Nov 25, 2019 | Psychiatry
Mount Sinai’s Partial Hospital Program provides intensive, highly structured outpatient behavioral health services to stabilize patients suffering from acute mental health symptoms.
Mount Sinai’s Partial Hospital Program provides an intensive level of psychiatric care for patients with acute symptoms—without hospitalization. The program treats patients with a range of psychiatric conditions, and places them on specialized tracks based on symptom presentation and level of self-harm. Most of the patients who are admitted do so as a step down after being discharged from inpatient care. But the program can also be used as a step up for patients who have been getting regular care but are on a downward trend, as a way to avoid full hospitalization. “It’s great for patients to have this program as an option to reduce the length of their stay in the hospital,” said Joan Bell, MSW, Clinical Director of Ambulatory Behavioral Health Services for The Mount Sinai Hospital. “It’s so hard for people to stay on an inpatient unit, and this offers them an alternative.”
The program was launched in 2016 to fill a service gap of patients needing care after being discharged from inpatient treatment. The staff consists of one full-time psychiatrist, one full-time nurse practitioner, and seven master’s-level therapists, and they can support a total of 20 patients at a given time. Ivan Chavarria-Siles, MD, PhD, is the Medical Director, and Jessica Rothenberg, MSW, is the Clinical Director. Patients come for treatment 10:30 am-4 pm, five days per week, for a maximum of six weeks. The Sheehan Disability Scale, which is a questionnaire completed on intake and discharge that measures how patients’ disabilities affect their lives and functioning, indicates that patients leave the program feeling more equipped to engage in their work, social, and family lives.
“This is an outstanding, well-organized program designed to maximize participants’ understanding of both cognitive behavioral therapy and behavioral principles,” said a former patient. “The group size ensures participation and feedback, and individual group members are provided a comfortable space to confide personal issues and receive group support. The group leaders are both empathetic and goal-oriented, and the material covered provides a rich array of strategies to foster mental health.”
The program focuses on group therapy (five groups per day), supplemented by individual therapy and, if needed, medication management. Patients sometimes leave before the end of six weeks, depending on their progress, stepping down to the intensive outpatient program, which is three hours per day for three days each week, and then down to regular clinical therapy services. The decision about the next step is a collaborative one, with the patient and treatment team deciding together.
The program has helped a wide variety of patients, many of them working professionals. “We see lawyers, doctors, and architects, and most of them are on leave of absence because they’re coming directly from hospital inpatient stays,” said Ms. Bell. “And then they’re able to leave the program and return to work. So it’s a really helpful and hopeful program.”
Nov 22, 2019 | Psychiatry
This year’s American College of Neuropsychopharmacology (ACNP) conference takes place December 8-11 in Orlando, Florida. Faculty from the Department of Psychiatry will be contributing via the president’s plenary, panels, study groups, and posters. The schedule of talks is listed below.
President’s Plenary
Cannabinoids: Addiction, Mental Health and Therapeutics
Speaker: Yasmin Hurd, PhD
When: Sunday, 8:00-11:30 am; Dr. Hurd will speak at 8:30 am on unlocking the neurobiological impact of developmental cannabis and psychiatric risk
Where: Bonnet Creek I-VI
Panels
Using Stem Cell Models to Explore Polygenic Risk for Psychiatric Disease
Chair and presenter: Kristen Brennand, PhD
When: Monday, 8:30-11:00 am; Dr. Brennand presents at 8:40 am on exploring synergistic effects of schizophrenia risk variants using stem cells
Where: Grand Ballroom 2
