Sunday, May 31, 2009

Hold on Tight!

A lot of psychiatrists I know always have "full" practices and they don't take new patients. I kind of wonder what this means. For those who do psychotherapy (like me), does it mean that every slot is filled with a patient who comes at the same time every week, or even more often? Or some come every other week but those patients patients sync up perfectly?

I never feel totally and completely 'full' for very long: My patients disappear (oh, they reappear too, quite often). Well, they don't
disappear, but they announce that they are better and either don't want to come any more or they want to come less often. While most people start therapy in a state of distress and come every week, many people I see start to feel burdened by the inconvenience and expense of weekly appointments, so after some period of time, they start cutting back to every other week or every month, and some come less often then that, maybe only a couple of times a year if all is well and they need medications renewed. And my patients who have standing times-- sometimes they are students and their class schedules change every few months, sometimes they change jobs and can't get that same time off, sometimes there is a meeting at work or a child's school event to attend. Maybe we skip a session, but often we reschedule, something I couldn't do if everyone were rigidily assigned to a spot. Sometimes patients move to other cities. People get sick and go on vacation. Or my schedule is full and a former patient calls saying they need help again--I never turn away former patients, I just don't-- I usually feel flattered when that they feel comfortable returning to me.

A friend tells me that some psychiatrists are better than others at holding on to their patients. This must be true, and I'm not very good at holding on. When people want to leave treatment or decrease the frequency of visits, if I don't think it's a good idea, I tell them why. I list the reasons like bullet points. They've heard. If they choose to leave/decrease the frequency of their sessions anyway, I usually just accept this and say "fine." If, a few weeks down the road, they aren't doing as well with less frequent visits, I say "Maybe we should go back to meeting more often?" Do patients who've left treatment return? All the time, sometimes after years. And since I've been at it for a while, I have patients I've been seeing for a long time, some for over a decade. It doesn't seem reasonable to say they must come for regular therapy sessions or see someone else-- they know me, and generally I let them come and go as they want, the least often rate may be my comfort level with writing a prescription. In theory, I'd have no trouble saying to a patient, "Look, you've just had a huge issue (hospitalization, suicide attempt), and if you won't come in as often as I'd like, I'm not comfortable treating you." But so far I haven't given many ultimatums. Usually I just present it as the patient needs to come more often until things are better and they just do it.

I talked about this in the post on the final In Treatment session...the TV therapists tries much harder than I do to hold on tight. He's successful with some patients, though he lost a bunch in both five-week seasons. Psychotherapy is process over time, but sometimes people feel very much helped by only a few sessions -- and many sessions in the journey along the way can be total duds.

Sometimes I wonder if it would be better to hold on tighter? Might I be able to do more for my patients? Might I make more money? Might I live a somewhat more predictable life? The predictable life thing doesn't suit me so well--- I like having flexibility...some shrinks have 4-12 week long waits for appointments, and I can't imagine having a patient call with a problem and saying I can't see them within days. I also can't predict my own personal life more than a few weeks in advance and I generally don't even give out appointments more than 6 weeks in advance (You want to come back in 3 months? Call me closer to the time.) It seems like if I mapped my schedule out that far down the line, either patients would be calling all the time with "I have a conflict" or I'd be calling them because... a meeting was scheduled, an event's happening at
my kids' school, and over time, I've moved pretty far away from a 9-5 work day mentality. I figure it suits me, but I don't hold people quite so tight as maybe our TV therapist would. Then again, he has time to care for abandoned turtles and to just leave to take a patient to chemotherapy.

What do you think: What holds patients tight? And does that result in better psychotherapy results?

Saturday, May 30, 2009

Wipe That Smile Off Your Face!

"You may not smile in Arkansas, Indiana, Nevada, or Virginia." At least, not if you are getting your driver's license photo taken.

Apparently, they use photo detection software to compare faces for identity fraud purposes. And smiling thwarts the computer.

Is it even legal (or constitutional) to require drivers to not smile? Can they frown? Stick out their tongues? Look cross-eyed? (Interesting face research where you can combine 2 faces; and a blog on pics of faces in places; and make your own Flash face like Mr Potato Head).

I supposed DMV would prefer folks who are depressed when they get their photo taken, to keep the computers happy. One man's downer is another machine's Prozac.

Just bizarre.

