Sep 24, 2019 | Engagement, Featured, Psychiatry, Research
The research team from the Icahn School of Medicine at Mount Sinai included, from left, Priscilla O. Agyeman, MPH, research coordinator, Division of Liver Diseases; Principal Investigator Craig L. Katz, MD; and Sarah MacLean, third-year medical student.
Mount Sinai researchers found that children being held in an immigration detention center experienced high levels of mental health distress, with 44 percent demonstrating at least one significant emotional or behavioral symptom. The report was the first large, empirical study examining the mental health of children in U.S. immigration detention, says the Principal Investigator, Craig L. Katz, MD, Clinical Professor of Psychiatry, Global Health, and Medical Education, Icahn School of Medicine at Mount Sinai.
“Perhaps our findings should not really be a surprise,” says Dr. Katz, who considers the study a valuable baseline for further research. “Kids who had been previously separated from their parents had higher rates of emotional problems, compared to those who were always detained with a parent. And the detained children overall had higher rates of distress compared to the general population in the U.S.”
The research team from Mount Sinai spent two months in summer 2018 at a detention center in the Southwestern United States. speaking to women and children, most of whom had fled Honduras, Guatemala, or El Salvador. The researchers were not allowed to use telephones or take photographs while interviewing the families in a visitation trailer. The study was published in June 2019 in the journal Social Science and Medicine.
The mothers told stories of escaping gang violence or domestic violence in their home countries, where government and police officials often turned a blind eye. The team interviewed 425 women about their eldest child, using the standard Parent-Report Strengths and Difficulties Questionnaire. Among those 425 children, 32 percent had elevated scores for emotional problems, and the rate was 49 percent for those who had previously been separated from their parent. A subset of 150 children who were age 9 or older also completed the UCLA Post-Traumatic Stress Disorder Reaction Index. Seventeen percent of those children had a probable diagnosis of PTSD, compared with 4.7 percent in the general population of U.S. children.
“Children with emotional distress showed symptoms like wanting to cry all the time; problems with conduct, such as fighting with other kids or having temper tantrums; and peer problems like not having a lot of friends or only wanting to interact with adults,” says Sarah MacLean, lead author of the study and a third-year medical student at the Icahn School of Medicine who was part of the field team. “The children with symptoms of PTSD reported having flashbacks or nightmares about a trauma, or feeling depressed or sad.”
The field research for the study was conducted by Kim A. Baranowski, PhD, Associate Director of the Mount Sinai Human Rights Program; Priscilla O. Agyeman, MPH, a research coordinator in the Division of Liver Diseases, Icahn School of Medicine; Ms. MacLean; and Joshua Walther, a fourth-year medical student at the University of Texas Health Science Center in San Antonio, Texas. Authors of the report were the field team; Dr. Katz; and Elizabeth K. Singer, MD, MPH, Assistant Professor of Emergency Medicine, and Medical Education, Icahn School of Medicine, and Director of the Mount Sinai Human Rights Program.
Dr. Katz hopes to expand on the research, which had certain limitations. The subjects were a “convenience sample,” meaning they were the families who were accessible for interviews in the center’s visitation trailer, as opposed to a randomly selected sample. Because of the setting, some mothers completed the forms in their child’s presence, which may have influenced their responses.
The study also could not pinpoint the cause of the children’s distress, whether it was detention, or the journey to the U.S. border, or the violence they faced in their home countries, says Dr. Katz, who is also an Associate Director of the Mount Sinai Human Rights Program. Regardless of the cause, the study concluded that the children “would benefit from culturally responsive and trauma-informed mental health care.” Dr. Katz says that ideally, the mothers and children would receive appropriate psychiatric support once they settle into a community. “But even if they don’t get psychiatric help, social support helps,” he says. “Making sure people have clothes, a backpack, a phone, know how to take a bus. That support is going to make an enormous different in the trajectory of their recovery.”
