Psychiatry | Mount Sinai Today

Psychiatry Grand Rounds: Winter 2018-2019

Nov 14, 2018 | Psychiatry

The Department of Psychiatry at the Icahn School of Medicine at Mount Sinai has put together a fantastic lineup for the 2018-2019 Grand Rounds season—check out some of the highlights below.

On November 27, Raquel Gur, MD, PhD, discussed genetic and environmental effects in the emergence of psychosis. Dr. Gur is Professor of Psychiatry, Neurology, and Radiology at the University of Pennsylvania Perelman School of Medicine, where she directs the Neuropsychiatry Section and the Schizophrenia Research Center and is Vice Chair of Research Development in the Department of Psychiatry.

December 18: Eric J. Fombonne, MD, from Oregon Health and Science University School of Medicine, will discuss rates and environmental risk of autism epidemiology. Dr. Fombonne is Professor of Psychiatry and Director of Autism Research at Oregon Health and Science University.

January 22: David Glahn, PhD, Yale University School of Medicine will discuss genetics insights in psychiatry. Dr. Glahn is Professor of Psychiatry and Professor of Psychology at Yale School of Medicine.

February 5: Mark Solms, PhD, from the University of Cape Town, will discuss how and why consciousness arises. Dr. Solms is Director of Neuropsychology at the University of Cape Town, and Director of Training of the South African Psychoanalytical Association.

February 19: Maurizio Fava, MD, from Massachusetts General Hospital/Harvard Medical School, will discuss novel pharmacological approaches to treatment-resistant depression. Dr. Fava is Slater Family Professor of Psychiatry at Harvard Medical School, Executive Vice Chair of Psychiatry at Massachusetts General Hospital (MGH), Executive Director of Clinical Trials Network and Institute at MGH, and Director of the Division of Clinical Research at MGH.

March 19: Francis S. Lee, MD, PhD, from Weill Cornell Medical College, will discuss treating the developing versus the developed brain. Dr. Lee is Professor of Molecular Biology in Psychiatry, Vice Chair for Research Psychiatry, and Interim Director of the Sackler Institute for Developmental Psychobiology Psychiatry/Pharmacology at Weill Cornell Medicine. Photo credit: Jesse Winter

Does Aerobic Exercise Help Improve Cognition in People With Schizophrenia?

Sep 6, 2018 | Psychiatry

EA SPORTS Active 2 and screenshots of it are licensed property of Electronic Arts, Inc.

David Kimhy, PhD, joined the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai In September of 2017 as an Associate Professor, Leader in New Interventions in Schizophrenia, and Director of the Experimental Psychopathology Laboratory.

Dr. Kimhy’s current focus is on improving daily function in people with psychosis. In 2017 he received, along with co-investigator Dr. T. Scott Stroup of Columbia University, a 4-year, $6.2 million research grant from the National Institute of Mental Health for a multi-site, single-blind, randomized clinical trial entitled Improving Cognition via Exercise in Schizophrenia, the largest study of its kind. The goal of the study is to confirm the impact of aerobic exercise training on cognitive functioning, along with examining its impact on daily functioning and biomarkers of neuroplasticity and cognitive change.

Background

Schizophrenia is commonly characterized by psychotic symptoms such as hallucinations and delusions. However, it is often the accompanying cognitive deficits (e.g., difficulties with poor attention, memory, processing speed, and executive functioning) that lead to life-long functional difficulties and disability. Such deficits can get in the way of attending school, gaining and maintaining employment, as well as developing relationships with family, friends, and romantic partners. While antipsychotic medications have been found to relieve psychotic symptoms, available treatments offer limited benefits for cognitive deficits.

Targeting these deficits, in 2014 Dr. Kimhy demonstrated that such deficits in people with schizophrenia are closely associated with poor aerobic fitness. A year later, he tested a novel intervention to improve cognitive functioning in people with schizophrenia. Completing a small clinical trial, he demonstrated that individuals with schizophrenia who participated in a 12-week aerobic exercise program using active-play video games (i.e., Xbox Kinect) improved their cognitive functioning by 15% (compared to minimal change in the control group). The cognitive improvements were associated with upregulation of Brain rived Neurotrophic Factor (BDNF), a biomarker of neuroplasticity.