Friday, May 29, 2009

Shoveling Up the Mess

This went out on a mass email. I liked it and I decided that since the author wants it disseminated, he wouldn't mind being made a Guest Blogger:

According to a report CASA issued this morning, federal, state and local governments spend almost half a trillion dollars every year -- almost 11 percent of their total budgets -- as a result of alcohol, tobacco and other drug abuse and addiction. The worst part is that, for federal and state spending, about 95% of that money is spent "Shoveling Up" the mess created by a failure to provide enough money for prevention and treatment.
That's right. Out of every dollar federal and state governments spent on substance misuse in 2005 (the latest data available), 95 cents paid for the enormous burden of this problem on health care, criminal justice, child welfare, education, and other programs. And only 2 cents were invested in prevention and treatment programs that could reduce many of these costs -- and save lives.
This huge waste of money is hidden in many different budgets, so most of our elected officials don't have a clue about how much alcohol, tobacco and other drugs really cost taxpayers, and how little governments spend to effectively address the problem. Maybe if they knew, they might do something. You can tell them.
Please do two important things today:
Our researchers studied all federal, state and local budgets for 2005 using careful, conservative methods to determine how much of each major budget category was directly linked to substance misuse. For example, they determined how much of each state's Medicaid and other health care expenses were due to one of over 70 medical diagnoses that are caused or made worse by alcohol, tobacco and other drug abuse and addiction. They did the same for criminal justice, welfare and other key government budgets. They also identified all government spending on prevention, treatment and research, regulation of alcohol and tobacco products and drug interdiction.
When the numbers are added up, the total is really shocking: 467.7 billion dollars. Spending less than 2% of the federal and state costs for prevention and treatment, and more than 95% shoveling up the mess, is upside down public policy that wastes billions in taxpayer dollars at a time when resources are scarce, and results in untold human suffering.
Our leaders need to make new investments in prevention and treatment now to reduce the awful burden that untreated tobacco, alcohol and drug problems place on our budgets -- and our citizens.
Please act today.
David L. Rosenbloom
President and CEO
The National Center on Addiction and Substance Abuse at Columbia University
P.S. Please forward this important message to your friends and colleagues today.

Wednesday, May 27, 2009

In Treatment: The end of Season Two: Walter Signs on and Paul Signs Off

Walter returns after his hospitalization. He arrives early and barges into Paul's session, surprised that Paul has other patients. I'm surprised Paul doesn't lock his door.

It's a busy session, and I won't recap it here. Instead, let me just talk about the parts that grabbed my attention.

Walter mentions "tearing up" the session before-- clearly he's embarrassed and later he will mention that when he was young, boys were taught never to cry. In fact his father shook him hard when he cried after his brother's death. Paul, however, doesn't let Walter get away with "tearing up," he reminds Walter that he "sobbed." One more episode where Paul shoves the truth in his patient's faces...a habit he has that may feel like real psychotherapy, but to me it sometimes feels too harsh, too inconsiderate of someone's need to protect themselves a little. And this is a man who just had a serious suicide attempt and was hospitalized. Personally, I would have back off when Walter mentioned "tearing up," I wouldn't have shoved in his face that he sobbed. Walter has already proved that despite his tough exterior, he's really fragile.

At the end of the session, Paul tells the 68-year-old Walter that he can still change. He implies that an introspective, insight-oriented psychotherapy is a higher way to go then simply having them both talk to Walter's psychopharmacologist (--hmm, and what would they say?) and having Walter restored to his old self with his old ways. Walter says he's an old dog, but Paul pushes with a hopefulness for future change and better ways, better relationships, and Walter bites: he'll come more often, a few times a week: Where do we start? There are echoes of Paul's lost efforts to have a better relationship with his own, now-dead father, and Paul focuses on how there is still time for Walter to improve his relationship with his two sons--even though Walter explicitly states that this is not his goal. Is Paul using Walter to address his own loss?