Despite their higher rates of emotional distress, 98 percent of the children studied had normal scores on the “prosocial” scale, which included being considerate of other’s feelings and volunteering to help others. The team found signs of hope and humanity at the center, a broad expanse of trailers surrounded by a barbed wire fence. One boy from Honduras drew a picture and shyly presented it to Ms. Agyeman, and she intends to keep it forever. “The picture gave me a bittersweet message,” she says, “that a little boy can do the things any other kid would do, laughing and playing, even in an otherwise very sad environment.”
Sep 20, 2019 | Psychiatry
Timothy Brennan, MD, Director of the Addiction Institute at Mount Sinai St. Luke’s and Mount Sinai West, and Yasmin Hurd, PhD, Director of the Addiction Institute of Mount Sinai.
In August, Mount Sinai St. Luke’s and Mount Sinai West launched the Addiction Consultation and Evaluation Service (ACES) to address the growing need for addiction-specific support for physicians, nurse practitioners, and physician assistants caring for general medical and surgical inpatients.
Due to the opioid crisis, in recent years general medicine and surgery clinicians have been reporting an uptick in patients with addiction-related conditions, such as abscesses due to intravenous drug use, as well as patients requesting treatment for addiction. ACES was established to serve as a resource in these situations by providing prompt, evidence-based recommendations for the full range of addiction pathology, including complex withdrawal syndromes and other manifestations of substance use disorders. Since the soft launch on August 1, ACES has handled 18 consults.
ACES is currently led by Timothy Brennan, MD, Director of the Addiction Institute at Mount Sinai St. Luke’s and Mount Sinai West. The team is made up of addiction medicine fellows and addiction psychiatry fellows, and six attending physicians in two-month rotations: Prameet Singh, MD, the Site Chair for Psychiatry at MSSL and MSW; Annie Levesque, MD, Medical Director of the Opioid Treatment Program at MSW and Associate Director of the Fellowship in Addiction Medicine Program at the Icahn School of Medicine at Mount Sinai; Manassa Hany, MD; Anil Thomas, MD, Director of the Addiction Psychiatry Fellowship Program; and David Lehman, MD.
Addiction medicine is the newest member of the American Board of Medical Specialties, and hospitals and health systems are now focused on integrating addiction medicine providers into their various clinical service lines. Less than one percent of hospitals and health systems nationwide have a service like ACES, but the field is evolving quickly and organizations are adapting accordingly with their own versions. “Historically, addiction care was provided outside of the hospital by non-credentialed providers,” said Dr. Brennan. “Our goal with ACES is two-fold: to support our medical and surgical colleagues by optimizing addiction care for their patients, and also to help destigmatize addiction care and incorporate it into the fabric of other hospital services.”
Sep 16, 2019 | Psychiatry
In July, two new postdoctoral fellows began a two-year psychology fellowship to study psychosis, suicide, and major mental illness in veterans at the Mental Illness Research, Education and Clinical Center (MIRECC) at the James J. Peters VA Medical Center (JJPVAMC) in the Bronx, in partnership with the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.
In this fellowship, individualized, mentored research and clinical training is combined with a state-of-the-art curriculum that emphasizes research methods, statistics, epidemiology, mental health systems, quality improvement methods, education, and service delivery. In collaboration with their mentors, the fellows will develop and implement a research project, publish and present findings, participate in grant writing, and utilize the latest technology for educational activities and clinical service delivery. The mentorship team includes MIRECC faculty members, as well as other faculty from the Icahn School of Medicine at Mount Sinai.
Emily Edwards, PhD
Dr. Edwards received her PhD in clinical psychology from CUNY Graduate Center / John Jay College and completed a predoctoral fellowship with the Intensive Outpatient DBT program at Yale-New Haven Hospital. Dr. Edwards has provided DBT in a variety of settings, including private practice, psychiatric inpatient, and intensive outpatient. Her research focuses primarily on treatment and theory for people with emotion processing and emotion regulation difficulties. She is especially interested in adapting treatments for individuals with severe personality disorders and for forensic contexts. Dr. Edwards will be working with Erin Hazlett, PhD, and Joseph Geraci, PhD, LMHC.