Clinical and Pre-Clinical Implications for Ion Channels in Psychiatric Disorders
Presenter: James Murrough, MD, PhD
When: Monday, 3:00-5:30 pm; Dr. Murrough presents at 4:55 pm on targeting KCNQ channels for the treatment of depression
Where: Bonnet Creek XII
Recent Advances in the Role of Social Factors in Drug addiction: Preclinical and Clinical Studies
Co-chair and presenter: Keren Bachi, PhD
When: Monday, 3:00-5:30 pm; Dr. Bachi presents at 4:20 pm on neurocircuitry of simulated social interactions in cocaine addiction: implications for real-world social competence
Where: Grand Ballroom 2
Toward Precision Psychiatry in Eating Disorders – Computational Modeling of Brain Response and Behavior for Diagnostic Classification, Disease Model Development, and Outcome Prediction
Presenter: Laura Berner, PhD
When: Tuesday, 8:30-11:00 am; Dr. Berner presents at 9:50 am on neural computations of inhibitory control after remission from bulimia nervosa
Where: Bonnet Creek VII
Neuroimmune Signaling in Mental and Physical Health: Mechanisms and Interventions
Presenter: Vilma Gabbay, MD
When: Tuesday, 8:30-11:00 am; Dr. Gabbay presents at 9:50 am on neuroimmunological correlates of reward function in youth across psychiatric conditions
Where: Bonnet Creek IX
The Power of Transdiagnostic Circuit, Physiologic, and Behavioral Data to Support and Refine Critical RDoCs Domains
Chair and presenter: Harold W. Koenigsberg, MD
When: Tuesday, 8:30-11:00 am; Dr. Koenigsberg presents at 9:50 am on examining impaired emotion regulation as a transdiagnostic domain
Where: Bonnet Creek XII
Targeting Balance Among Limbic and Cortical Networks to Prevent Suffering and Suicide
Presenter: Helen Mayberg, MD
When: Tuesday, 3:00-5:30 pm; Dr. Mayberg presents at 4:55 pm on searching for a depression switch: electrophysiological changes with initial exposure to therapeutic subcallosal cingulate DBS
Where: Bonnet Creek VII
Biomarkers in Autism Spectrum Disorder: Promise for Differentiation, Subtyping, and Treatment
Presenter: Jennifer Foss-Feig, PhD
When: Wednesday, 8:30-11:00 am; Dr. Foss-Feig presents at 9:50 am on EEG response to simple sensory stimuli as a potential biomarker for predicting outcomes and differentiating syndrome-specific profiles in autism
Where: Grand Ballroom 2
Modeling and Dissection of Decision-Making Deficits Across Mood, Anxiety, Substance, and Psychotic Disorder
Presenter: Vincenzo Fiore, PhD
When: Wednesday, 2:30-5:00 pm; Dr. Fiore presents at 3:50 pm on modelling addiction in the intersection between endophenotypes and the role of environment complexity
Where: Bonnet Creek VII
Using Genome Editing Technologies to Understand the Mechanisms of Neuropsychiatric Disorders
Presenter: Peter Hamilton, PhD
When: Wednesday, 2:30-5:00 pm; Dr. Hamilton presents at 3:50 pm on CREB-mediated activation of Zfp189 in nucleus accumbens and how it drives behavioral responses to psychostimulants, but not opiates
Where: Bonnet Creek XI
Shared Risks for Brain and Heart Across the Lifespan: Impact of Sex
Presenter: Thalia Robakis, MD, PhD
When: Wednesday, 2:30-5:00 pm; Dr. Robakis presents at 2:40 pm on multi-morbidities of insulin resistance: diabetes, dementia, and depression
Where: Bonnet Creek XII
Study groups
ABCD Data Use: Challenges and Opportunities for Prospective and Current ABCD Data Users
Co-chair: Muhammad Parvaz, PhD
When: Sunday, 3:00-5:30 pm
Where: Bonnet Creek X
Should MDMA and Psilocybin be Used for the Treatment of PTSD?
Co-chair and participant: Rachel Yehuda, PhD
When: Tuesday, 3:00-5:30 pm
Where: Bonnet Creek XI
What Should the General Psychiatrist Know About Genetics?
Co-chair: Dorothy Grice, MD
Participant: Antonia New, MD
When: Tuesday, 3:00-5:30 pm
Where: Bonnet Creek X
Teaching Day Session
Neural-Immune Interactions
Speaker: Scott Russo, PhD
When: Wednesday, 11:30 am–1:30 pm; Dr. Russo will speak on neuroinflammatory mechanisms in depression
Where: Bonnet Creek I-VI
Nov 12, 2019 | Psychiatry
From left to right: Dennis S. Charney, MD, Nora Volkow, MD; Yasmin Hurd, PhD; Sabina Lim, MD, MPH; and Eric Nestler, MD, PhD.
