewed and discussed in Soldiers. Military units resumed normal scheduling, an interactive session with case-based examples. but cumulative work that had been sidelined simultaneously needed to be addressed, resulting in Operational Mental Health Implications During the longer work hours, increased perception of stress, COVID-19 Pandemic for Active Duty Army Units and the potential for an upward trend of negative Chair: Connie Thomas, M.D. outcomes, including suicidality, substance-related Presenters: Joseph Dragonetti, Rogelio Martinez incidents, and domestic violence. Due to restrictions related to COVID-19, identifying high risk behaviors EDUCATIONAL OBJECTIVES: and suicidality in military formations was a challenge At the conclusion of this session, the participant for leaders and behavioral health officers assigned to should be able to: 1) Describe unique COVID-19 military units. Several strategies used in order to response considerations for the military as prevent negative outcomes from occurring among compared with civilian populations in mental health Soldiers included regular mental health screening surveillance, prevention, and treatment in the among socially distanced and quarantined outpatient setting.; 2) Compare the differing individuals; education about high risk alcohol use surveillance, prevention and treatment needs of and restriction of alcohol access on military military subgroups during COVID-19.; 3) Discuss installations; leader presence and ongoing methods that military behavioral health engagement strategies with Soldiers; enhanced professionals have used to assist Leaders and virtual capabilities for behavioral health care; Soldiers in identifying and coping with stress related medical and unit policies for the triage and to COVID-19.; 4) Participate in an interactive case management of Soldiers at high risk for suicide; and discussion of high risk suicidal Soldier identification reintegration training to improve unit and management during COVID-19.; 5) Utilize communication and efficiency while establishing military COVID-19 lessons learned to identify steps “new normal” practices. Altogether, we hope that leaders can take to cultivate preparedness for these lessons learned, when combined with ongoing response to future public health emergencies.. training and policy revisions, can help organizations identify ways forward for responding effectively to SUMMARY: future public health emergencies. The COVID-19 pandemic was unprecedented in its scope and impact on the day-to-day lives of Presidencies: What They Taught Us Americans. Preliminary studies focusing on& the Chair: John A. Talbott, M.D. mental health effects of COVID-19identify trauma- Presenter: Nada Stotland, M.D., M.P.H. related symptoms, anxiety, and depression as growing trends as a result of economic unrest, lack EDUCATIONAL OBJECTIVES: of confidence in leadership, fear of being ill, and At the conclusion of this session, the participant clerkship years were pulled from hospitals with very should be able to: 1) What Presidents Can Do; 2) little patient care for months. As a direct What Presidents Really Do; 3) What Presidents Don’t consequence, medical students were unable to see Do. patients directly and continuity of care via student- run clinics became a valuable clinically oriented SUMMARY: supplement during this unique period in medical This session will feature two past Presidents of the training. One example of a student-run clinic is the APA summarizing the lessons they’ve learned. The Columbia Student Medical Outreach (CoSMO) Discussant is the spouse of a past president who will program that exists to provide free healthcare to the reflect on what the presenters omitted. uninsured and medically underserved population in northern Manhattan. CoSMO also has a behavioral Providing Equitable Healthcare to Marginalized health (BH) clinic that offers diagnostic and Groups Via Student-Run Mental Health Clinics: psychosocial assessments for patients with mental Approaches, Advantages and Challenges During health needs. In the beginning of the pandemic, COVID-19 clinical services were halted while adapting for Chair: Jessica Spellun, M.D. remote care delivery. Specific barriers included Presenters: Matthew Wickersham, Constance Zhou, needing telephone Spanish translation services and Rebecca Breheney lacking access to the Internet. Assessments and longitudinal care now continue via telephone EDUCATIONAL OBJECTIVES: appointments, with phone translators on an At the conclusion of this session, the participant additional line as needed. Another example of a should be able to: 1) Describe advantages of the student-run clinic is the Weill Cornell Medicine student-run clinic care delivery model to provide (WCM) Wellness Qlinic. This is a free student-run mental health care to under-resourced communities; mental health clinic serving the LGBTQ population of 2) Illustrate how student run clinics supplement and New York City, regardless of insurance status. Since advance medical school curricula and training; 3) COVID-19, the WCM Wellness Qlinic has transitioned Compare and contrast two student run clinic to entirely virtual care using a telehealth platform, approaches to provision of mental health care; 4) providing individual psychotherapy and medication Explain the advantages, challenges, and management to existing patients, along with group opportunities COVID-19 presented to student-run therapy for coping skills. As of August 2020, the clinics in delivering care. Wellness Qlinic has adapted to resume new patient intakes virtually. For this session, representatives SUMMARY: from each clinic will describe their approaches to the Student-run clinics are a hallmark feature at many challenges and opportunities COVID-19 posed. These medical schools to provide early clinical exposure to case studies will model equity and access students in training environments and improve considerations for how to transition student-run clinical care. Beyond the advantage of clinics to adapt to stressful circumstances while supplementing clinical education, student-run clinics maintaining important clinical services for frequently offer free or sliding scale services, disenfranchised communities. allowing marginalized communities to receive and access care otherwise unavailable. This ranges from Psychiatry in the Courts: APA Confronts Legal Issues homeless populations; lesbian, gay, bisexual, of Concern to the Field transgender and queer individuals (LGBTQ); Chair: Reena Kapoor, M.D. socioeconomically disadvantaged persons; and Presenters: Howard V. Zonana, M.D., Marvin Stanley underrepresented minorities. With COVID-19 Swartz, M.D. stopping many clinical operations, medical student education was drastically altered at the beginning of EDUCATIONAL OBJECTIVES: 2020. While pre-clerkship education was able to At the conclusion of this session, the participant transform to virtual platforms, medical students in should be able to: 1) 1. Understand the process by which APA becomes involved as a “friend of the and mental status exam; 5) Order and interpret court” in major legal cases.; 2) 2. Review the courts’ relevant CSF and imaging biomarkers to make an decisions and APA’s positions on intellectual accurate final diagnosis. developmental disorder and the death penalty.; 3) 3. Review the courts’ decisions and APA’s positions on SUMMARY: same sex-marriage and parenting.; 4) 4. Review the The neurocognitive disorders (NCD) result in late- courts’ decisions and APA’s positions on transgender onset psychosis much more commonly than late- youth.. onset schizophrenia. An increased risk of cognitive decline is also seen in both late-onset and chronic SUMMARY: young-onset schizophrenia, further confounding the The Committee on Judicial Action reviews on-going differential diagnosis. Late-onset psychosis can also court cases of importance to psychiatrists and our occur in the preclinical and prodromal stages across patients, and it makes recommendations regarding the NCD, where it can mimic a primary psychiatric APA participation as amicus curiae (friend of the disorder and prompt a psychiatric referral. court). This workshop offers APA members the Prodromal NCD can present with neuropsychiatric opportunity to hear about several major issues that symptoms while cognitive symptoms may not be the Committee has discussed over the past year and present/ prominent, which can make an accurate to provide their input concerning APA's role in these clinical diagnosis particularly difficult in such cases. cases. Three cases will be and the issues they raise The term mild behavioral impairment (MBI) is used will be presented: 1) Fulton v. City of Philadelphia for such cases, and provisional criteria for MBI were involves the right of a private organization providing first proposed in 2016. MBI carries a poor prognosis government-funded services to refuse adoption by with extremely high rates of progression to major same-sex couples based on religious objections; 2) NCD. Around a third of patients with NCD due to Moore v. Texas and subsequent cases involve the Alzheimer’s disease (NCD-AD) in cross-sectional diagnosis of Intellectual Developmental Disorder in clinic-based studies have psychotic symptoms at any death penalty cases; 3) Grimm v. Gloucester County given time, and the diagnostic criteria for psychosis School Board involves the rights of transgender in NCD-AD were updated in 2020. Recurrent well- students to use the school bathroom consistent with formed visual hallucinations are a core clinical their gender identity. Since new cases are likely to feature in the diagnostic criteria for major NCD with arise before the annual meeting, the Committee may Lewy bodies (NCD-LB) last updated in 2017, and in substitute a current issue on its agenda for one or the criteria for prodromal NCD-LB first proposed in more of these cases. Feedback from the participants 2020. Other hallucinations and systematized in the workshop will be encouraged. delusions are included as supportive clinical features in both criteria sets. Misidentification phenomena Psychosis in Dementia or Dementia in Psychosis? A such as Capgras syndrome also occur, strongly Clinical Approach to Late-Life Psychosis and suggesting NCD-LB when associated with visual Cognitive Decline hallucinations. This session will examine the Chair: Vimal M. Aga, M.D. interface between aging, psychosis, and cognitive decline in older adults. The clinical work-up of late- EDUCATIONAL OBJECTIVES: life psychosis and cognitive decline based on the At the conclusion of this session, the participant latest literature will be reviewed, office screening should be able to: 1) Understand the broad tools will be discussed, and genetic testing and differential diagnosis of late-life psychosis and diagnostic CSF as well as structural, functional, and cognitive decline; 2) Differentiate between the molecular imaging biomarkers will be introduced. common NCD types based on patterns of cognitive Real cases from the presenter’s practice will be used and psychotic symptoms; 3) Demonstrate familiarity to help the attendees synthesize the data and apply with several new and updated diagnostic criteria and it in their own practices. While the session will be constructs in the field; 4) Use appropriate office helpful for clinicians at all levels, those with screening tools to supplement the clinical history experience in diagnosing and treating the NCD will this session, presenters from four major faiths benefit the most. (Christianity, Hinduism, Islam and Judaism),some of whom have been responsible for previous APA Race, Religion, and Equity: Implications for symposia and books dealing with prejudice and Psychiatry mental health (2), will discuss the historical struggles Chair: John Raymond Peteet, M.D. within their tradition with issues of race, their Presenters: Thema Bryant-Davis, R. Rao Gogineni, impacts on psychiatric conditions and access to care, M.D., Ahmed Hankir, Steven Moffic suggested clinical and institutional responses, and examples of the use of religious resources to effect EDUCATIONAL OBJECTIVES: individual and social change. Dr Thema Bryant-Davis At the conclusion of this session, the participant is a professor of psychology at Pepperdine should be able to: 1) Recognize the role of religion in University, and an ordained elder in the African shaping, reinforcing and challenging attitudes Methodist Episcopal Church. Dr. Rama Rao Gogineni toward race, including the historical contributions of is a Professor of Psychiatry at Cooper Medical School different faith traditions to both racism and social at Rowan University. Dr. Ahmed Hankir MBChB justice; 2) Understand the impact of racism on MRCPsych is Academic