Molly Gromatsky, PhD
Dr. Gromatsky received her PhD in clinical psychology from Hofstra University and completed a predoctoral internship at Northport VA Medical Center in Northport, New York. Her clinical experience has primarily involved providing DBT in a variety of settings to adults, young adults, adolescents, and their families. She is also proficient in ACT, CBT, motivational interviewing, PE, and CPT. Dr. Gromatsky’s research interests include identifying predictors and better understanding the etiology of suicide among veterans. She is particularly interested in the role of risk and resiliency factors associated with suicide, and hopes to assist in the development of screening tools to inform effective outreach interventions and treatment development. Dr. Gromatsky will be working with Dr. Hazlett.
Sep 16, 2019 | Psychiatry
From left: Erin Hazlett, PhD, Philip Szeszko, PhD, and Marianne Goodman, MD.
In August, Marianne Goodman, MD, Erin Hazlett, PhD, and Philip Szeszko, PhD, all faculty staff at the James J. Peters VA Medical Center (JJPVAMC) in the Bronx and the Icahn School of Medicine at Mount Sinai, were awarded two new grants in suicide prevention.
Drs. Goodman and Hazlett are the principal investigators on a study entitled “CTBI: Traumatic brain injury-induced inflammation effects on cognitive evaluations and response inhibition: Mechanisms of increased risk for suicidality.” This Collaborative MERIT Award involves a three-site study that will use the new 3T MRI scanner at the JJPVAMC to examine brain activation during impulsivity tasks in veterans with mild traumatic brain injury (mTBI) with and without suicide attempts. A VA site in New Jersey will do similar work using an animal model of mTBI, and a VA site in Indianapolis will examine impulsivity and inflammatory biomarkers in the same groups of veterans as the JJPVAMC.
Dr. Szeszko is the Principal Investigator on a study entitled “Predicting suicidal behavior in veterans with bipolar disorder using behavioral and neuroimaging based impulsivity phenotypes.” He will investigate two neural circuits tapping state measures of rapid response inhibition and choice impulsivity, respectively, using functional magnetic resonance imaging to predict suicidal behavior longitudinally over one year in veterans with bipolar disorder. This study will also investigate novel measures of crossing white matter fiber arrangement comprising these circuits and their relationship to impulsivity.
These renewable grants are known as VA MERIT Awards and provide funding for four years. Drs. Goodman and Hazlett also have three other suicide prevention MERIT awards, bringing the current portfolio of grants focusing on suicide prevention at the JJPVAMC to a total of four.
“We are thrilled that our neuroimaging research program is thriving in terms of its focus on the neurobiology of suicidal behavior,” said Dr. Hazlett, research career scientist at the JJPVAMC. These studies received initial support from the JJPVAMC’s Mental Illness Research, Education and Clinical Center, Mental Health Patient Care Center, and Erik Langhoff, MD, PhD, director of the JJPVAMC.
Updated on Jun 30, 2022 | Psychiatry
The Department of Psychiatry at the Icahn School of Medicine at Mount Sinai has a stellar 2019-2020 roster.
The Department of Psychiatry at the Icahn School of Medicine at Mount Sinai has put together a fantastic lineup for the 2019-2020 Grand Rounds season—check out the list below.