Beyond Medication: Hope for Patients

In the present study, Dr. Kimhy is aiming to replicate these results in a larger cohort, employing a similar intervention to study 200 participants with schizophrenia across four sites in New York, North Carolina, Georgia, and California. Participants engage in a 12-week, 3 times per week, 1-hour training program with a trainer using active-play video games along with traditional exercise equipment. “Our innovative use of active-play video games as part of exercise is fun, as well as inexpensive and scalable,” said Dr. Kimhy.

“This study is important for a number of reasons. Primarily, it highlights poor aerobic fitness as a modifiable risk factor for cognitive deficits in schizophrenia, for which aerobic exercise is a safe, non-stigmatizing, and nearly side-effect free intervention,” said Dr. Kimhy. Additionally, aerobic exercise may potentially improve mood symptoms and poor physical health, as well as minimize the risk of premature death—all issues that are prevalent among people with schizophrenia. Results from this efficacy study will inform policy makers’ “go/no-go” decisions regarding the dissemination of aerobic exercise to target cognitive deficits in people with schizophrenia.

Faculty Retreat at The Met

Sep 5, 2018 | Psychiatry

New and veteran faculty mingled over cocktails at the Met’s Great Hall Balcony Bar.

On Thursday, July 28, the second annual Faculty Retreat took place at the Metropolitan Museum of Art. Over the course of the day, 17 new faculty members introduced themselves to the department and presented their current research, followed by a cocktail reception.

Keren Bachi, PhD, LCSW, Assistant Professor of Psychiatry, Assistant Professor of Department of Environmental Medicine and Public Health, presented “Neuroimmune and Psychosocial Pathways to Disease and Recovery in Drug Addiction.” Dr. Bachi received her PhD in Social Welfare from the City University of New York, and completed her postdoctoral fellowship training with the Neuroimaging of Addiction and Related Conditions Research Program.

Veerle Bergink, MD, PhD, Professor of Psychiatry, Professor of Obstetrics, Gynecology and Reproductive Science, Director of Women’s Mental Health Program, presented “Perinatal Psychiatry Research: Between a Rock and a Hard Place.” Dr. Bergink received her MD from the University Groningen, trained at OLVG West and University Hospital Utrecht, and completed her PhD at Erasmus University Rotterdam (all in the Netherlands).

Alexander Charney, MD, PhD, Assistant Professor of Psychiatry, Assistant Professor of Genetics, Assistant Professor of Neurosurgery, presented “Advancing the Treatment of Mental Illness Through Multiscale Neuroscience.” Dr. Charney received his MD, PhD and residency in psychiatry at the Icahn School of Medicine at Mount Sinai.

Cheryl Corcoran, MD, Associate Professor of Psychiatry, Program Leader in Psychosis Risk, Staff Physician, The James J. Peters VA Medical Center (Bronx VA), presented “Language and Psychosis Risk.” Dr. Corcoran received her MD from Harvard University, trained at Cambridge Hospital, and completed a fellowship at NewYork-Presbyterian Hospital/Columbia University Medical Center.

Silvia De Rubeis, PhD, Assistant Professor of Psychiatry, presented “A Translational Approach to DDX3X Syndrome: From Basic Science to Clinical Studies.” Dr. De Rubeis received her PhD in cellular and molecular biology from the University of Rome “Tor Vergata” (Italy), and completed postdoctoral fellowships at the VIB Center for Human Genetics (Belgium), and the Seaver Autism Center at the Icahn School of Medicine at Mount Sinai.

