Updated on Jun 30, 2022 | Psychiatry
Timothy Brennan, MD, Director of the Addiction Institute at Mount Sinai West and Mount Sinai St. Luke’s, spoke about the opioid crisis at the White House.
On June 25, Timothy Brennan, MD, Director of the Addiction Institute at Mount Sinai West and Mount Sinai St. Luke’s, gave a speech at the White House. During the event, entitled “Building the Addiction Medicine Workforce: Giving Americans Access to the Care They Need,” he discussed the role of addiction medicine in addressing America’s opioid crisis. In particular, he emphasized the rise of addiction medicine as a medical specialty, and spoke about the importance of addiction medicine fellowships in educating the next generation of addiction change-agents.
The other speakers included James Carroll, Director of the U.S. Office of National Drug Control Policy; Admiral Brett Giroir, MD, Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS); George Sigounas, MD, PhD, Administrator for the HHS’s Health Resources and Services Administration; Nora Volkow, MD, Director of the National Institute on Drug Abuse; and George Koob, PhD, Director of the National Institute on Alcohol Abuse and Alcoholism.
Dr. Brennan is the Director of the Fellowship in Addiction Medicine Program at the Icahn School of Medicine at Mount Sinai. He has spoken at local, state, national, and international levels about addiction policy issues, particularly involving young adults. He was appointed by New York Governor Andrew Cuomo to serve on the Medical Review Board at the New York State Justice Center. He also volunteers as a member of the Adolescent Advisory Panel at the New York State Office of Alcoholism and Substance Abuse Services.
Updated on Jun 30, 2022 | Psychiatry
The Psychiatry Department faculty presented on their current research at The Metropolitan Museum of Art in Manhattan. Image courtesy of The Met.
On Thursday, June 20, the Department of Psychiatry’s third annual faculty retreat took place at the Metropolitan Museum of Art. The morning began with opening remarks from Rene Kahn, MD, PhD, Professor of Psychiatry and Chair of Psychiatry and Behavioral Health, followed by the keynote talk by Joel Dudley, PhD, Director of the Institute for Next Generation Healthcare and Executive Vice President for Precision Health, on moving from precision medicine to next generation healthcare. Over the course of the day, faculty presented on “What’s New in Psychiatry?” followed by a cocktail reception.
Schahram Akbarian, MD, PhD, Professor of Psychiatric Epigenomics, covered how the chromosomal contact map of adult dopaminergic neurons shows convergence of psychiatric and metabolic risk variants.
Nelly Alia-Klein, PhD, Associate Professor of Psychiatry and Neuroscience and Co-Chief of the Neuropsychoimaging of Addiction and Related Conditions Research Program, discussed targeting the prefrontal cortex for intervention in human drug addiction.
Michal Beeri, PhD, Professor of Psychiatry, presented on the effects of advanced glycation end products on the brain and cognition.
Lotje D. De Witte, MD, PhD, Assistant Professor of Psychiatry, discussed the role of microglia in schizophrenia and depression.
Erin A. Hazlett, PhD, Professor of Psychiatry and James J. Peters VA Medical Center (JJPVA) research career scientist, discussed clinical research at the JJPVA, from suicide to schizophrenia and bench to bedside.
Muhammad A. Parvaz, PhD, Assistant Professor of Psychiatry and Neuroscience, discussed phenotyping adolescents with elevated risk for developing substance use disorders.
Mercedes Perez-Rodriguez, MD, PhD, Assistant Professor of Psychiatry and Assistant Training Director for Research, covered challenges and strategies for recruiting, training, and retaining physician-scientists in psychiatry.
Avi Reichenberg, PhD, Professor of Psychiatry and Environmental Medicine, discussed cognitive decline in schizophrenia and bipolar disorder.
Nikolaos K. Robakis, PhD, Professor of Psychiatry, Neuroscience, and Experimental Therapeutics, discussed clinical trials and the etiology of Alzheimer’s disease.