On October 30, the Addiction Institute of Mount Sinai hosted a full day of lectures, posters, and discussions by prominent scientists, clinicians, and policymakers tackling addiction from all angles: across the lifespan, psychosocial, epidemiology, policy, neurobiology, neuroimaging, prevention, treatment, big data, and more, with a focus on addiction solutions.
Yasmin Hurd, PhD, Director of the Addiction Institute of Mount Sinai (AIMS), opened the day with a welcome address setting the scene for the day’s discussions. “The health care system for addiction is under siege,” she said. “Today is about solutions. Our objective is to start a dialogue between scientists, policymakers, and clinicians, holding everyone’s feet to the fire so we can create more opportunities to collaborate and work in tandem toward developing more effective treatment strategies, support structures, and policy infrastructure for people and families struggling with addiction.”
Her remarks were followed by introductions from Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and President for Academic Affairs for the Mount Sinai Health System, and Eric Nestler, MD, PhD, Dean of Academic and Scientific Affairs and Director of The Friedman Brain Institute at the Icahn School of Medicine at Mount Sinai. “Ultimately, the management of an illness—indeed, its perception by the public—is driven by a fundamental understanding of its causes,” said Dr. Nestler. “Society’s view of an illness depends on what we know about it, and we can rebrand addiction when we can explain it better and develop definitive treatments.”
Nora Volkow, MD, Director of the National Institute on Drug Abuse (NIDA), gave the keynote lecture on drugs and addiction in the United States. “When I first came to Washington, D.C., as director of NIDA, one of the most frustrating things was my naïve perception that policy would be guided by science—and it’s not,” she said. “So what do we need to do make sure it’s not ignored? What can we, as scientists, do to increase the likelihood that our evidence-based findings are implemented into policy?”
Dr. Volkow giving her keynote on drugs and addiction in the United States.
She emphasized the critical importance of adolescence, as this is a time of life when the brain is undergoing rapid and major development while exposed to many experiences and influences. She discussed studies showing that social and emotional deprivation increases risk for substance abuse and mental illnesses and that early drug use can modify brain development, which is why the National Institutes of Health has funded the Adolescent Brain Cognitive Development (ABCD) Study. The study examines how experiences (such as playing sports, using social media, and smoking) affect developing brains and lifelong health and wellbeing. She also showed that pain, depression, and opioid addiction are connected—16 percent of adults in the United States have a mental health disorder (mostly mood disorders) and receive more than 50 percent of prescribed opioids. She concluded by emphasizing the power of language to reduce stigma, and also highlighted that loneliness is a huge factor. “Addiction isolates, and the isolation is one of the highest hurdles that people suffering from addiction have to jump,” she said.
After the keynote, the event featured four “showcases” consisting of talks from experts followed by panel discussions: taking addiction policy into the 21st century; early predictors of addiction; objective assessment of addiction symptoms and treatment outcomes; and new frontiers in addiction treatment.
Dr. Hurd’s closing remarks included a call for translating the day’s concepts to action. “Today’s discussion provided a foundation of focused topics for future town halls, workshops, and conferences. I hope that today is just the beginning of our work in taking a more integrated and multipronged approach toward confronting addiction,” she said. The day concluded with a networking reception with posters on science, policy, and care.
Oct 29, 2019 | Psychiatry
In October 2018, the Addiction Institute of Mount Sinai (AIMS) announced its strategic alliance with Center on Addiction (CoA), formerly known as The National Center on Addiction and Substance Abuse or CASA. The alliance combines AIMS’ clinical expertise with CoA’s research, policy, and advocacy resources to design innovative and effective models of treatment for addiction for adolescent and young adult populations.
Shilpa Taufique, PhD, has been named the Director of the Alliance. In this role, Dr. Taufique will drive the Alliance’s initiatives to develop, implement, and measure the efficacy of new interventions for opioid use disorder across the Mount Sinai Health System, with a focus on adolescents and young adults. She will also develop and implement the clinical arm of Alliance projects and ensure achievement of clinical intervention-related milestones; participate in research and efficacy measurement related to the Alliance projects; and serve as primary spokesperson and liaison of the Alliance to internal and external stakeholders. Dr. Taufique will also maintain her roles as the Director of the Division of Psychology for the Mount Sinai Health System, and as the Director of the Comprehensive Adolescent Rehabilitation and Education Service at Mount Sinai St. Luke’s.