Gaelle Doucet, PhD, Assistant Professor of Psychiatry, presented “Role of Resting-State FMRI in Vulnerability and Resilience to Psychotic Disorders.” Dr. Doucet completed a PhD in cognitive neuroscience from the University of Caen (France), a postdoctoral fellowship at Thomas Jefferson University, and postdoctoral fellowship at the Icahn School of Medicine at Mount Sinai.

Elodie Drapeau, PhD, Assistant Professor of Psychiatry, presented “iPSC Modeling of Rare Neurodevelopmental Disorders.” Dr. Drapeau received her PhD in neurosciences and neuropharmacology at the University of Bordeaux (France) and completed her first postdoctoral training at Columbia University and completed her second postdoctoral training at the Seaver Autism Center at the Icahn School of Medicine at Mount Sinai.

Martijn Figee, MD, PhD, Associate Professor of Psychiatry, Director of Interventional Psychiatry Program, presented “Optimizing Neuromodulation of Circuits for Mood, Motivation, and Motor Control.” Dr. Figee received his MD and PhD, and completed his residency at the University of Amsterdam (Netherlands).

Xiaosi GU, PhD, Assistant Professor of Psychiatry, presented “Computational Psychiatry: Promises and Challenges.” Dr. Gu completed her PhD in neuroscience at the Icahn School of Medicine at Mount Sinai, and completed her postdoctoral training in computational psychiatry at Virginia Tech and the University College London.

Hala Harony-Nicolas, PhD, Assistant Professor of Psychiatry and Neuroscience, presented “Neural Circuits and Brain System Alterations Underlying Social Deficits.” Dr. Harony-Nicolas received her PhD in molecular biology at the Technion Institute (Israel), completed her first postdoctoral training in molecular neurobiology at University of Haifa (Israel), and completed her second postdoctoral training at the Seaver Autism Center at the Icahn School of Medicine at Mount Sinai.

David Kimhy, PhD, Associate Professor of Psychiatry, Program Leader in New Interventions in Schizophrenia, Director of Experimental Psychopathology Lab, presented “Novel Cognitive and Behavioral Interventions for People with Psychosis and At-Risk States.” Dr. Kimhy received his PhD from Long Island University, trained at Long Island Jewish Medical Center, and was a postdoctoral fellow in schizophrenia research at Columbia University.

Dolores Malaspina, MD, MS, MSPH, Professor of Psychiatry, Professor of Neuroscience, Professor of Genetics, Director of the Psychosis Program, presented “A Behavioral Ecology Approach to Schizophrenia.” Dr. Malaspina completed her residency and fellowship training at the New York State Psychiatric Institute and Columbia University; she also completed an MPH in epidemiology. She joined the Icahn School of Medicine at Mount Sinai from New York University, where she had served as the Chair of Psychiatry.

Helen S. Mayberg, MD, Professor of Neurology, Professor of Neuroscience, Professor of Neurosurgery, Professor of Neurotherapeutics, Professor of Psychiatry, Director of Center for Advanced Circuit Therapeutics, presented “Evolution of the Center for Advanced Circuit Therapeutics.” Dr. Mayberg received her MD from the University of Southern California, trained at the Neurological Institute of New York at Columbia University, and was a postdoctoral fellow in nuclear medicine at Johns Hopkins Medicine.

Julie Spicer, PhD, Assistant Professor of Psychiatry, presented “The Role of Maternal Prenatal Stress in Mother-Infant Outcomes: A Health Neuroscience Approach.” Dr. Spicer completed her PhD in psychology with a specialization in cognitive affective neuroscience from Columbia University, and postdoctoral training in behavioral medicine at Columbia University Medical Center.

An-li Wang, PhD, Assistant Professor of Psychiatry, presented “Neuroimaging of the Public Health and Clinical Interventions in Opioid Addiction.” Dr. Wang completed her PhD in human electrophysiology and pain at the University of Oxford, and her postdoctoral training in neuroimaging and addiction at the University of Pennsylvania.