Clinical Fellow in General mental health and health care delivery for minority Adult Psychiatry at the Institute of Psychiatry religious individuals and communities; 3) Identify the Psychology and Neuroscience, King's College London ways that religious beliefs and practices can help and Senior Research Fellow with the Centre for individuals to change; 4) Appreciate the potential for Mental Health Research in Association with antiracism collaboration with and among faith Cambridge University. Dr. Steven Moffic retired from communities. psychiatric practice and his tenured professorship at the University of Wisconsin in 2010, but continues to SUMMARY: write and speak widely. Presenters will focus on the Growing awareness of structural and systemic clinical implications of experience with their racism and resultant inequities has led to tradition and engage the audience in discussion of widespread calls for both soul searching at the examples. individual level and substantive change at policy and population levels. While many of these calls come Redeployed: Accounts From Psychiatrists from faith leaders, overt racists also often justify Redeployed During the Initial Phases of the COVID- their beliefs in religious terms. Relatively little 19 Pandemic attention has been given to the relationship Chair: Uchenna Barbara Okoye, M.D., M.P.H. between deeply entrenched religious beliefs and Presenters: Saghir Ahmed, Divya Chaabra, M.D., racial bias (conscious and/or unconscious), or to its Djibril Moussa, Alexander Kaplan, M.D., Abraham implications for psychiatric practice. For example: Taub, Joseph Manuel Villarin, M.D., Ph.D. How does religious faith influence racist beliefs, or function for those who are objects of racist EDUCATIONAL OBJECTIVES: behavior? How can psychiatrists collaborate with At the conclusion of this session, the participant faith communities to mitigate the impact of racism, should be able to: 1) Discuss 3 different roles and act against it? In the UK, Islamophobia has psychiatrists can serve outside of their traditional stealthily infiltrated the provision of mental scope of practice during a pandemic; 2) Recommend healthcare services in the guise of the British supports that may benefit psychiatrists redeployed Government’s controversial Prevent strategy. As during times of crisis and hypothesize the impact of part of Prevent, it is a statutory duty of mental redeployed physician preparedness and well-being healthcare professionals to screen their patients for on patient care; 3) Describe coping mechanisms signs of radicalization. Prevent disproportionately utilized by various psychiatrists working on the front targets members of the Muslim community. The UK lines of COVID-19; 4) Appraise the role psychiatrists is the only country in the world where it is expected serving in acute care and medical leadership during a of a healthcare system to screen for radicalization. In pandemic, and the role of psychiatry within larger health systems during times of national and global The Biden Administration has prioritized behavioral crisis; 5) Infer the impact of COVID-19 on psychiatric health as a critical component of recovery from education and training, and on psychiatric services. coronavirus (COVID-19) and building a nation that is strong, resilient and healthy. The Substance Abuse SUMMARY: and Mental Health Services Administration In March of 2020, the COVID-19 pandemic hit the (SAMHSA) within the U.S. Department of Health & United States. In those first months, a surge in Human Services is the leading federal agency in the COVID-19 cases left healthcare systems unable to prevention, treatment and recovery support of meet the overwhelming needs of places severely individuals. Tom Coderre, as Acting Assistant impacted, such as New York City. Given the unmet Secretary for Mental Health and Substance Use, is need, physicians were called from various areas of one of several recent appointees who are in medicine to fill the critical gaps in acute medical care recovery and supports providing equitable access to needed to battle a pandemic. This tactic became treatment and clinical care. Far too many people in necessary in other states, and ultimately redeployed need of treatment cannot access it and this is psychiatrists were called to the front lines of especially true for communities of color. This town medicine around the world. In this session, we will hall will begin with a brief orientation to current be privy to first line accounts of redeployed SAMHSA priorities and will transition to a listening psychiatric administrators, attendings, and trainees session so that attendees can convey their from NYC and abroad. Their accounts will provide perspectives and experiences related to the mental insights into the value and potential roles of and substance use disorder needs of our nation psychiatry and psychiatrists during times of global before, during and after the COVID-19 pandemic. crisis, as well as insights into how to support and prepare those who are charged with caring for Saving Which Asians? One or Many at a Time: others. Our panelists are: Saghir Ahmed, MBBS: Clinically, Legally, Through Media and Live Theatre Psychiatry Resident, Maimonides Medical Center, Presenter: Rona J. Hu, M.D. Brooklyn, NY Divya Chhabra, MD: Psychiatrist and Freelance Writer, New York City Metropolitan Area EDUCATIONAL OBJECTIVES: Jibril Ibrahim Moussa Handuleh, MD MPH: At the conclusion of this session, the participant Psychiatry Resident, St.Paul's Hospital Millennium should be able to: 1) Describe some of the Medical College, Addis Ababa, Ethiopia Alexander M. challenges endangering the mental and physical Kaplan, MD, MP: CPT, USA, Medical Director, health of Asians and Asian-Americans today, Inpatient Behavioral Health, Carl R Darnall Army including discrimination, stereotyping, scapegoating, Medical Center, Fort Hood, TX Joseph Villarin, MD, and violence.; 2) Describe clinical challenges in PhD: Psychiatry Resident, Neuroscience Research treating this population, including communication Fellow, New York – Presbyterian Hospital, New York, issues, stigma, shame, adherence, increased risk of NY suicide, untreated depression and other mental health issues.; 3) Develop plans to help care for, SAMHSA Priorities teach, mentor, advocate for, protect and serve the Chair: Tom Coderre Asian and Asian-American community, individually and as a group.. EDUCATIONAL OBJECTIVES: At the conclusion of this session, the participant SUMMARY: should be able to: 1) Identify barriers to care, Asians in America have faced discrimination, including health service delivery issues; 2) Apply stereotyping, scapegoating and violence since our quality improvement strategies to improve clinical earliest history here, but recent events have care; 3) Provide culturally competent care for accentuated these issues to dangerous levels. Yet a diverse populations. host of internal and external obstacles, some well- intentioned and some not, have made it difficult for SUMMARY: Asians and Asian-Americans to get help. This session seeks to honor the legacy of the Kun-Po Soo Award religion and psychiatry have to offer to each other in by highlighting efforts that may inspire and provide constructive dialogue. practical advice in key areas: Direct clinical care: highlighting the SMHART (Stanford Mental Health SUMMARY: for Asians Research and Treatment) clinic providing Religion has been a much misunderstood topic cultural-informed care for patients previously within psychiatry. Research over the last 3 or 4 underserved despite their population density and decades has gone some way to improving the seeming resource and education levels. Brief HIPAA- situation, but only at the cost of a somewhat compliant cases will be presented, with a discussion restricted view of religion, divorced from spirituality, of strategies for dealing with issues relating to and with an impoverished view of the meaning that stigma, adherence, family, immigration, cultural human beings find in their existence. Taking on differences, gender and sexuality, expectations and board thinking from the humanities, and particularly assumptions. Discussion will include the forming of a the work of Anne Taves on “special things” as the multidisciplinary clinic within an academic building blocks of religion, a different approach is institution, teaching opportunities for residents, proposed. Psychiatrists should properly be fellows, medical students and other trainees, and concerned with those things that are special to their working together with other clinics in Diversity, patients, whether they be religious, spiritual, both, Equity and Inclusion. Opportunities in legal, policy or neither. A patient-centered approach to and advocacy work: highlighting Stanford’s Program psychiatry is respectful of special things. The in Psychiatry and the Law and a sampling of the type approach will be illustrated by reference to work on of work psychiatrists can get involved in. Print and voice hearing (auditory verbal hallucinations) and in broadcast media and live theatre: highlighting particular to a recent study of spiritually significant Stanford CHIPAO (Communication Health voices. Voices are sometimes indicative of Interactives for Parents of Adolescents and Others), psychopathology, but they are also widely its development to a nationally and internationally experienced in the absence of mental disorder. In recognized program for parent education and spiritual and religious context they may be culturally informed care, its pivot from live theatre meaningful, affirming and life enhancing. In keeping to online and Zoom/webinar programs, and with the approach taken by Oskar Pfister, it will be nurturing similar activities elsewhere such as argued here that religion and psychiatry both have Oakland Chinatown. Other programs targeting their own part to play in clarifying the importance of stigma will be mentioned, with excerpts from “The special things, such as spiritually significant voices, in Manic Monologues”, “Beyond the Reasons”, the human experience. Mutual understanding and SAMHSA-sponsored Spanish language telenovela cooperation between religion and psychiatry is “Mariposa”, Chinese language news series “The important for the wellbeing of patients and for a Silent Storm”, and Stanford undergraduate- fuller appreciation of the mystery and meaning of produced “Sikhs in the Spotlight”. the human condition.

Special Things in Religion and Psychiatry Structural Racism and Psychiatric Training: Barriers Introduction: Mary Lynn Dell, M.D. to Equity and Ongoing Interventions Presenter: Christopher C. H. Cook, M.D., Ph.D. Chair: Michael Ofosu Mensah, M.D., M.P.H. Presenters: Ann Crawford-Roberts, M.D., M.P.H., EDUCATIONAL OBJECTIVES: Kazandra De La Torre, M.D., Dwight E. Kemp, M.D., At the conclusion of this session, the participant Brittany Tarrant, M.D., Eric Rafla-Yuan, M.D. should be able to: 1) Understand some of the advantages and disadvantages of the approach that EDUCATIONAL OBJECTIVES: psychiatric research has taken to religion; 2) At the conclusion of this session, the participant Understand the significance of some anomalous should be able to: 1) Name three barriers experiences – particularly voice hearing - in undermining URM psychiatric trainee performance; spiritual/religious context; 3) Reflect on what 2) Name three ongoing interventions to improve training specifically for URM trainees in psychiatry; Suffering in Silence: Uncovering the Prevalence of 3) Articulate the role of financing in improving Major Depression Amongst Black Men in Specific training for URM psychiatrists; 4) Define Holistic Impoverished Areas review processes in contradistinction to traditional Chair: Louis Belzie, M.D. review processes. Presenters: Myriane Isidore, M.D., Mahfuza Akhtar