Kara Bagot, MD, joined Mount Sinai in October 2019 and will be the Medical Director of the AIMS-CoA Alliance. In this role, she will focus on assessing the efficacy of the clinical Alliance initiatives, serve as the physician expert, and work with Dr. Taufique in the engagement and liaison work with internal and external stakeholders. Dr. Bagot is a child and adolescent psychiatrist, and her research background is in adolescent substance use disorders (SUDs) and overlapping childhood psychopathology. She completed her adult and child and adolescent psychiatry and clinical research training at Yale University School of Medicine Child Study Center. Dr. Bagot’s current work focuses on the effects of technology (e.g. social media, video gaming, internet use) on development of SUDs and psychiatric illness in children and adolescents, and ways to use mobile and digital technologies to improve assessment, monitoring, and treatment of SUDs in adolescents.
In addition, Rachel Weller, PsyD, has been appointed as the Project Manager for the AIMS-CoA alliance. In this role, Dr. Weller will be responsible for all project management administration, and will support the director and research director to ensure successful operational execution of the projects. She will also assist Drs. Taufique and Bagot with development and implementation of the clinical arm of Alliance projects and with monitoring achievement of clinical intervention-related milestones. Dr. Weller is a licensed clinical psychologist whose clinical interests include trauma and resilience, co-occurring disorders (mental health and chemical dependency), diversity issues, and program development.
“It is our hope that, through this partnership, we will gain information about how we can offer useful and relevant information, resources, and services to students and their families, faculty, and the schools, at large,” said Dr. Taufique.
Oct 2, 2019 | Psychiatry
This year’s Mental Health Services Conference (IPS), put on by the American Psychiatric Association (APA), takes place October 2-6 at the Sheraton New York Times Square in Manhattan. This years’ conference focuses on four core tracks: addiction psychiatry, collaborative and interdisciplinary care, community psychiatry, and diversity and health equity.
The schedule of sessions presented by faculty from the Department of Psychiatry is listed below.
Thursday, October 3
Bipolar and Related Disorder Due to Another Medical Condition: A Case of Mania in the Setting of Glioblastoma Multiforme
Poster number: P1-022
When: 2:30-4:00 pm
Where: Poster Hall in Central Park West, Second Level
Presenters: Xavier Diao, MD; Omar Mirza, DO; and Xiteng Yan (medical student at Icahn School of Medicine at Mount Sinai)
Friday, October 4
The Engagement Challenge: Lessons From a High Utilizer Pilot
When: 10:00-11:30 am
Where: New York Ballroom West
Chair: Sabina Lim, MD, MPH
The Role of Mental Health in Getting to Zero New HIV Infections: The Science, Psychosocial Issues, and Disparities
When: 1:00-2:30 pm
Where: Riverside Suite, Third Level
Chair: Kenneth Ashley, MD
Presenter: Carmen Casasnovas, MD
Conversion Therapy: Boy Erased, Can It Alter Sexual Orientation Without Causing Harm?
When: 1:00-4:00 pm
Where: Empire Ballroom East
Presenter: Daniel Safin, MD
The Launch of a Substance Use Disorder Initiative in a Student-Run Free Clinic
Poster Number: P3-026
When: 2:30-4:00 pm
Where: Poster Hall in Central Park West, Second Level
Presenter: Ben Shuham, medical student
Co-Authors: Craig Katz, MD; Co-Author: Samuel Powell, MD/PhD student
Saturday, October 5
Controversies in Adult Psychopharmacology
When: 8:00 am–12:00 pm
Where: Columbus Circle, Lower Level
Director: Joseph Goldberg, MD
Faculty: Carrie Ernst, MD; Shari Lusskin, MD
Improving Access through a Proactive Behavioral Health Team’s Collaborative Consultation Model
When: 10:00-11:30 am
Where: Union Square, Lower Level
Chair: Marisa Schwartz, MSN
Presenters: Victoria Azzopardi, LMSW; Omar Mirza, DO
The Impostor Syndrome: International Medical Graduates Navigating Immigration Challenges and Beyond
When: 10:00-11:30 am
Where: Flatiron, Lower Level
Presenter: Ali Maher Haidar, MD
Medical History Mystery Lab
When: 3:00-4:30 pm
Where: Riverside Ballroom, Third Level
Chair: Kenneth Ashley, MD
Presenters: Carmen Casasnovas, MD; Daniel Safin, MD
Sunday, October 6
Update on Mental Health Issues in LGBTQ Youth
When: 10:00-11:30 am
Where: Riverside Ballroom, Third Level
Chair: Kenneth Ashley, MD
Presenters: Gabrielle Shapiro, MD; Ali Maher Haidar, MD
Sep 27, 2019 | Psychiatry
“With more education about opioids and medication-assisted treatment, we will make it through this crisis,” says Anita Kennedy, a certified recovery peer advocate and a peer engagement specialist.