And finally, we're left with the question of the appropriateness and the real capacity of insight-oriented psychotherapy to help someone change. I'm a psychotherapist, I believe it helps. But, I might look at this totally differently then Paul does. Paul seems to see Walter in terms of his weaknesses, as someone who should be ripped down and built back up differently-- he cages changing his ways of reacting as a positive. I might look at Walter as someone who had been through a lot (his brother's death, his lost childhood, Vietnam, his wife's problems, immense struggles with guilt, a crushed career, an episode of depression, the indignity he saw in his recent hospitalization, and the list marches on) and view him as someone who has been quite successful. I might emphasize his successes, that maybe it's fine to return him to just being him. It's not that I think there is anything wrong with Walter working on his relationships with his family members-- that might be good-- but I would not phrase this sort of change in such deep and all-or-nothing terms, complete with judgment. Will a 68-year-old change in such extreme ways? I think I'd follow the patient's agenda a little more closely and be a little less intent on holding to an ideology, if that makes sense. Sometimes therapy is more about getting people to accept themselves than it is about getting them to change.
Gina and Paul have a nicer session-- it's warmer. He tells her how lovely she looks and he reminisces about seeing her back when he was a grad student and she was out with her husband at their country club (Paul was the valet parker). He talks about how Gina has helped him be more hopeful. In the middle of the session, Paul's lawyer calls and says the case against him is being dismissed. Paul talks about April's choice to leave therapy and his realization of the uncertainty of the work: "all I can do is walk with them for a while, keep them company through a rough patch...if we're lucky there's someone in the room who can listen" Gina realizes that Paul is terminating his treatment with her. "I'm just disappointed that we're here again," she tells him. Don't these people ever accept that patients sometimes feel helped? Is there some gold standard for self-awareness, when is it reasonable to end? Isn't there ever a "Call if you need to come in?" Why is therapy such an all-or-nothing thing here? Do people ever get better or do they just abandon each other? Can anyone terminate without the therapist saying "I'm just worried..." about your tools, your timing, the wisdom of this decision.

"Some days I feel like I'm sitting there with a patient and we're two mice with our legs stuck in a glue trap." He talks about hating his chair, about the loneliness of psychotherapy and how he needs to be with more people. Paul needs a break from the intensity of one-on-one psychotherapy.

We all think Paul is a good therapist, don't we? People like this show-- I've lost count of how many people have asked me if I've seen In Treatment. There's something about Paul-- his striking looks, his eyes, his intensity, his accent, the depth of his conversation, his interest, his caring. Something about his charisma is entangling and enchanting, and it takes hold.

Our time is up.

What's Holden Got?

There's a copy of the DSM-IV sitting on my coffee table. Not the usual, not even at a Shrink Rapper's house, but I'm trying to write the Shrink Rap book and, in theory, I may need to look something up.

So, kid looks at the DSM and informs me, "We read that in English class today." They read the DSM in English class? Hey in the good old days, we read Macbeth in English class. We didn't need psychiatric diagnostic manuals. "Oh, why?" So they're reading Catcher in the Rye and they decided to diagnose Holden Caufield. Interesting. What's he got? Oh, we shrinks don't do that. Until I personally examine Holden, I'm not venturing a guess as to his psychiatric diagnosis. The APA and the medblogging community would have me de-shrunked.

So what did the English class say? (They're kids, they can venture guesses if they like). One thought he had Borderline Personality Disorder, some thought he had Bipolar Disorder, and a few thought he had Schizophrenia.

Funny, I was writing today about how hard it is to diffentiate developmental issues, family complexities, and psychiatric illness in adolescence. Seems like a funny coincidence.
Well, what's Holden got?