SUMMARY: EDUCATIONAL OBJECTIVES: Structural racism remains salient to psychiatric At the conclusion of this session, the participant practice (Hansen, Braslow et al. 2018), as COVID-19 should be able to: 1) Identify the prevalence of and public health mandates have increased distress major depression amongst black men living in and demand for care while reinforcing barriers to specific underserved communities; 2) Describe care. All these forces have increased rates of poor evidence based practices when screening for major mental health outcomes among racial depression amongst black men in diverse sub- minorities (Bray, Daneshvari et al. 2020). Psychiatry communities; 3) Summarize cultural and financial residents—already susceptible to burnout (Dyrbye, barriers to receiving mental health treatment; 4) Burke et al. 2018, National Academies of Sciences Identify what role churches may play in helping to 2019)— are frontline workers in the pandemic, and screen for major depression in underserved witness these disparities first hand. structural racism populations. pervades medical training (Amutah, Greenidge et al. 2021), rendering these disparities doubly SUMMARY: problematic for trainees who are underrepresented Major depression has been the fourth leading cause in medicine (URM). Decreased racial representation of disability in the United States, affecting among faculty in academic psychiatry (Chaudhary, approximately 350 million people worldwide; Naveed et al. 2020) exacerbate problematic aspects however it’s projected to increase as the second of training for URM residents and fellows(Mensah leading cause of disease burden by 2020. (Lopez & 2017, Osseo-Asare, Balasuriya et al. 2018, Mensah Murray, 1998; World Health Organization, 2008, 2020), who are by design less powerfully and more 2009). According to the CDC in 2010, approximately transiently positioned on the departmental 13% of Black Americans has reported suffering organizational hierarchy. Poor representation within symptoms of major depression when compared to a training environment can demoralize URM non-Hispanic White Americans. Not only is major trainees, dissuading them from becoming depression more prevalent in the black community academicians (Owoseni 2020), and pipeline but also the intensity of symptoms is more severe programs meant to recruit URM faculty are not when compared to other ethnic groups. According to always successful (Guevara, Adanga et al. 2013). As the U.S. Census Bureau published in 2014, 27 % of such, there exists a still unmet need to reform Black Americans live below poverty level when psychiatric training to better accommodate the compared to 11% of non-black Americans. Black needs of URM trainees in the absence or death of Americans are more likely to live in conditions that junior and senior URM faculty. The following may precipitate or aggravate symptoms of major presentation builds upon previous work (Balasuriya, depression for instance many of them live in Gregory et al. 2020), presenting new efforts to impoverished areas where poverty, crime, violence, render psychiatric training and academia more incarceration, drugs, homelessness may run hospitable to URM trainees. Department wide anti- rampant. The black community has consistently racism training, holistic review (Barceló, Shadravan relied on their faith in religion in order to seek et al. 2020), minority housestaff organizational guidance and strength. According to a study in 2015 action and training climate evaluation and Hankerson, 22.5 % of black men and 17.7 % of black intervention will be presented and discussed. women had a positive depression screening test after depression screenings were conducted in African American churches. However, studies have shown women are, four times more likely, to seek medical treatment for their depressive state than both parental unawareness and adolescent denial of men. In order to understand this discrepancy is to their own suicidal thoughts, were higher among understand black culture. During our discussion, we racial minority families, pointing to the need for will delve into the culture basis that black men face research on improved risk detection and within their communities and why they may avoid assessment. Approaches to addressing these seeking psychiatric treatment. We will also discuss challenges are beginning to go beyond individual risk the benefits of mental health workers engaging with factors to take a broader approach focused on pastors in underserved communities. protective factors, as well as a development view. Recent work on sexual/gender minority youth points Suicide Prevention Research for Underserved to contributing stressors that include intrapersonal Youth: Approaches to Addressing the Challenges factors and interpersonal interactions with schools, Chair: Jane Pearson, Ph.D. families, and communities (Hatchel et al 2019). Presenters: Dorothy L. Espelage, Ph.D., Rhonda C. Research that has reported that increased family Boyd, Ph.D., Brian S. Mustanski, Ph.D. support and peer support are associated with Discussant: Sherry D. Molock, Ph.D., M.Div. decreased suicidality among Black youth (Matlin et al 2011) is consistent with intervention findings EDUCATIONAL OBJECTIVES: where family acceptance of youth sexual/gender At the conclusion of this session, the participant identity decreases youth suicide risk. While many should be able to: 1) Name multiple contributors to policy solutions need to be considered, efforts within suicide risk among Black, sexual/gender minority, the mental health field can be improved and intersectional youth; 2) Understand why immediately. These include rethinking risk focusing only on individual suicide risk factors may assessments to consider how youth view and limit the effectiveness of current risk assessment and leverage social support from peers, families, schools conventional intervention approaches; 3) Learn the and communities. Earlier developmental (e.g., research base for considering the developmental preschool) programs that enhance family and and contextual contributors to risk and protective school-based supports, to avoid suicide risk factors among underserved youth. trajectories in the first place, hold much promise. The panel discussion will include considerations of SUMMARY: risk detection and interventions needing further Youth suicide death rates have increased in the past research. decade. A CDC survey conducted during the pandemic has revealed that underserved youth are Supporting Medical Directors in Behavioral Health experiencing suicidal distress at even greater rates. Clinics This session, involving experts in Black and Chair: Saul Levin, M.D., M.P.A. sexual/gender minority youth suicide prevention, Presenters: Tristan Gorrindo, M.D., Nitin Gogtay, will highlight research gaps and propose ways M.D., Regina James, M.D. forward to mitigate youth suicide risk. These underserved youth, despite their greater needs, are EDUCATIONAL OBJECTIVES: less likely to have their suicide risk detected, and are At the conclusion of this session, the participant less likely to engage in effective suicide preventive should be able to: 1) Apply quality improvement services. Underserved racial, gender and sexual strategies to improve clinical care.; 2) Provide minority youth are often over-represented in state- culturally competent care for diverse populations.; supported systems (e.g., homeless youth; child 3) Describe the utility of psychotherapeutic and welfare; juvenile justice), reflecting their past high- pharmacological treatment options.. risk trajectories, as well as future high-risk trajectories. Many of these challenges are not SUMMARY: system specific. If and when youth and their families This session is open to APA members who are active are able to receive care in behavioral health clinic medical directors in behavioral health clinics. In a settings, Jones and colleagues (2019) found rates of small group discussion with APA CEO and Medical Director Saul Levin, medical directors will have an professionals can perform in facilitating recovery opportunity to discuss challenges faced in the from immediate and longer term CC disasters.; 4) community setting and to brainstorm ways in which Recognize ethical & public health duties for mental the APA might be able to assist. Topics for discussion health professionals to advocate for policies to include administrative and payment challenges faced address the threats to health posed by the climate in the FQHCs, challenges related to staff recruitment, crisis.; 5) Recognize that the climate crisis, a major contracting, workforce development, and leadership social determinant of health, requires the public development. mental health intervention of building community resilience to prepare us for the long haul.. Tell Me Something Good Presenter: Jacki Lyden SUMMARY: Abundant evidence exists that we are in the midst of EDUCATIONAL OBJECTIVES: an ongoing, inexorable climate crisis, one that At the conclusion of this session, the participant threatens the political, socio-cultural, and economic should be able to: 1) Provide culturally competent stability and sustainability of human civilization and care for diverse populations; 2) Identify barriers to the rest of life on our home planet. Indeed, many care, including health service delivery issues; 3) health-oriented groups have declared that global Integrate knowledge of current psychiatry into warming and the climate crisis constitute the discussions with patients. greatest public health threat of the 21st century. Many mental health impacts have been described, SUMMARY: including those directly related to increasingly Tell Me Something Good, the title of Jacki Lyden’s frequent extreme weather events (e.g., heat waves, memoir-in-progress, tells the story of six decades on severe storms, wildfires) and the damage and the frontlines as her mother’s mental health disruption to lives and communities that persistent advocate, through the prism of this pandemic year. changes bring, e.g., changes in average temperature, Lyden’s bipolar nonagenarian mother is the subject seasons and sea-level rise. They also include more of her earlier bestselling memoir, Daughter of the insidious but harmful psychiatric and neurocognitive Queen of Sheba. Lyden is a veteran of NPR, where impacts of air pollution, mass migration, conflict and she was a host and foreign correspondent for over violence. A growing area of concern is the increasing three decades. She will discuss with compassion and emergence of various forms of anxiety, trauma, and humor the shifting narratives of family sacrifice, luck, depression associated, at least in part, with concerns and endurance that have made her and her mother about global warming and the future of life on Earth. long-term survivors. Inspired by Rosalynn Carter, she Successive public surveys have conclusively was a Rosalynn Carter Fellow for Mental Health demonstrated dramatic increases in public Journalism. awareness of and significant worries about climate change. Stories about eco-anxiety have appeared The Climate Crisis and Mental Health: What Will regularly in mainstream media and professional You Do? literature. As some have observed, once you truly Chair: David Alan Pollack, M.D. know and understand the reality of the climate crisis, its current and probable impacts, and the EDUCATIONAL OBJECTIVES: various future scenarios that we face, it becomes At the conclusion of this session, the participant almost impossible to eliminate these concerns from should be able to: 1) Recognize psychiatric your thinking and being. How should we, as mental conditions and other mental health impacts that health professionals, come to grips with these facts emerge from and/or are affected by the climate and how can we help? How do we support those crisis.; 2) Recognize psychological factors that who have been living with this awareness for the contribute to the refusal or disavowal to longest (scientists, advocates, and those directly acknowledge the reality and urgency of the climate charged with planning for and implementing crisis.; 3) Understand roles that mental health solutions in our communities), as well as those who more recently are or will be coming to similar important and potentially modifiable risk factor for degrees of conscious acknowledgement of the psychosis, depression, cognitive health, and other ongoing and worsening nature of this slow moving important health-related outcomes. This Symposium mega-disaster? This session will describe the status will provide an overview of changes in sleep of the climate crisis and its mental health impacts. associated with aging and psychiatric illnesses as There will be a panel discussion that will include well as research and clinical findings in three discussion of the concept of deep adaptation, how different diagnostic realms: psychotic disorders, to cultivate the adaptive mind, as well as clinical and affective disorders, and neurocognitive disorders. self-help techniques and resources aimed at helping Ellen Lee, M.D. will review the literature on sleep us all to stay present and active in our long-term and abnormalities in persons with schizophrenia and collective efforts to save the planet and our species. present data on the links between sleep disturbances, inflammatory biomarkers, cognition, The Impact of Sleep on Geriatric Mental Health: and psychopathology, in middle-aged and older Research Findings in Schizophrenia, Affective adults with schizophrenia. Stephen Smagula, Ph.D. Disorders, and Cognitive Disorders will present on morning activation and the link with Chair: Ellen Lee, M.D. depressive