In November 2016, Mount Sinai Beth Israel hired Anita Kennedy, a certified recovery peer advocate, as a peer engagement specialist in East Harlem. The role is funded by a grant from the New York State Office of Alcoholism and Substance Abuse Services (OASAS). Peer engagement specialists (Anita is one of two in New York City) use their personal experiences recovering from addiction to serve as a supportive resource for people seeking recovery. Her role was initially created in response to the neighborhood’s synthetic marijuana (known as “K2”) epidemic, but she covers addiction across the board, especially opioids.
Anita’s job involves going out into the community, including emergency rooms and on the streets, to engage with people struggling with substance abuse. Over the last couple of years, she has gained a reputation on the streets of East Harlem as someone people can turn to if they are ready to seek treatment. She says people routinely approach her on the streets or even on the subway in other parts of the city. “I don’t know how they know to talk to me,” she said. “People see me and, for whatever reason, they know I’ll be able to help them out.” And she and the city seem to be making inroads—in 2018, the number of deaths in New York City from opioid overdose fell from 1,082 to 1,044.
Once an individual has expressed an interest in recovery, Anita helps them get to a detox or inpatient rehabilitation program as well as to outpatient programs. She keeps in touch with them throughout the process, checking in regularly and building rapport. As they move through the system, Anita helps them build a recovery plan. The individuals decide how they define success, and Anita helps them achieve their goals by connecting them with the necessary services to make it happen. The recovery plan could include anything from setting up housing to scheduling dental work—anything that they see as a barrier to being successful, as defined on their own terms. She helps them monitor progress, following up to ask how to ensure their success will continue and what can be done next.
To achieve these goals, Anita helps peers learn and practice new skills such as how to use public transportation, parenting tips, and progressing with education like getting their GED degree. She also helps them learn and practice coping skills, like how to calm anger or how to deal with a triggering event via breathing exercises, journaling, reading, or taking a walk. She encourages them to re-engage in hobbies that they may have forgotten about that used to bring them pleasure and fulfillment. She also shows up to offer support when needed, such as court appearances and Social Security meetings, liaises with parole and probation officers, and facilitates support groups.
Anita’s role has expanded beyond helping individuals. She also spreads the word about Mount Sinai’s addiction treatment services at City Hall, health fairs, soup kitchens, the New York Public Library, halfway houses, and local police precincts. She routinely provides overdose prevention trainings by distributing Naloxone kits and showing people how to use them—in the month of June, she completed 143 of these trainings. “There’s nothing better than hearing that an organization was prepared for overdoses and saved someone’s life because of these trainings,” she said. She has administered Naloxone six times since she started. “They’re not pleased with you for saving their life,” she said. “You’ve basically ruined the best high they’ve ever had, so you need to be prepared for them to be combative.” In spite of this, all six people she rescued reached out to her for assistance, and she remained involved with their journey to recovery and rebuilding their lives.
“I vividly remember the first time I had to administer Nalaxone,” Anita said. “The person was taken to the hospital and entered a detox program, and is now in recovery. It was inspiring to see that I could help someone begin to get back to a more normal life, though I know it can be difficult and take time and support.” She added, “We are turning the tide with regard to opioid overdose deaths. With more education about opioids and medication-assisted treatment, we will make it through this crisis.”