Tuesday, May 26, 2009

In Treatment Season 2: Final sessions with Mia, Oliver, and April

Mia announces she's ending therapy; it's making her worse. Her last therapy session inspired her to question her father about the past and her Dad "lost it" on her. Her father blamed her for everything. "I never would have confronted him if I hadn't been talking to you...I lost my father thanks to you." Mia then says to Paul "Put that in your therapy notes: Successfully shattered patient's romanticized vision of her narcissistic father." Paul rephrases it a bit differently. They decide to work on closure. Mia tells Paul she needs a therapist to deal with therapy. "What would you like to talk about?" Mia talks about wanting to train a parrot to imitate Paul (--Is this a compliment?...have I ever mentioned that ClinkShrink has a parrot thing? Please do send her a parrot joke!). Mia wants to be Paul's friend, she knows it's against the rules...then she mentions his relationship with Laura. Paul zings her a few more times about her dysfunctional life long patterns. She blames him for what he didn't say when she was in treatment with him 20 years ago. "Closure is you telling me it's all my fault." Mia zings him, "You like to have a woman on the couch who thinks she's in love with you." Paul fixes his poker face as Mia talks about where they should have sex in rather crude terms. They talk about what would happen if they broke all the rules, "Would you finally feel special enough or would you just blame me for crossing the line?" When Paul starts talking about how Mia's career as a malpractice attorney is really about trying to defend her father, I've had enough. Paul's ability to cut to the chase, to tear people's defenses down--it's more about theatre then a realistic view of therapy-- he's ruthless in his disregard for Mia's need to keep some defense mechanisms, to not be totally raw. They say goodbye and the music fades. "So, I guess I'll see you next week," she says and he responds, "I'll be here."
April's cancer is responding to chemo. She talks about how the cancer has changed her, how the old April is gone. April wants to end therapy and Paul pushes her, he wants her to continue, he tells her he wants to bring her family in. She curses him out, then apologizes and he says she doesn't need to. I'm so happy my patients don't curse me out. April talks about life, her family, her mom, the girl next to her in chemo who died. Paul promises April a future, "You will know such joy." She cries, "I think I'm going to be lonely my whole life." They talk about love as something exhausting. April tells Paul that Sophie-from-Season-1 wrote on his webpage and she says Paul saved her life, just as he saved April's. "Let me thank you and then let me leave." "Are you sure?" He asks. Why, I'm wondering, it is an all or nothing thing, this therapy with Paul. She can't say goodbye and he can't say "Call if you need me." She tells Paul he saved her life so he can't be her therapist. "People do survive without therapy," April tells Paul. Paul gives April a hat that was his father's one that will be less aviator thing. It's his nicest moment in a while and April kisses him goodbye.
Bess is getting ready to move with Oliver. Paul still thinks she shouldn't move Oliver. They talk about leaving, about how Paul is Oliver's best friend. Luke comes in. The couple are nice to each other for once, it's a pretty warm session for two people who are splitting up. Bess leaves. Paul and Luke talk, Paul desperately doesn't want this move to happen, and Luke says he's already lost Oliver. Paul encourages Luke not to give up. Paul talks to Oliver--he's more hopeful and they talk about how Paul has maintained a relationship with his own son from a distance. They role play a phone call to each other and then they end. This parent-child is difficult.

Sunday, May 24, 2009

How Much for Access to APA Mtg Talks?

The American Psychiatric Association's 162nd Annual Meeting just ended in San Francisco last week.  These are 5-day long academic smorgasborgs attended by a large proportion of the APA's 35,000-plus members, in addition to other interested people. 

There were about 600 individual talks totaling about 600 hours, not to mention the 800-odd poster presentations.  To see an example of the first two days' worth of talks, skip to the bottom of this post.  

We are thinking about bringing most of the meetings' talks online -- audio, video, slides, and all.  Here's my question: Do these talks have any interest outside of just psychiatrists?  How much would you be willing to pay on a per-talk basis (this is the non-member price)?  These would be streaming talks (not downloads) and payment includes access for 12 months so it can be watched multiple times (update: no CME).

(Please tweet this survey, blog it, email it, circulate widely. Thanks.)

View Comments

Below is a list of talks from the first couple days.

Advances in Medicine (~1.5 each) 

AM01. The Top 10 Medical Articles of 2008: A Comprehensive and Practical Review of What We Need to Know Monique Yohanan, M.D. 

AM02. Infertility Issues Elena Gates, M.D. 

Advances In Research (~3 hr each) 

AR01. Advances in Research. Herbert Pardes, M.D. 

Advances In Series (~3 hr each) 

A01. Neuropsychiatry Stuart Yudofsky, M.D. 

A02. Psychopharmacology Alan Schatzberg, M.D., Charles Nemeroff, M.D. 

A03. Substance Abuse Mark Galanter, M.D., Herbert Kleber, M.D. 

A04. Psychosomatic Medicine James L. Levenson, M.D. 

A05. Psychotherapuedic Psychiatry Glen Gabbard, M.D. 

A06. Personality Disorder John Oldham, M.D. 

A07. Forensic Psychiatry Robert I. Simon, M.D., Lisa Gold, M.D. 

Component Workshops (~1.5 hr each) 

CW01. High-Risk Student Populations: Innovative Approaches to Treatment and Outreach. Chair: Jerald Kay, M.D. 

CW02. Lost and Not Found: Depression and Suicide in Elderly Asian Americans. APA Committee of Asian-American Psychiatrists; Chair: Jacquelyn Chang, M.D. 

CW03. A Family-Related Approach to Reducing Risk and Promoting Well-Being Among LGBT Youth. Association of Gay and Lesbian Psychiatrists; Chair: Ellen Haller, M.D. 

CW04. International Disasters: Challenges and Opportunities to Contribute. APA Committee on Psychiatric Dimensions of Disaster; Chair: Shirley Liu, M.D., Co-Chair: Patcho Santiago, M.D. 