symptoms in dementia caregivers and Presenters: Ruth O'Hara, Makoto Kawai, Stephen older adults. Ruth O’Hara, Ph.D. will present on Slow Smagula Wave Sleep and its relationship to affect and Discussant: Charles Reynolds cognition. Makoto Kawai, MD, DSc will present on the intersection of aging, sleep architecture, and EDUCATIONAL OBJECTIVES: cognition. Charles Reynolds, III, MD will moderate At the conclusion of this session, the participant and lead a discussion of sleep research in the aging should be able to: 1) At the end of this session, population. The proposed session is fully consistent participants should be able to describe the common with the theme for the 2021 APA meeting – i.e., sleep abnormalities in older adults with psychiatric “Finding Equity Through Advances in Mind and Brain disorders.; 2) At the end of this session, participants in Unsettled Times.” The new Covid-19 pandemic should be able to describe the research findings on has increased stress and social isolation for many the relationships between sleep and inflammation in older adults worldwide, with noted effects on daily older adults with schizophrenia.; 3) At the end of this activities and sleep. Dissemination of cutting-edge session, participants should be able to describe the research findings is important for informing clinical research findings linking chronotype and depressive practice and developing new, interdisciplinary symptoms in caregivers and adult from the general collaborations to further our understanding of sleep. population.; 4) At the end of this session, There will be ample time for discussion involving the participants should be able to describe the research audience throughout the session. findings on the role of slow wave sleep in affect and memory in older adults.; 5) At the end of this The Role of Psychedelics in Psychiatry session, participants should be able to describe the Chair: William McDonald, M.D. research findings on links between aging, sleep Presenters: Stephen Ross, M.D., Michael Mithoefer, architecture, and cognitive impairments.. Charles Raison, M.D. Discussant: Collin Reiff, M.D. SUMMARY: Sleep problems are highly co-morbid with many EDUCATIONAL OBJECTIVES: psychiatric disorders and affect brain health, At the conclusion of this session, the participant psychopathology, and cognitive health; though the should be able to: 1) Review the evidence of neurobiological mechanisms connecting sleep and psilocybin for the treatment of depression and psychopathology are not well understood. Older anxiety in cancer patients; 2) Review the MAPS adults have different sleep architecture as well as phase III clinical data on the efficacy of MDMA for increased incidence of insomnia and other sleep the treatment of PTSD; 3) Review the potential role disorders, compared to younger adults. Sleep is an of psilocybin in the treatment of depression; 4) Review ethical concerns and safety parameters for Presenters: Sherin Khan, L.C.S.W., Amy Cohen, Ph.D., psychedelics in psychiatry; 5) Participate in a Tristan Gorrindo, M.D. moderated discussion on psychedelics. EDUCATIONAL OBJECTIVES: SUMMARY: At the conclusion of this session, the participant There is currently a paucity of novel pharmacological should be able to: 1) At the conclusion of this mechanisms in the treatment of many psychiatric session, the participant will be able to guide patients disorders, and some commentators have called for a and colleagues to technology that improves health “disruptive pharmacology” to investigate new outcomes.; 2) At the conclusion of this session, the treatments with novel mechanisms using drugs that participant will be able to screen patients for have previously been restricted by the FDA, depression and anxiety using gold-standard including psychedelic agents. Over the course of the measures delivered via a smartphone app.; 3) At the past decade, there has been a resurgence of conclusion of this session, the participant will be research on the potential therapeutic benefits of able to generate a psychiatric advanced directive.; 4) psychedelic compounds, with the number of At the conclusion of this session, the participant will published review articles and clinical trial reports be able to access evidence-based resources, steadily increasing. Recent randomized clinical trials consultation, and tools to support clinical practice support the efficacy of 3,4- and make treatment decisions.; 5) At the conclusion methylenedioxymethamphetamine (MDMA) in the of this session, the participant will be able to treatment of posttraumatic stress disorder (PTSD) integrate digital navigators into care settings and and psilocybin in the treatment of depression and understand their core competencies.. cancer-related anxiety. MDMA has been designated a “breakthrough therapy” for PTSD and psilocybin SUMMARY: has been designated a “breakthrough therapy” for The COVID-19 crisis has challenged mental health treatment-resistant depression by the U.S. Food and care, especially for those with serious mental illness. Drug Administration (FDA). Clinical research data This population has typically been provided in- shows that both drugs can have a robust effect on person pharmacotherapy and/or recovery-oriented psychiatric pathology that persists for months to behavioral health services and the pandemic has years, and may provide a clinical advantage over the required rapid shifts in care management. Clinicians current standards of care. The Drug Enforcement now have the opportunity to utilize new resources to Administration (DEA) currently classifies both make the digital clinical experience better and compounds as Schedule I substances. However, both improve continuity of care and mental and medical drugs are currently in FDA clinical trials. If proven to health outcomes. Digital technology has emerged as be efficacious, MDMA and psilocybin could be a feasible and increasingly acceptable method to rescheduled in the near future with clinical monitor and provide support for self-management indications for the treatment of PTSD and and symptom management. Key components of depression, respectively. In this symposium leaders effective digital health care include access, self- in psychedelic research from NYU, Usona Institute direction, strategies for monitoring, strategies for and the Multidisciplinary Association for Psychedelic illness self-management, and multimodal contact Studies (MAPS) will present recent data that methods. This session will focus on hands on highlights the therapeutic potential of psychedelic learning in using smartphone apps, digital tools, and compounds in psychiatry. Ethical and safety new clinical team members with expertise in the use parameters will also be presented. The of technology. We will introduce learners to new presentations will be followed by a moderated resources they can download and try today, and discussion with questions and answers. integrate into their clinical practice immediately after. This include using the SMI Adviser app to find Three New Tools to Augment Care for People With immediate answers to clinical questions and gold- Serious Mental Illness standard measures that score and interpret in real- Chair: John Torous, M.D. time, the My Mental Health Crisis Plan app to collaboratively work with patients to make a crisis Toward this end, this symposium will offer privacy- plan and psychiatric advance directive, and using centered social media use recommendations for digital health navigators as new team members to professional development, recruitment of clinical better help patients utilize many types of trial participants, and engaging hard-to-reach technology. populations. The format will be a series of 5 interactive presentations (interactive audience To Tweet or Not to Tweet: Social Media Use for survey/polling and eliciting questions/cases from the Professional Development and for Mental Health audience) followed by a panel/Q and A session. Research Specific new research studies will be presented as Chair: Carolyn Rodriguez, M.D., Ph.D. follows: Dr. Drew Ramsey will review lessons learned Presenters: Christopher A. Ramsey, M.D., Adrienne L. in using social media for managing and building a Grzenda, M.D., Ph.D., M.S., Christina V. Mangurian, platform for professional development. Dr. Adrienne M.D., Kara Bagot, M.D. Grzenda will present a systematic review conducted (n=176 studies) to characterize the current use of EDUCATIONAL OBJECTIVES: social media in recruiting participants for mental At the conclusion of this session, the participant health research. In 68.3% of studies, social media should be able to: 1) Review social media use for recruitment performed as well as, or better than, professional development; 2) Present advantages traditional recruitment methods at a large cost and pitfalls of social media in recruiting participants savings over traditional recruitment. Dr. Carolyn for mental health research; 3) Review existing policy Rodriguez will describe how social media platforms and recommend guidelines for social media use for raise methodological and privacy concerns not recruitment of clinical trial participants; 4) Present covered in current research guidelines and methods for leveraging social media to engage hard- regulations. Using federal government policies and to-reach populations; 5) Understand the impact of the reviewed literature, she will present a patient- social media use on adolescent neurodevelopment oriented set of best practices. Dr. Christina and mental and physical health.. Mangurian will describe the difficulties conducting research with certain hard-to-reach populations. SUMMARY: Particularly challenging is obtaining opinions from While regulatory agencies currently offer stakeholders that are nationally representative. comprehensive resources for the ethical conduct of Methods for leveraging social media to engage hard- clinical research, good clinical practice (GCP) to-reach populations for two separate nationally methods, and privacy protection, surprisingly little representative study populations will be presented: guidance is available regarding the use of social Study 1: Parents of children with rare diseases, and media recruitment in research. Currently available Study 2: physician mothers Dr. Kara Bagot will guidelines are silent as to the responsibility of the present the first data building on existing research researcher in protecting a participant’s information from the ABCD cohort via active and passive in such direct or indirect disclosures. All information collection of social network data to study the impact shared online, even if edited or removed, may be of social media use on neurodevelopment and retained permanently, creating the potential for mental and physical health. enduring HIPAA violations. Until binding regulatory guidelines are available, researchers must approach Triple Threat: Young, Female, Professional—the all questionable situations with caution and act Experiences of Young Female Psychiatrists and conservatively to ensure participant protection and Psychologists in Academic Medicine privacy. At the same time, research demonstrating Chair: Marcia Unger, M.D. causal relationships between media use and short Presenters: Anu Gupta, M.D., Meera Ullal, Ph.D. and long-term health outcomes in pre-adolescent children is sparse, and this symposium will also EDUCATIONAL OBJECTIVES: highlight new findings extending from the At the conclusion of this session, the participant Adolescent Brain and Development (ABCD) study. should be able to: 1) Review the recent and historical literature about women’s careers in face more career obstacles than men with or academic medicine and specifically within without children, perhaps due to rigid workplace psychiatry.; 2) Demonstrate and discuss frequent practices that can be particularly challenging to challenges faced by young female psychiatrists and navigate for women with childcare responsibilities. psychologists in academic psychiatry.; 3) Understand This session will review the above literature and various organizations and interventions statistics regarding women faculty in academic implemented by academic institutions to improve medicine, including the progression of women’s the status and to support female faculty in academic representation in higher education and professional medicine.. careers in medicine. Then the presenters will review personal case examples of challenges they have SUMMARY: faced as early career, young, women faculty The number of female medical school graduates members within an academic department of continue to rise each year, with the numbers psychiatry. The case examples will lead to activities becoming increasingly close to equal that of male with