Mary Sano, PhD, Professor of Psychiatry and Director of the Alzheimer Disease Research Center, covered prevention research for cognitive loss and Alzheimer’s disease.
Updated on Jun 13, 2019 | Psychiatry
Psychiatry residents at the Icahn School of Medicine at Mount Sinai have been awarded several prestigious national prizes and fellowships this year in recognition of their exceptional patient care, outstanding leadership, and remarkable research prowess.
Psychiatry residents and training directors at the Icahn School of Medicine at Mount Sinai.
Jessica Ables, MD, PhD, was selected as one of 12 Laughlin Fellows by the American College of Psychiatrists. She was also selected for membership in Alpha Omega Alpha, the national medical honor society, in recognition for her service as an outstanding clinician, scholar, mentor, teacher, and role model. Finally, she was selected as one of 20 residents for the Career Development Institute for Psychiatry, a highly competitive national training program funded by the National Institute of Mental Health. “I am extremely honored to be selected,” she said. “I’m thankful for the wonderful mentorship at Mount Sinai that has enabled me to be competitive for these awards.”
Youngjung Kim, MD, PhD, was one of 10 psychiatry trainees nationwide awarded the APA/APAF Leadership Fellowship. The award fosters leadership development by connecting trainees with thought leaders, peers, and mentors in order to grow their networks and learn about governance in organizational psychiatry. “It is an honor to be selected to be an APA/APAF Leadership Fellow,” said Dr. Kim. “I hope to learn from the leaders and colleagues in psychiatry to bring about a positive change in my community. I am very lucky and grateful to have amazing mentors in our Mount Sinai program who will challenge, encourage, and support me to apply for this incredible opportunity.”
Adjoa Smalls-Mantey, MD, DPhil, received the Resident Recognition Award from the American Psychiatric Association (APA). This award is given to outstanding residents who exhibit one or more of the following: compassion, leadership, community service, political action, and clinical excellence. “It is an honor to be recognized by the APA,” said Dr. Smalls-Mantey. “I hope that more trainees and faculty become involved in the APA because it is a great organization through which to effect change for patients and the field of psychiatry.”
May 30, 2019 | Psychiatry
On May 19, James Murrough, MD, PhD, director of Mount Sinai’s Depression and Anxiety Center for Discovery and Treatment, and Martijn Figee, MD, director of Mount Sinai’s Interventional Psychiatry Program, chaired a session on next-generation solutions for treatment resistant depression (TRD). The speakers covered ketamine, inflammation, deep brain stimulation (DBS), and electroconvulsive therapy (ECT).
Ketamine: Then, now, and looking ahead
Dr. Murrough discussed how the road to discovering new treatments for TRD has been paved with medications that have almost identical biological mechanisms, and that a new pathway—like targeting the glutamate system via ketamine—has been an inevitable next step. The first iteration of this, Janssen’s newly approved SPRAVATO (esketamine) CIII Nasal spray, could bring relief to millions of patients. Dr. Murrough discussed the first multi-site clinical trial of ketamine in TRD, studies on repeated dosing of ketamine for TRD, and the first study of intranasal ketamine in TRD—all conducted at Mount Sinai. He also covered the rapid antidepressant effects of the novel GABA-A modulator brexanolone, which the FDA recently approved for the treatment of postpartum depression. He concluded that the long-term efficacy and effects of ketamine remain to be seen, but based on preliminary rodent studies he believes the treatments will need to be regular and conducted indefinitely in order to maintain efficacy in patients.
Dr. Murrough discussing ketamine at the APA Annual meeting in San Francisco.
A subgroup: Patients with inflammation
Andrew Miller, MD, professor of psychiatry and behavioral sciences at Emory University, showed that as many as 25-30 percent of depressed patients exhibit the primary features of chronic inflammation. He covered how administration of inflammatory stimuli causes depressive symptoms, and how inhibition of inflammation reduces depressive symptoms. In addition to targeting the inflammation directly, he recommends targeting the “downstream effects” of inflammation on the brain, such as dopamine and glutamate systems. Dopaminergic medications these patients may respond to include bupropion, stimulants, monoamine oxidase inhibitors, and dopamine agonists. This targeted treatment, available by way of the red flag of inflammation, means precision medicine is possible for these patients.