CW05. Career Advancement in Administrative Psychiatry for Early Career Psychiatrists. APA Assembly Committee of Early Career Psychiatrists; Chair: Dimitri Markov, M.D., Co-Chair: Marina Goldman, M.D. 

CW06. Show Me the Money! Sustainable Funding for Education in Psychiatry. APA/GlaxoSmithKline Fellows; Chair: M. Justin Coffey, M.D. 

CW07. Revitalizing Service: Strategic Planning Success Within District Branches and State Associations APA Council on Member and District Branch Relations; Chair: Nioaka Campbell, M.D. 

CW08. Combat to Community: Needs and Resources for Post-September 11th Veterans and Their Families APA Alliance; Chair: Kay Brada 

CW09. Becoming a Public Psychiatry Leader: Mentoring Models for Everyone, From Residents to Medical Directors APA Council on Social Issues and Public Psychiatry; Chair: Peter Chien, M.D. 

CW10. Biracial Americans: "Check One Box Only" and the Development of Multiracial Identity APA Council on Minority Mental Health and Health Disparities; Chair: Jacquelyn Chang, M.D., Co-Chair: Kehinde Ogundipe, M.D. 

CW11. Recognition and Treatment of Dementia in a Changing America APA Committee on Ethnic Minority Elderly; Chair: Maria llorente, M.D., Co-Chair: Khushro Unwalla, M.D. 

CW12. How General Psychiatrists Can Effectively Screen and Treat Substance Use Disoders APA Corresponding Committee on Treatment Services for Patients With Addictive Disorders; Chair: Varinder Rathore, M.D., Co-Chair: Petros Levounis, M.D. 

CW13. Outpatient Forensic Services and Interventions to Improve Clinical Outcomes and Reduce Recidivism APA Task Force on Forensic Outpatient Services; Chair: Steven Hoge, M.D., Co-Chair: Alec Buchanan, Ph.D. 

CW14. National Security, the Hippocratic Oath, and the War on Terror APA Council on Global Psychiatry; Chair: Shirin Ali, M.D., Co-Chair: Karinn Glover, M.D. 

CW15. Current Topics in Forensic Psychiatry: Update From the Council on Psychiatry and Law and the Committee on Judicial Action APA Council on Psychiatry and Law and APA Committee on Judicial Action; Chair: Patricia Recupero, M.D., J.D., Co-Chair: Jeffrey Janofsky, M.D. 

CW16. Indications for the Use of Combined Talking Therapy and Pharmacotherapy and How to Teach in Residency APA Corresponding Committee on Graduate Education; Chair: Sidney Weissman, M.D. 

CW17. Medical Issues for Psychiatrists in Disasters APA Committee on Psychiatric Dimensions of Disaster; Chair: Mark Viron, M.D., Co-Chair: Nidal Hasan, M.D. 

CW18. Ethical Dilemmas in Psychiatric Practice APA Ethics Committee; Chair: Wade Myers, M.D. 

Debate/Roundtable (~1.5 hr each)

DR01. To Be Announced 

DR02. To Be Announced 

DSM Track (~3 hr each) 

DSM01. DSM-V: Progress in Research and Development Chair: Darrel Regier, M.D. (Forum 01) 

DSM02. Evolution of the DSM-V Conceptual Framework: Development, Dimensions, Disability, Spectra, and Gender/Culture Chair: Darrell Regier, M.D. 

DSM04. Public Health—Revisions Review Chair: Norman Sartorius, M.D. 

Focus Live (~1.5 hr each) 

FL01. FOCUS LIVE! Geriatric Psychiatry. Barry Lebowitz, Ph.D. 

FL02. FOCUS LIVE! PTSD and Disaster Psychiatry Anand Pandya, M.D. 

FL03. FOCUS LIVE! Panic and Social Anxiety Disorder Mark Pollack, M.D. 

Forum (~1.5 hr each) 

F01. DSM-V: Progress in Research and Development Chair: Darrel Regier, M.D. (DSM Track 01) 

F02. The Relationship Between the APA and Pharmaceutical Industry Chair: Ken Silks, M.D. 

F03. Developing the Next Generation of Clinical Translational Researchers: Innovation in an Academic Department of Psychiatry Chair: Renée Binder, M.D. 

F04. Treating Women With Alcohol Use Disorders Chair: Grace Chang, M.D. 

F05. Anxiety in Patients With HIV: Importance and Drugs Chair: Ramaswany Viswanathan, M.D. 