participants about these experiences, which will medical school graduates. Within graduate include straw polls as well as small group Psychology training, women comprise approximately discussions. Finally, the session will conclude by 75 percent of the student body. While a majority of introducing interventions from various academic psychologists are female and the number of female institutions, specifically psychiatry departments, that physicians rise each year, many of the challenges have the purpose to support women in academic faced by female physicians in the 1970s still very medicine as well as provide recommendations that much exist today. In 1973, Drs. Malkah Notman and the audience will be able to adopt and implement in Carol Nadelson published an article in the American their own departments. Journal of Psychiatry about women in medicine. In this article, they write, “Most of the students we Using Motivational Interviewing to Improve have seen have noted that there is a lack of women Medical and Behavioral Health Outcomes in Under in prominent faculty and administrative positions to Served Communities serve as acceptable role models and figures for Chair: Joseph Laino, Psy.D. identification.” The same observation can be made Presenters: Sandy Lulu, L.C.S.W., Jabari Jones today. According to the AAMC, in 2018, while the proportion of women faculty have increased overall EDUCATIONAL OBJECTIVES: in academic medicine, only 25% are full professors, At the conclusion of this session, the participant 37% are associate professors, 46% are assistant should be able to: 1) Understand how using professors and 58% are only at instructor rank. Motivational Interviewing with under served Similarly, while female psychologists represent the populations is of unique importance in the majority, they remain underrepresented in academic treatment of LGBTQ+ and trans patients.; 2) roles and progress through promotion at a slower Recognize how foundational aspects of Motivational pace than their male counterparts. The lack of Interviewing can help cultivate a solid therapeutic female role models in prominent faculty roles has alliance and be applied in a community-based clinical serious downstream effects not only on early career setting to improve health and BH outcom; 3) female professionals but also within the overall Understand how to use the five basic skills of culture of medicine. Psychiatry, along with OB/GYN Motivational Interviewing.; 4) Practice using both and pediatrics, has over 50% full-time women faculty the underlying spirit and basic skills of Motivational members, based on data from the AAMC in 2018. Interviewing in an MI-adherent conversation that Although psychiatric academic departments have promotes change.; 5) Identify specific outcomes and more women faculty members than ever before, the potential benefits of using motivational interviewing unique challenges facing women, and especially in a community-based clinic, with clinical and/or young women, pursuing careers in academic non-clinical staff.. medicine are still present. For example, women with children working in medicine are documented to SUMMARY: Motivational Interviewing (MI) was originally be taught to clinicians and non-clinicians in diverse developed as a treatment approach in substance use health care settings. disorders but has subsequently demonstrated effectiveness for a broad range of health-related Presidential Sessions behaviors. Despite evidence of the effectiveness of MI, there has been limited uptake of the techniques Saturday, May 01, 2021 in community-based mental health populations. This is surprising given that clinicians in these settings (Almost) 50 Years of Community Psychiatry often feel like they’re struggling to encourage clients Chair: Stephen Mark Goldfinger, M.D. to make healthier choices and can feel more invested in the client adopting a healthier lifestyle EDUCATIONAL OBJECTIVES: than the client appears to be. This dynamic can often At the conclusion of this session, the participant lead to an incomplete or impaired therapeutic should be able to: 1) Describe strategies for, and alliance, which may increase the number of clients impediments to, treating the most seriously ill who discontinue care prematurely and elevate rates patients; 2) Describe the interplay between beliefs, of clinician burnout. MI can be a vehicle to promote training, opportunities and serendipity in carving improved medical and behavioral health outcomes, one’s career path; 3) Examine your professional strengthen the clients’ sense of agency and trajectory and goals and how to best to achieve empower them to make positive change in their them. lives. Thus, MI enhances the therapeutic alliance and improves clinicians’ satisfaction with the work. This SUMMARY: session will focus on the implementation of MI at “Community psychiatry” was not something I had the Family Health Centers at NYU Langone, an urban, ever heard about. I probably knew more about federally funded outpatient mental health clinic in psychiatry than most 20-year-olds, having been the ethnically diverse, underserved, community of exposed to my uncle, a psychoanalyst and Sunset Park, Brooklyn in New York City. This session volunteering at the Kings County psychiatry provides an overview of MI principles for those department, one of the largest public psychiatry without previous MI experience and will start with a services in the country. Harvard’s Social Relations case presentation of a trans-woman for whom an Department exposed me to Freudian and object MI-adherent approach was instrumental in allowing relations theories, But these were, well… theoretical. her to engage in critical medical care. We will discuss The social end political forces of the late 1960s lead how to engage clients’ personal expertise and evoke to self examination and an eventual pilgrimage to their own internal motivation for change, Southeast Asia to explore becoming a Buddhist particularly with underserved populations such as monk. As is often said, sometimes you choose your the LGBTQ+ community and the trans community in career but sometimes your career chooses you. In particular. The presenters will discuss the this talk, I hope we can explore how serving the implications of using MI with diverse populations most disadvantaged and disaffiliated populations and the role culture plays in how Motivational can become one’s life path. Psychiatric residency Interviewing is both delivered to, and received by, rarely prepares one for working in busy public diverse communities. Next, we will present the emergency rooms or in shelters and soup kitchens. development of an MI learning collaborative within Nothing prepared healthcare practitioners— our clinic, and review data on the outcomes that particularly those newly self identifying as gay—to were measured after training both clinicians and work with individuals facing the HIV epidemic. If one non-clinicians to use an MI-adherent approach. At is extremely lucky, a few key mentors become the end of the session, attendees will understand models of how to approach the dilemmas early in how an MI-adherent conversation can promote one’s career. Patients and their families have so positive change in their patients’ lives, reduce much to teach if we are willing to be their students. clinician burnout, and improve treatment adherence Systems of care, and their successes and failures, can rates as well as understand how this approach can be our textbooks. As I reflect back over the past 50 years, I think I’ve learned some valuable lessons as depending on the availability of outpatient and practitioner, clinical leader, researcher and teacher. community-based resources. #3- Child and In what I hope will be an interactive session, rather adolescent psychiatry has a substantial workforce than a one-way lecture, I’d like to share some of shortage. Despite repeated efforts to increase these with you. number of residents matching into CAP training programs, and greater numbers of residents AACAP’s 2021 Initiatives matching into adult psychiatry, the percent of CAP Chair: Gabrielle A. Carlson, M.D. programs filling has ranged from 51%-72% in recent Presenters: Sandra M. DeJong, M.D., Lisa Cullins, years. There is increased interest and rationale for M.D., Jeffrey Hunt, M.D. medical students to have the option to enter a 4- year combined psychiatry/CAP residency training EDUCATIONAL OBJECTIVES: program directly out of medical school and At the conclusion of this session, the participant conferring board eligibility in for both general and should be able to: 1) Identify AACAP’s 4 current child and adolescent psychiatry. We describe the priorities; 2) Describe why mood dysregulation is an rationale for the shortened pathway, regulatory important clinical priority; 3) Summarize issues obstacles likely encountered, results of stakeholders’ complicating identification of inpatient bed needs; 4) discussions with AADPRT and AACAP, and proposed State the rationale for a 4 year CAP training strategies to move this plan forward. #4-The program; 5) Identity at least one of AACAP’s COVID19 pandemic has changed everyone’s lives Diversity Action Plan initiatives.. and has highlighted another pandemic: inequities, injustices and racism in marginalized communities of SUMMARY: color. As mental health providers and healers, we This symposium presents 4 talks summarizing AACAP must utilize our highly trained skills to integrate the key initiatives for 2021: #1-Emotion dysregulation, intersection of science and socio-environmental getting too angry or agitated, too quickly, for too factors with every patient encounter. Cultural long, with too little provocation accounts for about humility must effectively derive a formulation and 25% of outpatient, 75% of inpatient, and 34% of treatment plan suitable for every child and family we emergency room visits. Behaviors include verbal, treat. AACAP’s response to these co-existing property and physical aggression or self-injurious pandemics has been to empower the Diversity and behavior. We lack a consistent term for these Culture Committee to develop an Action Plan, led by behaviors, a diagnosis that fits them, measures that the Presidential Working Group to Promote Health quantify them and an evidence base to treat them. Equity and Combat Racism. This presentation will The first talk addresses what the AACAP Presidential share initiatives developed from the Action Plan. Task Force has learned about these children. #2-In May 2020, APA President Dr. Jeffrey Geller Advancing Quality and Equity in Women’s Health assembled a Taskforce (TF) on Psychiatric Beds with Care: Practical Advice About Women’s Health From experts in psychiatric systems of care, data Four Generations of Women Psychiatrists collection, and modeling. The TF will develop a Chairs: Carol C. Nadelson, M.D., Gail Erlick Robinson, model for responsible communities to determine M.D. how many psychiatric beds are needed within the Presenters: Aliza Grossberg, M.D., M.P.H., Gisele continuum of care, The Child/Adolescent Psychiatry Apter, Angela Devi Shrestha, Nada Stotland, M.D., (CAP) Bed Workgroup of the TF is charged M.P.H. specifically with creating a model for child psychiatric beds. We will try to address what a EDUCATIONAL OBJECTIVES: psychiatric “bed” for youth is, Its purpose(s) and At the conclusion of this session, the participant kinds of patients it should serve, types of beds should be able to: 1) Develop an increased needed within a continuum of care, what high- awareness of the importance of women’s quality inpatient psychiatric care for youth looks like reproductive health as a determinant of children’s and if the model differs among communities mental health; 2) Understand the effect of stress on women immigrants; 3) Learn about the role of changes in AAGP's leadership structure to manage women’s mental health in recruiting residents; 4) the fall-out from COVID19 crisis; 4) To enumerate Understand features of good mental health the steps taken by the leadership to maintain AAGP's treatment of women; 5) Be informed about how to educational, research, advocacy and clinical protect oneself from stalkers. missions..

