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.”
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