F06. Bridges and Barriers to Care: Current Strategies Chair: Mark Townsend, M.D. 

F07. New Perspectives on Cultural Issues in Alcohol Chair: Barbara McCrady, M.D. 

Issue Workshops (~1.5 hr each) 

IW01. Increasing Cultural Competency to Assess and Ameliorate Distress of Diverse Patients: Example From the Care of a South Asian Victim of Spousal Abuse. Chair: Jacob Sperber, M.D., Co-Chair: Nyapati Rao, M.D. 

IW02. Practical Pharmacotherapy for the Treatment of Alcohol Dependence National Institute on Alcohol Abuse and Alcoholism; Chair: Robert Swift, M.D., Co-Chair: Allen Zweben 

IW03. Incest—a Cultural Perspective APA Council on Global Psychiatry and the APA Council on Children, Adolescents, and Their Families; Chair: Rodrigo A. Muñoz, M.D. 

IW04. Playing in the Big League: Resident Leadership in the APA Board of Trustees Chair: Molly McVoy, M.D., Co-Chair: Lauren Sitzer, M.D. 

IW05. Risk Management Issues in Psychiatric Practice Chair: Martin Tracy, J.D., Co-Chair: Jacqueline Melonas, J.D. 

IW06. Ethical, Clinical, and Legal Challenges Chair: Malkah Notman, M.D., Co-Chair: Linda Jorgenson, J.D. 

IW07. Technology and Psychiatry: Practical and Clinical Tips for Using Telepsychiatry (Open to residents only) APA/Shire Fellowship Program; Chair: Jena Worley, M.D., Co-Chair: Michael Houston, M.D. 

IW08. Mindful Practice: Understanding Its Role in Psychiatry and Psychiatric Training Chair: Tana Grady-Weliky, M.D. 

IW09. Need to Reformulate "Risk" and Its "Assessment" in Clinical Practice World Psychiatric Association; Chair: Amresh K. Shrivastava, M.D. 

IW10. Imaging Insight: Basic Definitions, Measures, and Relevance to Psychopathology National Institute on Drug Abuse; Chair: Steven Grant, Ph.D., Co-Chair: Rita Goldstein 

IW11. Implementing a Telepsychiatry Program in the Kern County Mental Health System in Rural California (Part 2) Chair: Salvador del Rosario, M.D., Co-Chair: Tai Yoo, M.D. 

IW12. Using the DSM-IV-TR Cultural Formulation for Cultural Competence Skill Building Among Psychiatry Residents Chair: Treniece Lewis Harris, Ph.D., Co-Chair: Marshall Forstein, M.D. 

IW13. Diversion of Prescription Stimulants National Institute on Drug Abuse; Chair: Moira O'Brien, Co-Chair: Wilson Compton III, M.D. 

IW14. Challenging Stigmas & Stereotypes: Integrated Therapy for Multidiagnosed Addiction Patients Combining Innovative With Traditional Approaches Chair: Michael Scimeca, M.D. 

IW15. Man- and Non-Man-Made Disasters in Asia: The Role of Resilience Chair: Pedro Ruiz, M.D. 

IW16. Turning Lead Into Gold: Tragedy and Transformation in a Public Psychiatric Emergency Service Chair: Stephen M. Goldfinger, M.D., Co-Chair: Ellen Berkowitz, M.D. 

IW17. Can Disclosure of a Diagnosis of Borderline Personality Disorder Help Guide Treatment for Clinicians, Patients, and Families? Chair: Richard G. Hersh, M.D. 

IW18. Application of Cultural Variables for Practice of Effective Psychotherapy of Indians Settled in U.S.A. Chair: Nitin Gupta, M.D., Co-Chair: Vijoy Varma, M.D. 

IW19. Cognitive Therapy for Psychosis in Practice by Psychiatrists: Basic Techniques Chair: Shanaya Rathod, M.D., Co-Chair: Douglas Turkington 

IW20. Resident Wellness Survey Results and Discussion Chair: Paul O'Leary, M.D., Co-Chair: Hind Benjelloun, M.D. 

IW21. Tips for Effective Communication About Genetics and Mental Illness With Patients and Their Families Chair: Jehannine Austin, Ph.D., Co-Chair: Holly Peay, M.S. 

IW22. Clinical and Forensic Issues Concerning Infanticide, the Murder of a Child in the First Year of Life by Its Mother Chair: Malkah Notman, M.D., Co-Chair: Carl Malmquist, M.D. 