Deep brain stimulation
Dr. Figee brought the backstory on DBS, a treatment that uses implanted electrical impulses to control symptoms for a range of psychiatric and neurologic diseases. In patients with TRD, DBS targets are part of a larger ventral corticostriatal network involved in the regulation of negative and positive mood. Although DBS is effective in approximately 50 percent of patients with TRD, it is still experimental and can only be received as part of a clinical trial. Before taking this step, however, Dr. Figee emphasizes that patients need to have gone through a variety of attempts at treatment including psychotherapy, a variety of antidepressants, at least six sessions of ECT, and possibly repetitive transcranial magnetic stimulation and ketamine. In order to be considered for DBS, the patient must have suffered from TRD for less than two years, and exhibit no schizophrenia/non-affective psychosis, no primary Axis II personality disorder, and no cerebrovascular risk factors. They must also have no other implanted devices, no drug abuse in the past six months, and no cognitive impairment or mental retardation. For more information, check out the Nash Family Center for Advanced Circuit Therapeutics.
A slide from Dr. Figee’s talk on deep brain stimulation.
Ketamine and ECT for apathy, anhedonia, and suicidal ideation
Katherine Narr, PhD, professor of neurology, psychiatry, and biobehavioral sciences at The University of California, Los Angeles, discussed how ECT and ketamine are highly effective at reducing symptoms of apathy, anhedonia (reduced ability to feel pleasure), and suicidal ideation in patients with TRD. ECT has its advantages in that about 70 percent respond and about 50 percent achieve remission, and it’s fast-acting (within 2-4 weeks), it has no systemic effects (unlike medications). Its disadvantages, on the other hand, include stigma, anesthetic effects, cost, cognitive side effects, and the fact that approximately 50 percent relapse within six months. As for ketamine, the pros include that 50-70 percent respond positively, it’s fast-acting (within hours), and has been used safely as an anesthetic since the 1960s. The disadvantages, however, are durability (approximately one week), potential psychotic and dissociative effects, it’s an easy drug to abuse, and the high cost. She concluded that over the short term, ketamine may be as effective as clinically prescribed ECT for reducing depression, apathy, anhedonia, and suicidal ideation.
May 29, 2019 | Psychiatry
At the American Psychiatric Association’s 2019 Annual Meeting in San Francisco on May 21, Rachel Yehuda, PhD, director of Mount Sinai’s Traumatic Stress Studies Program, and Adriana Feder, MD, director of Mount Sinai’s Trauma and Resilience Program, chaired a session on separating migrant families and the impact it has on mental health and resilience.
Dr. Adriana Feder presenting findings from a child separation case study at APA 2019 in San Francisco.
Dr. Yehuda opened the session by stating that the current immigration policies create an untenable situation that leads to lifelong mental health complications for the victims of family separation. She recommended focusing efforts on prevention of trauma-related consequences, since obtaining mental health care can be challenging for even the most privileged in our society.
She also posed ethical questions concerning whether mental health providers have an obligation to align professional and personal values when it comes to advocacy and fighting injustice, as well as the role of the mental health provider in the face of trauma occurring outside the context of traditional practice. “Many of us have had mental health training in which specific values have been instilled: wait for the patient to make the first move, maintain objectivity with compassion, take a non-judgmental stance, and provide support from the sidelines,” she said. “This contrasts with ideals like finding people that need help and making the initial contact, and acting out of a conviction of social justice to fix broken policies rather than just pick up pieces from inadequate and ill-advised systems.”