Anna Zilverstand, PhD, Assistant Professor of Psychiatry, presented “Neuroscience-Based Personalized Interventions for Human Drug Addiction.” Dr. Zilverstand completed her PhD in cognitive neuroscience at Maastricht University (Netherlands), and was a postdoctoral fellow at the Neuropsychoimaging of Addiction and Related Conditions Research Program at the Icahn School of Medicine at Mount Sinai.

Eliminating Physical Restraints in the Psychiatric Emergency Department

Sep 4, 2018 | Psychiatry

Some of the key players in this project, from left to right: Gail Perry-Estime, clinical nurse; Francesca Jean, clinical nurse; Robin Kahn, clinical nurse; MaryJoy Adverderada, MSN, RN-C, nurse manager (now retired); and Kenneth Larock, nurse practitioner.

“Vision Zero” is New York City Mayor Bill de Blasio’s campaign to reduce pedestrian deaths to zero by improving traffic safety. Kenneth Hung, MD, Assistant Clinical Professor and Director of the Psychiatric Emergency Department at Mount Sinai Hospital, decided to create his own vision zero based on the mayor’s model. The goal? To completely eliminate the use of four-point restraints in the Psychiatric Emergency Department.

Background

As the hospital’s main access point for patients with psychiatric emergencies, the Psychiatric Emergency Department team treats a disproportionate number of our most highly agitated or violent patients. For the patient’s safety and the safety of hospital staff, four point restraints (securing wrists and ankles to the bedframe) have historically been used to manage very agitated patients. This is extremely traumatizing for both the hospital staff and the patient and can also lead to injury due to thrashing.

Leaders of the New Standard

To mitigate this situation, regulatory bodies such as the Joint Commission are pushing for a drastic decrease in the use of these restraints—and Mount Sinai Hospital has met these goals before any other psychiatric emergency departments in New York City. The department went from an average of 22 restraints per year between 2006 and 2012 to 7 in 2013, and an average of 1 per year thereafter (with zero in 2016). At the American Psychiatric Association’s annual meeting in May, Dr. Hung presented the multi-year process his department underwent to achieve this.

Data presented at the American Psychiatric Association’s annual meeting in May.

Transforming the Culture

To incorporate a culture of safety, four main changes were implemented:

Regular Crisis Prevention Institute training for all staff.
Modifying the clinical environment; specifically, redesigning the room to a layout conducive to walking off anger.
Constructing a padded seclusion room for extreme cases so the patients can’t hurt themselves.
Emphasizing early intervention including verbal de-escalation techniques and medication.

“The few cases of restraint use in the past five years have been for truly extreme circumstances and only as a last resort,” said Dr. Hung. “The success of this new ‘vision zero’ goal has really improved team morale, and we are continually looking for new ways to improve our processes.”

Melinda Lantz, MD, Assumes Leadership Role

Updated on Jun 30, 2022 | Featured, MSBI, Psychiatry

Melinda Lantz, MD

Members of the American Association of Geriatric Psychiatry (AAGP) have elected Mount Sinai Beth Israel physician Melinda Lantz, MD, to become the organization’s President. Dr. Lantz, Vice Chair, Chief of Geriatric Psychiatry, and Associate Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, assumes her new role at a pivotal time.

Founded in 1978 to promote the well-being of older people through education, advocacy, and career development of psychiatrists, AAGP has embraced change. Its growing ranks now include nurses, physician assistants, and mental health professionals coping with a growing geriatric population.

Every day, an estimated 10,000 people reach age 65. Behavioral health problems affect 15 percent of older adults and up to 5 percent have serious mental illnesses, according to the federal Substance Abuse and Mental Health Services Administration. In 2013, more than 7,000 people age 65 or older died by suicide. Additionally, experts say direct health care costs associated with dementia in the elderly often equal or exceed the costs for heart disease and cancer.

In her role as President of AAGP, Dr. Lantz—a specialist in dementia care and geriatric mental illness—plans to address the need for additional recruitment and training by increasing interest in and availability of subspecialty fellowships in geriatric psychiatry. Boosting physician compensation for providing care to older adults with complex needs would also revitalize career opportunities.