IW23. Extended Treatments for Alcohol Use Disorders National Institute on Alcohol Abuse and Alcoholism; Chair: James McKay, Ph.D. 

IW24. Cognitive Therapy for Personality Disorders Chair: Judith Beck, Ph.D. 

IW25. The Impact of Meditation as a Non-Pharmacological Intervention for Veterans With Mental Health Disorders Chair: Julie Malphurs, Ph.D., Co-Chair: Daniella David, M.D. 

IW26. Assessment of Capacity: Developments, Documentation, and Defendability Chair: Michael Wise, M.B.B.S., Co-Chair: Julian Beezhold, M.D. 

IW27. Lessons Learned About Resilience and Recovery Following Disasters Chair: Howard Osofsky, M.D. 

IW28. When Psychiatry Residents Treat Medical Students: Some Challenges Chair: Michael Myers, M.D. 

IW29. Bootcamp for Burnout Association of Women Psychiatrists; Chair: Tana Grady-Weliky, M.D. 

IW30. Lessons From the Post-Residency Road: Four Career Journeys Since Residency Graduation 

in 2004, With Insights From Our Training Director Chair: William Wood, M.D., Co-Chair: Kathy Sanders, M.D.

IW31. Assessment and Treatment of Sleep Disorders in Alcohol-Dependent Patients With ADHD and Other Co-Occurring Disorders National Institute on Alcohol Abuse and Alcoholism; Chair: Kirk Brower, M.D., Co-Chair: Iyad Alkhouri, M.D. 

IW32. Doing it Right the First Time: Recognizing, Maintaining, and Supporting Workplace Function APA Corresponding Committee on Psychiatry in the Workplace; Chair: Andrea Stolar, M.D. 

IW33. The Use of Research Measures in Clinical Practice Chair: Joan Busner, Ph.D. 

IW34. FFT-HPI and FIT: Two Different Approaches to Family-Involved Treatment for Bipolar Disorder Chair: Igor Galynker, M.D. 

IW35. Outpatient Mastectomies: Overview of Psychosocial Issues Chair: Zach Morairty, M.D., Co-Chair: Michelle Riba, M.D. 

IW36. Evaluation and Management of Patients With Excessive Daytime Sleepiness in Psychiatric Practice Chair: Dimitri Markov, M.D. 

IW37. The Portrayal of Psychiatry in Recent American Film Chair: Steven Pflanz, M.D. 

IW38. The Changing Managed Care Landscape for Behavioral Health Services National Institute on Alcohol Abuse and Alcoholism; Chair: Constance Horgan Sc.D., Co-Chair: Mark Willenbring, M.D. 

Lectures (~1.5 hr each)

L01. Prevalence, Correlates, and Risk of Posttraumatic Stress Disorder: How Latinos Fare.  Margarita Alegria, Ph.D., Simon Bolivar Award Lecture 

L02. Psychopathic Disorders Without Borders.  Alan R. Felthous, M.D., Henning Sass, M.D., AAPL/APA's Manfred S. Guttmacher Award Lecture 

L03. Pills to Treat Alcoholism. Bankole A. Johnson, M.D., Ph.D., D.S., Solomon Carter Fuller Award Lecture 

L04. Psychiatrists' Role in Prevention and Intervention in Domestic Violence Among South Asians. Surinder Sucha Nand, M.D., Alexandra Symonds Award Lecture

L05. Psychiatric Genetics: A Current Perspective. Kenneth Kendler, M.D., Distinguished Psychiatrist Lecture 

L06. Etiology in Psychiatry: Phenomes, Genomes, and Epigenomes. James Potash, M.D., Frontiers of Science Lecture 

L07. Psychiatric Education Across Civilization: The Search for a Guru and the IMG Nypati Rao, M.D., George Tarjan Award Lecture 

L08. Mental Health in the New Era of Cost Control Richard Frank, M.D., Frontiers of Science Lecture 

L09. To Be Announced Elyn Saks, J.D., Outside Lecture 

L10. Successful Aging and Wisdom: Are These for Real? Dillip Jeste, M.D., Distinguished Psychiatrist Lecture 

L12. To Be Announced Hon. Gavin Newsom, John Fryer Award 

L13. Modules of the Mind: Developing a Positive Psychiatry of the Person C. Robert Cloninger, M.D., Marmor Award Lecture 

L14. Borderline Personality Disorder: The Birth Pains of the Still New Diagnosis John Gunderson, M.D., Distinguished Psychiatrist Lecture 