A case study
Dr. Feder’s segment covered results of a cross-sectional study of asylum-seeking families that took place at a U.S. Immigration and Customs Enforcement center in mid-2018, overseen by Craig Katz, MD. Sarah MacLean, a student at the Icahn School of Medicine at Mount Sinai, and two other students spent two months speaking with more than 400 mothers about the mental health of their children who were being detained with them. A subset of the mothers had been separated from their children and sent to separate facilities across the United States, then reunited before the students spoke to them. Ms. MacLean and her colleagues reported a high rate of emotional problems and total difficulties in the children that had been separated compared to those who remained with their mothers. They also assessed a subset of the older children by directly giving them a PTSD questionnaire, and found that the rate of a probable PTSD diagnosis was 17 percent, which is almost four times higher than the lifetime prevalence in the United States.
In a video recording, Ms. MacLean states that the findings highlight the need for immediate mental health treatment for long-term wellbeing, specifically comprehensive mental health screening and culturally responsive and trauma-informed mental health care. “I think the efforts of Sarah and her colleagues exemplify how psychiatry can be more proactive, community-oriented, and public health oriented,” said Dr. Katz. “We as psychiatrists need to get out there in the world and not wait for the world to come to us.”
A Canadian perspective
Rachel Kronick, MD, professor of psychiatry at McGill University, spoke about recent research on the effects of immigration detention in Canada. Her research showed that children living in detention and experiencing separation from their parents, even when very brief, exhibited depression, sleep difficulties, developmental regressions, anxiety, PTSD, and even selective mutism while in detention, and often after release. “Trauma has long-lasting effects, and when we are doing nothing, we are doing something,” she said. Ultimately, she recommends protecting children from mental health harm by prohibiting the detention of children and families, as well as the separation of children from parents.
Taking action
Alicia Lieberman, PhD, professor of psychiatry at The University of California, San Francisco, covered the developmental stages of early childhood and how the lack of a clear reunion plan, chaotic shelter environment, and lack of physical touch contribute to psychiatric conditions, and even early mortality. She emphasized that children need external resources to help them cope with fear, such as stable caregivers and safe and predictable routines, and described her work with the National Child Traumatic Stress Network (NCTSN). The NCTSN has 13 centers working with separated or unaccompanied children, such as onsite mental health clinics on either side of the border in Las Cumbres, New Mexico. They provide trauma-informed, mental health interventions for children and families post-migration, including child-parent psychotherapy, dialectical behavior therapy, art therapy, and child-centered play therapy.
In the discussion that followed these presentations, Dr. Yehuda challenged the audience to consider whether mental health providers are mandated to respond to policies that create mental health casualties, or whether it is the job of the provider to try to reduce the emotional impact of harsh environments however they are caused. After a thoughtful debate, it became clear that it is certainly possible for mental health providers to have constructive discussions about best mental health practices that are independent of political leanings. Dr. Yehuda concluded the session by summarizing the general consensus of the group. “Psychiatry has entered a new era and the provision of humanitarian mental health aid to those unable to access or prioritize mental health is a moral imperative,” she said. “Social justice advocacy through primary prevention of trauma can be a powerful prophylactic for PTSD and other mental disorders.”
May 29, 2019 | Psychiatry
On Monday, May 20, a group from the Icahn School of Medicine at Mount Sinai won the $10,000 grand prize at the Psychiatry Innovation Lab at the American Psychiatric Association’s (APA) 2019 Annual Meeting in San Francisco. The APA’s annual “Shark Tank style” competition features contestants pitching three-minute videos on their ideas for innovating and disrupting in the field of mental health care.
Murad Khan, MD, Annie Hart, MD, Isobel Rosenthal, MD, MBA, and Jordyn Feingold, MAPP and MD/MSCR candidate, won for their concept of Medimmunity, an online platform that helps medical students and residents connect and help each other survive the stress of medical training. The community is based on Mount Sinai’s PEERS program, which is a curriculum comprised of small group sessions that address medical school and residency stressors, and provide skills for managing these challenges.
From left to right: Murad Khan, MD, Annie Hart, MD, Psychiatry Innovation Lab judge Debbie Profit, PhD, Isobel Rosenthal, MD, MBA, and Jordyn Feingold, MAPP and MD/MSCR candidate. Photo courtesy of David Hathcox.
