Fall 2008 Also Inside: Surviving Suicide Loss The Causes and Prevention of Suicide New Geriatric Psychiatry Fellowship Teaching and Learning Psychotherapy MESSAGE FROM THE CHAIRMAN Message Jamesfrom H .the Meador-Woodruff, Chairman M.D. elcome to the Fall 2008 issue of UAB Psychia- try. In this issue, we showcase some of our many departmental activities focused on patients of Wevery age, and highlight just a few of the people that sup- port them. Child and adolescent psychiatry is one of our departmental jewels, and is undergoing significant expansion. I am par- ticularly delighted to feature Dr. LaTamia White-Green in this issue, both as a mother of a child with an autism- spectrum disorder (and I thank Teddy and his grandmother both for agreeing to pose for our cover!), but also the new leader of the Civitan-Sparks Clinics. These Clinics are one of UAB’s most important venues for the assessment of children with developmental disorders, training caregivers that serve these patients, and pursuing important research outcome of many psychiatric conditions. One of our junior questions. The Sparks Clinics moved into the Department faculty members, Dr. Monsheel Sodhi, has been funded by of Psychiatry over the past few months, and I am delighted this foundation for her groundbreaking work to find ge- that we have Dr. White-Green to lead our efforts to fur- netic predictors of suicide risk. I am particularly happy to ther strengthen this important group of Clinics. As you introduce Karen Saunders, who shares how her own family will read, we are launching a new capital campaign to raise has been touched by suicide. funds to endow a new professorship in honor of Dr. Lee Ascherman, who gets much of the credit for having built Psychiatric care, due to many factors including insurance over the past 15 years our child and adolescent program. reimbursement, has changed over the past decade to em- Once funded, this chair will allow us to recruit a research phasize the use of medications, and shorter and less fre- star that focuses on understanding the psychiatric disorders quent visits with patients. We continue as a department to of childhood. We are in discussions to expand our child value traditional “talking” therapy, and I am thrilled to have and adolescent programs even further, and will hopefully an article by Dr. Fred Griffin that highlights the depart- have more exciting announcements in our next issue. ment’s ongoing commitment to these therapies and to the teaching of our residents these important skills. Geriatric Psychiatry is a similarly vibrant program, staffed by four extremely talented geriatric psychiatrists. Our most As I write this, we are in the middle of a global econom- recent addition to this group, Dr. Bates Redwine, discusses ic crisis that has dramatically affected all of us, including depression in the elderly in this issue, a significant and of- UAB. I am in the middle of trying to find ways to increase ten unrecognized problem in this age group. One of the revenues and decrease costs to preserve as much of the ser- most exciting developments in Geriatric Psychiatry at UAB vices we provide as a department as we possibly can. We is that we have applied to reopen our geriatric fellowship, to all know that we are in a difficult period and it is not clear train more geriatric psychiatrists to serve the state; we plan how long this crisis might last. Our departmental mission to reopen the fellowship next summer, and already have one is excellence of clinical care, patient safety, education of the of our residents lined up to train in this program. highest quality, and the generation of important new find- ings from research. I pledge to you that we cannot and will By far, most of the patients we serve are non-geriatric adults. not lose sight of this mission despite the hard times that We have chosen just one of many of the common problems have already impacted us of our patients of young and middle age adulthood, that of suicide. I am pleased that our department has partnered Sincerely, with the local chapter of the American Foundation for Suicide Prevention. Dr. Daniel Dahl, our Vice Chairman for Education and Clinical Affairs serves as their president. UAB Psychiatry fielded one of the largest teams to walk in the annual “Out of the Darkness” Walk this summer to raise funds, but more importantly awareness, of this fatal UAB PSYCHIATRY | FALL 08 TABLE OF CONTENTS 2 3 Table of Contents 3 Autism: A Personal Story By Dr. LaTamia White-Green 4 4 New Director for Civitan-Sparks Clinics Dr. LaTamia White-Green 5 Surviving Suicide Loss 6 What I Have Learned 6-7 The Causes and Prevention of Suicide New Research Direction in Psychiatry 7 New Geriatric Psychiatry Fellowship 7 A Team Approach 8 Depression is Not Normal at Any Age