SUMMARY: SUMMARY: Psychiatry is the specialty with the most We are living in an aging society. Currently 15. 2% of comprehensive understanding of and approach to the US population is 65 year or older. The number of women's health. A dedication to women's well-being older adults in the US is expected to increase to has been, and continues to be, the reason that 23.5% of the population or 95 million by 2060. generations of talented women have entered the Mental health disorders are not uncommon among field. Myths about abortion and breast feeding older adults with 20% of the older adults population confuse politicians, patients, and practitioners as having a diagnosable mental health disorder. The policies affecting women are debated, decided and care of older adults with mental health disorders has implemented all over the world.Immigrant women not been optimal due to various reasons including face stressors that cause or exacerbate mental ageist attitudes, limited services available for their health disorders. Women psychiatrists have an care, severe shortage of trained clinicians and increased risk of being stalked by patients. It is very financial constraints to name a few. The COVID-19 important to apply scientific bio-, psycho-, social pandemic has made the situation worse as the information so as to provide effective treatments for already limited resources available for the care of our patients. In this session, speakers, including a older adults with mental health disorders has been first year resident, a recent fellowship graduate and further depleted, as resources have been reallocated three senior colleagues from three countries will for the care of medical complications due to COVID- translate the science into practical strategies for 19. The American Association for Geriatric Psychiatry recruitment, education, policy, and everyday clinical (AAGP) is the only national organization that has practice. Active interactions with attendees will products, activities and publications, which focus focus on psychiatry as a a career and and issues for exclusively on the challenges of geriatric psychiatry. immigrant and postpartum women and advice for The AAGP in response to the COVID-19 pandemic protecting against stalkers, enriched by presenters' made changes to its leadership structure to deal multigenerational perspectives. Attendees will be better with the crisis. Additionally, the AAGP has gratified to find that many of the tools they need to initiated programs to maintain and then enhance its improve the lives of women are things they can educational, research, advocacy and clinical easily learn. missions. In this symposium, the AAGP's Co- Presidents and Executive Director will discuss the Caring for Older Adults With Mental Health effect of COVID 19 on older adults with mental Disorders and Dementia: American Association for health disorders in addition to individuals with Geriatric Psychiatry’s Response to the COVID-19 dementia and their care partners, they will describe Pandemic the changes in AAGP's leadership structure that Chair: Rajesh R. Tampi, M.D., M.S. were initiated to manage the fall-out from COVID19 Presenters: Brent Forester, Christopher Wood, Marc crisis and finally enumerate the steps taken by the Agronin leadership to maintain AAGP's educational, research, advocacy and clinical missions. EDUCATIONAL OBJECTIVES: At the conclusion of this session, the participant Developing Rapidly Acting Antidepressants: should be able to: 1) To discuss the effect of COVID Neurosteroids, Dissociative Agents (Ketamine 19 on older adults with mental health disorders; 2) Analogues and Psilocybin), and Accelerated Theta To discuss the effect of COVID 19 on individuals with Burst r-TMS dementia and their care partners; 3) To describe the Chair: Alan F. Schatzberg, M.D. Presenters: Samantha Meltzer-Brody, Charles be faster in onset than traditional r-TMS and to be DeBattista, Nolan Williams safe. The implications of these efforts for current treatment as well as further treatment development EDUCATIONAL OBJECTIVES: are discussed. At the conclusion of this session, the participant should be able to: 1) have a working knowledge Population-Based Approaches for Patients in regarding recent efforts to develop rapidly effective Medical Settings: Delivering More Equitable Care? treatments for depression; 2) understand how Chair: Michael C. Sharpe, M.D. mechanisms of action affect relative efficacy and Presenters: Nancy Byatt, Jesse Fann, Mark Oldham side effects; 3) be able to delineate specific r-TMS strategies. EDUCATIONAL OBJECTIVES: At the conclusion of this session, the participant SUMMARY: should be able to: 1) to understand benefits and Most patients who suffer from major depression challenges of delivering population-based psychiatric eventually respond to antidepressant medications or care in medical settings; 2) be able to describe best devices, alone or in combination. However, a practices for screening for mental health and considerable minority may not respond to typical substance use disorders in perinatal care settings; 3) strategies and there is a need to develop agents with be able to describe a population-based approach to novel antidepressant mechanisms. In this integrated psychosocial oncology care.; 4) be able to symposium, we review the status of four novel describe the four principles of proactive approaches to depressed patients, all of which have consultation-liaison psychiatry; 5) to appreciate the data to indicate that they are rapidly effective. These role of C-L psychiatry in medical care. new strategies rely on alternative mechanisms of action to previously approved agents. They include SUMMARY: ketamine and other glutamatergic agents, the The first talk in this session, by Michael Sharpe MD, hallucinogen psilocybin, the neurosteroids, and will describe the challenge of providing equitable accelerated theta burst r-TMS. DeBattista will review and effective psychiatric care. The limitations of a studies on ketamine and its various enantiomers and referral-based model of practice will be described analogues as well as the hallucinogen psilocybin and population-based approaches proposed as a which is currently being actively studied in refractory solution. The role of population screening and the and non-refractory depression. His talk will attempt importance of the service following the case to unravel ketamine’s various putative mechanisms identification will be emphasized. Effective post- of action (NMDA antagonism, mu opioid agonism, screening services include integrated care with etc.) that could explain clinical efficacy. Psilocybin is clinical teams, collaborative care and proactive a potent serotonin 2a/c receptor agonist that acutely consultation. These three innovative service models induces a dissociative/psychotic state and that will be examined using examples from three appears to induce relief in anxious and depressive different medical settings; namely perinatal care, symptoms in carcinoma patients with cancer care and inpatient medical care. The second anxiety/depression and potentially in refractory talk, by Nancy Byatt DO, will describe integrated depression. The relationship of the psychological perinatal psychiatric care. Mental health or response to the drug to ultimate antidepressant substance use disorders affect one in five women actions will be reviewed. Samantha Meltzer-Brody during pregnancy or during the year postpartum. will provide an update on the development of These disorders increase the risk of adverse neurosteroids—allopregnanolone derivatives—to maternal, infant, and child outcomes and account treat post-partum depression as well as refractory for 9% of maternal mortality. Given that frontline major depression. Last, Nolan Williams will present perinatal care providers are in an ideal position to recent data on accelerated theta burst that targets intervene, it is recommended that psychiatric care is theta wave activity and appears to induce positive integrated into perinatal care. This presentation will change in less than 3 days. The treatment appears to review how to detect, assess, and treat perinatal mental health and substance use disorders in 3) Suggest avenues to continue the work of the Task perinatal care settings and review models for doing Force in the future. so. The third talk, by Jesse Fann MD, will address collaborative psychiatric care of cancer patients. SUMMARY: Despite distress screening, it remains a challenge to Recent events have led many health advocates to ensure that all patients identified as having a expound on the relationship between healthcare psychiatric need, receive evidence-based treatment. and social justice. COVID-19, which has The collaborative care model is a team approach to disproportionately affected people of color, and population-based integrated psychosocial care that barbarous treatment of unarmed Black people by is reimbursable and effective in oncology settings. law enforcement officers shifted our attention to This talk will discuss how to implement collaborative how systemic racism can affect occupational, care by describing the core principles of the model residential, educational, nutritional, safety and and tools for implementation within oncology healthcare options and outcomes for minorities in settings. The experience of collaborative care at the the United States. Many medical organizations, Seattle Cancer Care Alliance will be presented as an including the APA, responded by denouncing racism. example. The fourth talk, by Mark Oldham MD, will Some groups vowed to increase diversity, equity and describe proactive psychiatric consultation in the inclusion in organized medicine. In May 2020, APA medical inpatient setting. Proactive consultation- President Jeff Geller committed to making structural liaison (C-L) psychiatry has sought to develop a new racism a top priority for the presidential year. On active approach to the psychiatric care provided to June 5, 2020, he hosted the APA’s first Structural general hospital inpatients. This presentation Racism Town Hall and appointed the APA reviews how the following four principles are Presidential Task Force to Address Structural Racism implemented within proactive CL psychiatry: a Throughout Psychiatry. The Task Force has population approach, a prevention mindset, endeavored to study structural racism in psychiatry multidisciplinary teamwork, and cross-specialty and to provide resources, including educational integration. The expanding literature on proactive material and town hall meetings, that can stimulate consultation-liaison psychiatry will be reviewed and discussion about how racism affects psychiatric the range of potential benefits including reduced patients, practice, policy, and perceptions. During length of stay, improved mental health care the session, Task Force members will describe the utilization, and improved staff satisfaction described. charge and other processes that have informed the The session will conclude with a panel discussion in Task Force’s work and will share the which all the speakers will respond to audience recommendations for reform made by it in reports questions and draw out common themes and to the APA Board of Trustees for consideration. The practical lessons for both C-L and general psychiatric session will review particular Task Force activities, practice including antiracism initiatives of APA Councils. Participants will be encouraged to discuss and Presidential Town Hall on Structural Racism #5: suggest future topics and avenues to continue the Annual Update work of the Task Force. Chair: Cheryl D. Wills, M.D. Presenters: Michele Reid, M.D., Renee Leslie Binder, Social Justice and Human Rights for Individuals M.D., Charles Dike With Mental Illnesses Presenter: Dinesh Bhugra, M.D. EDUCATIONAL OBJECTIVES: At the conclusion of this session, the participant EDUCATIONAL OBJECTIVES: should be able to: 1) Understand some effects that At the conclusion of this session, the participant racism has upon psychiatric patients, practice, policy should be able to: 1) Differentiate between and perceptions; 2) Recognize the charge of the Task characteristics of stigma and discrimination; 2) Force and the processes that have informed its work; Understand dimensions of health and human rights; 3) Be aware of existing discrimination across countries; 4) Explore routes to advocacy for their patients and carers; 5) Be aware of campaigns for EDUCATIONAL OBJECTIVES: health equity. At the conclusion of this session, the participant should be able to: 1) Define the relationship SUMMARY: between psychiatry, psychoanalysis and Stigma against mental illnesses and those with psychodynamic psychiatry; 2) List barriers to mental illness as well as those who look after equitable access to psychodynamic and individuals with mental illnesses is common. Various psychoanalytic treatments in the United States; 3) anti-stigma campaigns have contributed to some List basic psychoanalytic principles that contribute to reduction but it has not been eliminated altogether. understanding international conflicts; 4) Apply basic Discrimination against people with mental illnesses psychoanalytic/psychodynamic principles in a variety is rife. In a survey of the laws of 193 