September 10
Mary Jeanne Kreek, MD, Rockefeller University
September 17
Emil F. Coccaro, MD, University of Chicago
September 24
Ami Klin, PhD, Emory University School of Medicine
October 1
David A. Lewis, MD, University of Pittsburgh
October 8
Yasmin Hurd, PhD, Icahn School of Medicine at Mount Sinai
October 15
Chantal Kemner, PhD, University Medical Center Utrecht
October 22
Glenn N. Saxe, MD, Hassenfeld Children’s Hospital at NYU Langone Medical Center
October 29
Donald C. Goff, MD, NYU Langone Medical Center
November 5
Walter Kaye, MD, University of California, San Diego
November 12
Nelson B. Freimer, MD, University of California, Los Angeles
November 19
Rachel Yehuda, PhD, Icahn School of Medicine at Mount Sinai
December 3
Moriah E. Thomason, PhD, NYU Langone Medical Center
December 17
Edythe D. London, PhD, University of California, Los Angeles
January 7
Kathleen Brady, MD, PhD, Medical University of South Carolina
January 21
Jacob A. S. Vorstman, MD, PhD, The Hospital For Sick Children / University of Toronto
January 28
Sarah Lisanby, MD, Columbia University
February 4
Frances R. Levin, MD, Columbia University
February 25
Carrie Bearden, PhD, University of California, Los Angeles
March 3
Scott Woods, MD, Yale School of Medicine
March 10
Elliot Hong, MD, University of Maryland School of Medicine
March 17
Justin Baker, MD, PhD, McLean Hospital / Harvard Medical School
March 24
Peter Falkai, MD, Ludwig Maximilian University of Munich
April 7
Andrew McIntosh, MD, University of Edinburgh
April 14
Antonello Bonci, MD, National Institute on Drug Abuse
May 5
Bryan H. King, MD, MBA, UCSF Weill Institute for Neurosciences
May 12
David Nutt, DM, FRCP, FRCPSYCH, FSB, FMEDSCI, Imperial College
June 23
Catherine Monk, PhD, Columbia University
Updated on Jun 30, 2022 | Psychiatry
Marianne Goodman, MD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, with her patient, Wilfredo Santos. Photo courtesy of Medical Media, JJP (Bronx) VA Medical Center.
On June 1, Marianne Goodman, MD, Associate Director of the U.S Department of Veterans Affairs’ New York Mental Illness Research Education Clinical Center of Excellence (MIRECC) and Director of the MIRECC’s Suicide Prevention and Treatment Research Program, was honored by Congressman Jose E. Serrano (D-NY) with a flag flown over the U.S. Capitol.
This was requested by one of her patients, Wilfredo Santos, who had written to Congressman Serrano to ask how to honor Dr. Goodman and the VA team for their dedication to preventing suicide in veterans via the Project Life Force (PLF) program. Congressman Serrano suggested the June 1 flag ceremony, and on August 16, the patient presented her with the flag that was flown and the accompanying dedication letter. “You often hear negative news being published about the VA, specifically related to suicide,” Mr. Santos said. “But we don’t recognize the hard work and achievements of our providers, which is why I wanted to honor Dr. Goodman. Sometimes we need to recognize good work in the news.”
PLF is one of several suicide prevention projects at the New York MIRECC. It brings veterans with recent histories of suicidal thinking and completed suicide plans together in groups for safety planning and skills training. The program incorporates elements from dialectical behavior therapy, and emphasizes building interpersonal relationships with friends, family, and the treatment team. It also includes gun safety education and recommends a mobile app to help them stay on track with their safety plans.
As they move through the program, veterans update their safety plans with the new skills they learn in therapy. While group therapy is common for treating PTSD and anger, it is typically not used for suicidal patients because the prevailing belief has been that suicidal patients mixing and discussing their thoughts could actually increase risk. However, Dr. Goodman’s group has found that at least with veterans, the effect is the opposite. “Veterans no longer feel alone,” she said. “They feel someone understands their impulses and urges.”
Dr. Goodman has worked with Mr. Santos for the last 10 years, and he believes that she saved his life through PLF. “With PLF, we communicate with other veterans in the room to offer support and generate ideas on how to distract yourself so that you don’t hurt yourself,” he said. “We truly use our suicide safety plans and make them part of our everyday lives.”
“The flag and the dedication on Capitol Hill are an incredible honor,” said Dr. Goodman. “It’s a great feeling to know that our work is helping veterans find meaning and purpose in their lives.”