By M. Bates Redwine, M.D. 9 9 Teaching and Learning Psychotherapy Listening and Professionalism 10 Director Spotlight Department Launches Campaign to Honor Division Director Fall 2008 About the Cover Editor in Chief Dr. LaTamia White-Green along with James H. Meador-Woodruff, M.D. her mother, Laura White, and son, Teddy, is featured on the cover of this issue of Managing Editor UAB Psychiatry. This three generational M. Eve Rhea, M.A. picture captures the spirit of this issue, “Psychiatry Across the Lifespan.” Dr. Photographer White-Green is the new director of Jason Neel, M.L.I.S. the Civitan-Sparks Clinics as well as a mother of a son with an autism spectrum Publications Committee disorder. You can read about her personal journey with autism inside, and the unique David B. Allen, J.D., FACHE perspective she brings to her patients. In Gautam Bijur, Ph.D. this issue, we highlight illnesses, research, Karen Cropsey, Psy.D. "MTP*OTJEF Surviving Suicide Loss and personal stories that affect people at The Causes and Prevention of Suicide Rebecca W. Jones, M.D. New Geriatric Psychiatry Fellowship different ages. Jason Neel, M.L.I.S. Teaching and Learning Psychotherapy M. Eve Rhea, M.A. Monsheel Sodhi, Ph.D. Latamia White, M.D. UAB PSYCHIATRY | FALL 08 3 PSYCHIATRY EDUCATION Autism: A Personal Story By Dr. LaTamia White-Green varied. As I gained knowledge about the disorder, I realized that my son was manifesting several of the symptoms that were consistent with an autism spectrum disorder. Autism spectrum disorders or commonly referred to as “ASDs” are developmental disorders that are characterized by delays in language, impairments in social interactions, repetitive movements and severely limited activities and in- terests. The ASDs include autistic disorder (classic autism), Asperger’s disorder and pervasive developmental disorder not otherwise specified or PDD NOS. These disorders share some of the same symptoms, but differ in severity, age of presentation and nature of their symptoms. ASDs are not specific to any race, socioeconomic status or ethnicity. They occur in all of these groups, but occur 4 times more often in males than females. In 2007, the CDC’s (Centers for Disease Control) Autism and Developmental Disabilities Monitor- ing (ADDM) Network released data that stated 1 in 150 I“He remember might that moment ashave if it was yesterday. autism”. I had taken eight-year-old children in the U.S. has an ASD. my 3 year-old son to be evaluated at a clinic that specialized in developmental delays. After his evaluation, the psycholo- Autism spectrum disorders can be detected in children as gist on the interdisciplinary team made this statement. I told young as 18 months of age. Possible red flags for autism in- her that she was wrong and that I wanted a second opinion. clude avoiding eye contact and wanting to be left alone, not There was no way in my mind that my son was “autistic”. engaging in pretend, not understanding other people’s feel- True, he was only communicating with 1-2 word phrases and ings or being able to verbally express their own feelings, dif- was shy at times around other people. But, I attributed these ficulty in social interaction with other children, delay in lan- things to him being an only child. Theodore, or “Teddy,” was guage, having problems adapting to changes in their routines a happy and pleasant child who was well liked by his teach- and having odd movements such as pacing, hand flapping ers and peers, and enjoyed learning about cars and trucks. or rocking. No two people with autism have all of the same In my mind, autistic children sat in the corner rocking back symptoms and children can range from having severe mental and forth and lashed out aggressively at people who tried to retardation (more commonly associated with classic autism) enter their world. to having above average IQs (more common in Asperger’s Disorder). I spent my last year in medical school balancing my clerkship rotations and Teddy’s speech therapy appointments. I told If a child is suspected of having an autism spectrum disor- my family and friends that he had been diagnosed with a “re- der, a complete diagnostic evaluation is conducted in order ceptive-expressive language disorder” when they expressed to confirm the diagnosis. This diagnostic evaluation includes concern about his language or behavior. But, as he continued developmental history, parent interview, clinical observation, to be overly fascinated with cars and trucks and became fear- speech and language testing and psychological testing. Ad- ful of loud noises, I knew that something was wrong. ditional testing also includes a physical exam, genetic and neurological testing. Teddy and I moved to Birmingham in 1999 so that I could begin my psychiatry residency at UAB.