countries of mental health and substance use disorder care around the world, we studied 4 rights-right to vote, settings. marry, inherit property or make a will and employment. Although all countries are signatory to SUMMARY: the UN Charter for the Rights of persons with In a time of increased attention to health equity and Disability, only about 40% of countries allow all the social determinants of health, psychosocial four rights. In a separate study of 52 members of the treatments that engage psychosocial experiences British Commonwealth, only 48% of countries have like adversity and trauma are increasingly relevant. mental health policies. This indicates that there is This Presidential Session will review evidence that still a long way to go to bring about equity between emerging science supports a biopsychosocial model those with physical and mental illnesses. Training for psychopathology over a biomedical one, will mental health professionals to be advocates for their address the future role of a psychodynamic patients and their rights is a crucial step. Stigma perspective in general psychiatry, and explore against mental illnesses and those with mental clinical, theoretical, research and policy issues illness as well as those who look after individuals related to the future roles of psychotherapy and with mental illnesses is common. Various anti-stigma psychoanalysis. Dr. Plakun’s presentation will campaigns have contributed to some reduction but explore psychodynamic psychiatry as the it has not been eliminated altogether. Discrimination intersection of psychoanalysis with general against people with mental illnesses is rife. In a psychiatry, and examine issues in expanding access survey of the laws of 193 countries around the to psychodynamic treatments, including the impact world, we studied 4 rights-right to vote, marry, of the ruling in the landmark Wit v. United inherit property or make a will and employment. Behavioral Health class action, in which he served as Although all countries are signatory to the UN a plaintiffs’ expert. Dr. Wolfe will speak about Charter for the Rights of persons with Disability, only challenges to psychoanalysis from her experience as about 40% of countries allow all the four rights. In a a practitioner, training and supervising analyst, past separate study of 52 members of the British president of APsaA and president-elect of the Commonwealth, only 48% of countries have mental International Psychoanalytical Association. This health policies. This indicates that there is still a long includes perspectives on evolving theory, practice, way to go to bring about equity between those with education, research, her efforts to rebuild the physical and mental illnesses. Training mental health connection between the American Psychoanalytic professionals to be advocates for their patients and Association and the APA, and the contributions of their rights is a crucial step. psychoanalytic thinking to understanding international conflicts. Dr. Dwaihy, a private The Future of Psychodynamics, Psychotherapy, and practitioner who sought psychoanalytic education Psychoanalysis largely outside of institutional settings, will discuss Chair: Joseph R. Dwaihy, M.D. ways psychoanalytic/psychodynamic practice and Presenters: Joseph R. Dwaihy, M.D., Eric Martin theory can be incorporated into a range of clinical Plakun, M.D., Harriet Leeds Wolfe, M.D. settings, from the inpatient units to the outpatient office, including the use of psychodynamic in the recovery approach of Paul Grant and Aaron psychopharmacology. Following the presentations, Beck who showed that defeatist beliefs could be there will be a panel discussion and then an changed along with graded activity scheduling to interactive discussion with participants. improve even the most severe cases of chronic schizophrenia. More recent developments are The History of the Development of Cognitive described including the use of compassion focussed Behavioral Therapy for Psychosis therapy to treat critical hallucinations, acceptance Presenter: Douglas Turkington, M.D. and commitment therapy, mindfulness and imagery based approaches including Avatar therapy. Coming EDUCATIONAL OBJECTIVES: up to date cognitive remediation has added to the At the conclusion of this session, the participant CBT approach by helping cognitive deficits and should be able to: 1) Understand the roots of CBT for imagery based approaches have helped psychosis; 2) Learn the contributions of key with unprocessed traumatic memories and PTSD pioneers; 3) Learn how CBT techniques for psychosis within psychosis. Method of levels approaches based have changed over time; 4) Understand the evidence on Perceptual Control Theory have led to a renewed base; 5) Know where to find key publications. focus on working with conflict in schizophrenia. Potential future developments in CBT for psychosis SUMMARY: will be explored along with some of the key issues The development of CBT for Psychosis will be arising in training, supervision and implementation. described from the first publication in 1952 where Aaron Beck treated a systematised paranoid Sunday, May 02, 2021 delusion to the present date. Key early behavioral approached are described including Is Psychiatry’s Identity in Crisis? Implications for coping strategy enhancement for Residency Education hallucinations (Tarrier) and behavioral activation for Chair: Adam Marshall Brenner, M.D. negative symptoms (Rector). The contributions of Presenters: John Burruss, M.D., Sallie DeGolia, M.D., David Fowler, Richard Bentall and David Kingdon will Tracey Guthrie, M.D., David Ross, M.D. be described including the emergence of normalizing explanations to reduce stigma and the EDUCATIONAL OBJECTIVES: understanding of the personal meaning of certain At the conclusion of this session, the participant psychotic symptoms. It will be described how a full should be able to: 1) The attendee will understand process of CBT developed based on generation of a why psychiatry's identity seems to be in a chronic collaborative formulation including trigger, appraisal, state of crisis.; 2) The attendee will be able to exacerbating factors such as anxiety and sleep explain the relationship between's psychiatry's deprivation along with safety behaviors such as identity and the different explanatory models of social avoidance. The emergence of an early psychiatric illness.; 3) The attendee will be able to evidence based will be described including the define how an appreciation of the complexity of our development of low-intensity and high yield CBT for field leads to concrete implications for training new psychosis techniques which became widely deployed psychiatrists.. by psychiatrists and other mental health professionals as part of their day to day practice. The SUMMARY: central role of CBT in early intervention for psychosis A recent NEJM article referred to psychiatry’s will be described in line with the work of “identity crisis”. This is only the latest in a long line McGorry, Birchwood and Morrison. The emergence of articles that make this assertion over the decades. of metacognitive therapy of psychosis wil lbe Is our profession in an identity crisis? What are the described in relation to targeting meta-beliefs about fundamental questions about our identity has a worry, rumination and thought suppression. The field? How long has this “crisis” been going on? Will treatment of very disabled people with primary our field ever mature to a point where our identity is negative symptoms of schizophrenia was pioneered not in crisis? And in the meanwhile, what are the implications for what we teach our residents and recommending striving for better work-life balance how we utilize an always limited set of resources or practicing more yoga. Developing individual traits (resident time and faculty time especially)? such as resilience and grit can help navigate Psychiatry’s identity has long been complicated by challenges inherent to psychiatry. Psychiatrist the complexity of the illnesses we treat. routinely face career challenges that are more Neuroscience, general medicine, narrative commonplace in psychiatry. Some potential psychology, culture and the social and structural challenges include being stalked by former patients, determinants of health - all are necessary being named in civil litigation involving suicide, and components of any attempt to explain the etiology experiencing vicarious trauma. The panelists will and course of psychiatric illness. Attempts to narrow present information regarding these and other the scope of our explanatory models have potential challenges. They will discuss potential historically led to pendulum swings of competing approaches for navigating each scenario. For paradigms. In addition, the healthcare systems example, our understanding of the impact of chronic where psychiatrists see patients have also exerted stress has improved over the last several years. pressures that shape our profession’s identity. In this Vicarious trauma was added to the “A criteria” for symposium our panelists will explore the question of PTSD in the DSM-5, demonstrating the potential our field’s identity from the perspectives of health impact of repeated exposure to aversive content. Dr. care systems, advances in neurobiology, the place of W. Newman will provide an overview of potential narrative and psychotherapy, and the emerging pitfalls to wellness for psychiatrists, including awareness of social injustice as a determinant of boundary violations and stalking by patients. He will mental illness. Emphasis will be placed on discuss resilience and grit and recommend ways to understanding why identity questions may be foster those traits. Dr. Thompson will present the intrinsic to our field, as opposed to a crisis, and how development of Type A traits through the lifespan. this should guide our educational agenda. He will highlight positives and negatives of Type A traits and how they impact psychiatric practice. Dr. Navigating Potential Pitfalls to Wellness for Scott will cover the personal and professional impact Psychiatrists of being named in a lawsuit, highlighting cases Chair: William J. Newman, M.D. involving completed suicides. He will additionally Presenters: Christopher R. Thompson, M.D., Charles provide tips for navigating that process effectively. Leon Scott, M.D., John M. W. Bradford, M.D., Brianne Dr. Bradford will share his personal experiences with M. Newman, M.D. vicarious trauma. He will recommend ways to identify and mitigate the long-term risks. Dr. B. EDUCATIONAL OBJECTIVES: Newman will provide information on specific At the conclusion of this session, the participant mechanisms for maintaining wellness, with an should be able to: 1) Understand individual emphasis on their benefits for psychiatrists. She will personality traits that hasten burnout; 2) Better recommend practices for practitioners at different appreciate the impact of career-specific pitfalls phases of their careers. Understanding potential including being stalked by former patients, being pitfalls to wellness and how to navigate them can named in civil litigation involving suicide, and help psychiatrists strive for personal wellness and experiencing vicarious trauma; 3) Describe specific decrease their risk of burnout. mechanisms for promoting wellness in psychiatrists. Presidential Town Hall: The Assessment of SUMMARY: Psychiatric Bed Needs in the U.S. Physicians and medical trainees are displaying Chair: Anita Everett, M.D. alarming rates of depression and burnout, partially Presenters: Mark Olfson, M.D., Debra A. Pinals, M.D., related to chronic stress and frequent exposure to Robert Lee Trestman, M.D., Ph.D., C. Freeman, M.D., traumatic situations. Psychiatrists face risks unique M.B.A., Isabel K. Norian, M.D., Sandra M. DeJong, to the field. Addressing physician burnout goes M.D., Kristen Hassmiller Lich, Ph.D., Kenneth beyond merely holding informational sessions Minkoff, M.D. psychiatrist met during the pandemic was EDUCATIONAL OBJECTIVES: irremediably altered by the changes in how At the conclusion of this session, the participant psychiatry was practiced.; 3) To learn about the should be able to: 1) Provide culturally competent effects of the COVID-19 pandemic on the care for diverse populations; 2) Identify barriers to psychodynamic education and training of medical care, including health service delivery issues; 3) students and psychiatric residents.; 4) To learn how Apply quality improvement strategies to improve the pandemic affected psychiatrists working on the clinical care. front lines of medical care with patients having become profoundly ill and many dying from COVID- SUMMARY: 19.; 5) To obtain a psychodynamic perspective