Dr. Lantz would like to see an emphasis placed on empathy during training, a critical element for older patients who often cannot advocate for themselves. Elderly patients as a whole, she says, tend to like and respect doctors and welcome human contact.

Encouraging empathy in the treatment of patients “inspired me to be in the organization,” she says.

Too often, physicians lose empathy when they are stressed and have heavy workloads. “Everybody does better when they perceive empathy from physicians. One of the things that fellowships can do is help them get it back.”

After robust lobbying by the AAGP, the Centers for Medicare and Medicaid Services recently agreed to assign an insurance code to monitor the impact of geriatric psychiatry. “Getting that code suffix added was a major win,” says Dr. Lantz, who anticipates a favorable outcome once all of the factors are weighed. Tracking patients will show how geriatric psychiatry affects medical costs and resources.

Having spent billions of dollars researching dementia drugs with little success, many drugmakers have pulled back, according to Dr. Lantz. Today, she adds, “There are limited drug options for dementia in the pipeline. We need to focus on care and quality of life for those with dementia.”

An area that does show promise for helping in the treatment of geriatric psychiatry is technology. For elderly patients who are less mobile, telemedicine via videoconferencing can ease loneliness and increase access to care. Dr. Lantz says technology will also expand the scope of support to other health care providers who are located in communities where there are no specialists in geriatric psychiatry.

Celebrating Trailblazer Pamela Sklar, MD, PhD

Updated on Jun 30, 2022 | Community, Featured, Psychiatry

Luminaries in the study of psychiatric genomics joined the Mount Sinai community in celebrating the work of the late Pamela Sklar, MD, PhD, a groundbreaking psychiatrist and neuroscientist who made major discoveries that established the genetic roots of mental illness.

In her honor, the Icahn School of Medicine at Mount Sinai launched the annual “Advances in Psychiatric Genomics” lecture, held on Monday, April 16, in Goldwurm Auditorium, and renamed the division she created—now one of the best in the nation—the Pamela Sklar Division of Psychiatric Genomics. Dr. Sklar was Chair of the Department of Genetics and Genomic Sciences.

Celebrating her trailblazing research—and presenting their own—were scientists from the National Institute of Mental Health, Harvard University, the University of Pennsylvania Perelman School of Medicine, and the Icahn School of Medicine, among others. Attendees also included Dr. Sklar’s husband, Andrew Chess, MD, Professor of Genetics and Genomic Sciences; Cell, Developmental and Regenerative Biology; and Neuroscience; and their children, Michael and Isabel. The day after the event, the inaugural “Get Psyched” 5k Run/ Walk was held in Central Park to benefit the newly named division.

“Pamela was perhaps one of the bravest people I’ve ever met,” said Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System. “She led a revolution in the study of the genetic basis of mental illness, showing that hundreds of genes are implicated, not just a handful as was previously believed. It took courage to challenge the prevailing point of view.”

“With a keen intellect and an unusual force of personality, Dr. Sklar was both an outstanding scientist who changed the field of psychiatric disease and a beloved mentor to students and young scientists,” said Eric J. Nestler, MD, PhD, Nash Family Professor of Neuroscience; Director of The Friedman Brain Institute; and Dean for Academic and Scientific Affairs.

Kristen Brennand, PhD, Associate Professor, Genetics and Genomics, Neuroscience and Psychiatry, added: “In memory of Pamela Sklar, it was incredibly meaningful to spend a day surrounded by her closest friends and collaborators, hearing stories of the psychiatric genetics of lore as well as the newest insights from cutting-edge genetic research.”

At the inaugural “Advances in Psychiatric Genomics” lecture in honor of Pamela Sklar, MD, PhD, were, from left: Dennis S. Charney, MD; Isabel Sklar Chess; Andrew Chess, MD; Michael Sklar Chess; and Eric J. Nestler, MD, PhD.

Participants in the “Get Psyched” 5k Run/Walk.

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