on The 2020-2021 APA Presidential Task Force on mourning and grief reactions brought about by the Psychiatric Beds is charged with the development of impact of COVID-19 on individuals and their a model that can be used to determine the number families.. of psychiatric beds needed in any jurisdiction like a state or a county. The outcomes can be compared to SUMMARY: the current capacity of psychiatric beds in the United The COVID-19 pandemic has had profound effects on States, with resultant recommendations depending the mental health of individuals and families, and on upon the discrepancies between the model’s results psychiatric training and practice. The American and actual bed counts. This session will highlight the Academy of Psychodynamic Psychiatry and status of the task force's work defining the Psychoanalysis (AAPDPP) proposes to present a 90- contemporary psychiatric “bed”, reviewing funding minute workshop with the title: "Psychodynamic mechanisms that support the current capacity of Lessons from the Novel Coronavirus Pandemic." Our inpatient care, setting benchmarks for high quality or workshop will be chaired by Gerald P. Perman, M.D., high fidelity, and assessing the impact of variability Immediate Past President of the AAPDPP, and will in diverse populations in need of inpatient include presentations by Dr. Perman and four other psychiatric treatment. The session will also address distinguished speakers followed by a Q&A session. the critical shortage of access to inpatient care and Dr. Perman will describe how the coronavirus services for children/adolescents. Finally, the session pandemic, with the need for self-quarantine and will provide an update on where the Task Force social distancing, affected patients in outpatient stands with development of a white paper that psychiatric treatment. He will characterize common includes psychiatric inpatient beds as well as defenses used by patients to manage the challenges community services and alternatives that might presented by the pandemic with a resultant increase mitigate the demand for adult and child/adolescent in psychiatric morbidity, but also how in other inpatient beds. instances social isolation aided the healing of pre- existing interpersonal and interfamilial conflict. Psychodynamic Lessons From the Novel Douglas Ingram, M.D., Past Academy President, will Coronavirus Pandemic address the impact of COVID-19 on the therapeutic Chair: Gerald Paul Perman, M.D. space. He will describe how the consultation room Presenters: Kimberly R. Best, M.D., Douglas H. came to serve rather unthinkingly as the therapeutic Ingram, M.D., Eugenio M. Rothe, M.D., Saba Syed, space in which co-created dialogue unfolded and M.D. how recourse to digital technology required a rethinking of this space within which the psychiatrist EDUCATIONAL OBJECTIVES: and patient worked. Kimberly Best, M.D., Associate At the conclusion of this session, the participant Chairman and Program Director at Einstein Medical should be able to: 1) To demonstrate some of the Center, Philadelphia, PA, will discuss ways in which serious psychodynamic effects that the COVID-19 the pandemic dramatically affected medical student pandemic had on patients in an outpatient education and psychiatric training. Psychiatric psychiatric practice.; 2) To describe how the trainees were exposed to patients with COVID-19 or psychiatric space within which the patient and with unknown status, often without necessary supplies of protective equipment or test kits. Classes behavior, and death by suicide. The insomnia-suicide were cancelled, rotation schedules changed, and relationship has been best described in patients with telepsychiatry was implemented. Residents had to depressive disorders, but has recently been shown deal with their own anxieties while simultaneously to be present in persons with schizophrenia, too. attending to the needs of psychiatric patients who The insomnia-suicide relationship remains in persons themselves were impacted by the pandemic. Syed with depression after adjusting and controlling for Saba, M.D. works for the Department of Health the severity of other symptoms of depression.The Services in Los Angeles and has had extensive mechanistic pathways which mediate the insomnia- experience in consultation-liaison psychiatry. She suicide relationship have yet to be proven, but there was thrust into a front-line position as a psychiatrist are many candidate theories. For example, persons within the public health system caring for patients with insomnia often exhibit physiologic with severe mental illness. She will describe changes hyperarousal, which is thought to be a common that she made in the delivery of consultative care feature of persons with suicidal ideation. Also, including collaboration with primary medical teams severe insomnia is associated with difficulties in to assist with diagnostic clarification, behavioral higher executive function, which is similarly seen management and recovery while balancing staff and among survivors of suicide attempts when they try patient safety concerns. Finally, Eugenio Rothe, M.D, to solve personal problems. The insomnia-suicide President of the American Association of Social relationship has been replicated so many times that Psychiatry, was deeply moved by cases of it can now be justifiably incorporated as an indicator unresolved mourning and memories of previous of increased risk of suicide during a clinical separations from loved ones that were elicited by encounter. For example, if an established patient the pandemic lockdown. He will present brief complains of a recent, serious emergence of patient vignettes in support of his presentation. insomnia, then this might lead a psychiatrist to dig deeper into recent worsening of risk of suicide. Monday, May 03, 2021 Nightmares represent an independent risk factor for suicidal ideation and suicidal behavior, over and Addressing Insomnia in Psychiatric Practice: A above the risk that is seen attributable to insomnia Modifiable Risk Factor for Suicidal Ideation when nightmares and insomnia co-occur. A Chair: William Vaughn McCall, M.D. relationship between hypersomnia and suicide is not yet well-described, but obstructive sleep apnea is a EDUCATIONAL OBJECTIVES: concern in MDD patients with insomnia. The timing At the conclusion of this session, the participant of sleep in relation to the 24-hour circadian clock is should be able to: 1) To understand the also relevant, as persons with a delayed sleep-wake epidemiologic relationship between insomnia and cycle have greater suicidal ideation. Treatment of suicide; 2) To describe the possible mediating insomnia in MDD patients with suicidal ideation mechanisms between insomnia and suicide; 3) To often begins with SSRIs, SNRIs, or bupropion, but incorporate insomnia as an indicator of suicide risk these choices do not reliably resolve insomnia in within the psychiatric encounter; 4) To clarify the MDD. Cognitive behavior therapy for insomnia (CBT- insomnia-suicide relationship in the context of I) is recommended by the American College of nightmares, hypersomnia, and obstructive sleep Physicians and the American Academy of Sleep apnea; 5) To create treatment plans for treating Medicine as the first-line treatment of insomnia, but insomnia in patients at risk of suicide. access to therapists trained in CBT-I is limited. As a result, psychiatrists treating insomnia in suicidal SUMMARY: MDD patients may need to consider instead the Epidemiologic studies across the globe have adjunctive use of hypnotic medication. While universally established insomnia as a risk factor for suicidal self-poisoning often incudes the suicide, and the risk has been demonstrated in combination of hypnotic medications with alcohol or children, adolescents, young adults and the elderly. other drugs, hypnotics by themselves rarely seem to Insomnia is a risk factor for suicidal ideation, suicidal induce suicidal ideation. The judicious and time- limited addition of hypnotics to SSRIs may reduce state of investigational pharmacologic treatments suicidal ideation to a great extent than SSRIs alone in for those who develop a cannabis use disorder. suicidal MDD patients with severe insomnia. Research has focused on noradrenergic, serotonergic and gabaminergic agents, cannabinoid agonists and Facing the Challenge of Cannabis Legalization: antagonists, endocannabinoids, and anti- Psychiatry’s Role glutaminergic and novel agents such as ketamine. Chair: Kevin Allen Sevarino, M.D. While many of these agents may ameliorate some Presenters: Timothy W. Fong, M.D., Frances Rudnick aspects of cannabis withdrawal, facilitation of Levin, M.D., Laurence Westreich, M.D. abstinence has been elusive. Certain agents may reduce use but whether this results in clinically EDUCATIONAL OBJECTIVES: meaningful improvement is unclear. Examining the At the conclusion of this session, the participant role of gender, age, co-morbidity, motivation to should be able to: 1) Describe the extent of cannabis cease use, and severity of cannabis use may allow legalization in the US and its territories for medicinal for the refinement of how to best assess efficacy in and recreational use; 2) Identify risks and benefits of better defined populations. Dr. Laurence Westreich the therapeutic use of cannabis; 3) Review promising will discuss the challenges for U.S. employers and avenues of research for treatment of cannabis use employees of the legal, business and practical issues disorder; 4) Discuss the increasing challenge for U.S. of cannabis use in the workplace as well as the employers and employees regarding legal, business, tension between perceived risk to public and and practical issues of cannabis use in the individual health and the civil liberty constraints workplace.. implied by prohibition of cannabis use. Employers must manage a rapidly changing set of federal and SUMMARY: state laws, legal obligations concerning safety- Dr. Kevin Sevarino will provide a brief overview. As sensitive positions, potential Americans with of Jan. 2021 medicinal use of cannabis had been Disabilities Act lawsuits, confidentiality, and the legalized in 35 states, the District of Columbia (D.C.) notoriously long-lasting THC molecule in drug tests. and 4 U.S. territories. Recreational use has been Relatively few data exist on workplace accidents or legalized in 15 states, D.C. and 2 territories and use lost productivity due to cannabis, the effects of has been decriminalized in another 15 states and the instituting drug testing programs for cannabis, and U.S. Virgin Islands. Indications for medicinal use of the cost/benefit of Employee Assistance Programs. cannabis vary between states and are often The information presented will inform psychiatrists approved despite lack of evidence for efficacy, or and other clinicians in a advising their patients positive evidence of harm. State laws may conflict regarding pre-employment and occupational drug with federal law, including in industries regulated by testing. A panel discussion will follow. federal guidelines prohibiting cannabis use. Dr. Timothy Fong will review the current evidence for The Psychology of Racism and Nonviolence therapeutic benefits and adverse effects of cannabis Chair: Nassir Ghaemi, M.D. used for medicinal purposes. As cannabis becomes Presenters: Steven Roberts, Charles Collyer, more available via permissive laws, psychiatrists Clayborne Carson, James Lawson must strengthen awareness and understanding of what is currently known about the therapeutic EDUCATIONAL OBJECTIVES: effects of cannabis in order to better educate and At the conclusion of this session, the participant inform patients and families. There has been a surge should be able to: 1) To examine the psychological in the demand for cannabis to be used as medicine aspects that contribute to American racism; 2) To along with a dizzying amount of misinformation and explore psychological components of nonviolent myths. This review will succinctly summarize the methods to combat racism; 3) To describe historical evidence that can provide psychiatrists with a experience with identifying and combating roadmap on how to address the issues with inquiring psychological aspects of racism in the US. patients. Dr. Francis Levin will review the current SUMMARY: This past year has identified increasing and persistent tensions in the United States around racism. The continuing experience of racism in the United States tends to be examined from social, economic, and legal perspectives. The psychological aspects of American racism are less well understood and less frequently discussed. In this symposium, psychologists and participants in the civil rights movement will provide their perspectives.