L15. Cross-Cultural Psychopharmacology: Shaping Our Future via Bridging Science and Service Edward Pi, M.D., Kun-Po Soo Award Lecture 

L16. How Alcoholism Develops: Identification of Genetic and Environmental Influences in a 25-Year Longitudinal Study Marc Shuckit, M.D., Adolf Meyer Award Lecture 

L17. When Politics Distorts Science: A Psychiatrist Reports From the Trenches of the Culture Wars Jack Drescher, M.D., Distinguished Psychiatrist Lecture 

L18. The Movement for Global Mental Health: Why You Should Join Virkram Patel, M.Sc., M.R.C.Psych., Ph.D., International Lecture 

L19. Translational Neuroscience for Schizophrenia Akira Sawa, M.D., Ph.D., Frontiers of Science Lecture 

Media Workshop (~3 hr each) 

MW1. Ready? OK! A Film About Childhood Gender Variance American Academy of Child and Adolescent Psychiatry; Chair: Richard Pleak, M.D., Co-Chair: Sarah Herbert, M.D. 

MW2. Silver Spurs—Severe and Chronic Mental Illness, and Life in a Residential Care Facility Chair: Steven Harvey, M.D., Co-Chair: Doug Whyte, B.S. 

MW3. The Joy Luck Club: Universal Stories About Mothers and Daughters From China Chair: Francis Lu, M.D. 

MW4. Provoked: Combating Domestic Violence Indo-American Psychiatric Association; Chair: Vishal Madaan, M.D., Co-Chair: Surinder Nand, M.D. 

Medical Update (~1.5 hr each) 

MU1. 21st Century ECT—Updating the APA Recommendations on ECT Task Force to Revise the Practice of Electroconvulsive Therapy; Chair: Sarah Lisanby, M.D., Co-Chair: Richard Weiner, M.D. 

Presidential Symposia (~3 hr each) 

PS01. Is Psychiatry Better for Patients and Physicians in a Real Health Care System? Chair: Gisele Apter, M.D., Ph.D. 

PS02. Psychiatrists' Relationships With Industry Chair: Paul Appelbaum, M.D., Co-Chair: Laura Roberts, M.D. 

PS03. Psychiatry and the Control of Fertility Chair: Gail Robinson, M.D., Co-Chair: Susan Kornstein, M.D. 


Scientific and Clinical Reports (~0.5 hr each; ~1.5 hr each session) 

Session 1. Forensic Psychiatry 

1. Characteristics of Mentally Ill Offenders From 100 Psychiatric Court Reports Yasser Elsayed, M.D., M.S. 

2. Homicide and During the First Episode of Psychotic Illness Olav Nielssen, M.B.B.S. 

3. Differences Between Men and Women Found Not Guilty By Reason of Insanity for Homicide Offenses at Napa State Hospital Jessica Ferranti, M.D. 

Session 2. Measurement of Personality Disorder Severity 

4. The Severity Indices of Personality Problems—A New Dimensional Questionnaire for Measuring (mal)Adaptive Personality Functioning Helene Andrea 

5. Severity Indices of Personality Problems (SIPP-118) in Adolescents: Factor Structure and Validity Joost Hutsebaut, Ph.D. 

6. The Severity Indices of Personality Problems (SIPP-118) as a Clinical Instrument Dineke Feenstra, M.A. 

Session 3. Genetic, Neuroimaging, and Neuropsychological Studies in Schizophrenia 

7. Does Aberrant Stimulus Salience Lead to Psychosis in Schizophrenia?: A 20-Year Longitudinal Study Martin Harrow, Ph.D. 

8. Association of G-1438A Polymorphism of 5HT2A Receptor With Schizophrenia in Three Ethnic Groups in Malaysia Zahurin Mohamed, B.S.C., Ph.D. 

9. MEG Analysis of Early Processing of Facial Expressions in Schizophrenia and Controls Stephen Lewis, M.D. 

Session 4. Adjunctive Treatment and Comorbidity in Schizophrenia 

10. Effects of Adjunctive Treatment With Armodafinil in Schizophrenia Ashwin A. Patkar, M.D.

11. Prevalence of Alcohol Use Disorders in Schizophrenia: A Systematic Review and Meta-Analysis Jouko Miettunen, Ph.D. 

12. Zolpidem in Treatment-Resistant Catatonia: Case Reports and Literature Review Cristinel Coconcea, M.D. 

Session 5. Psychopharmacology: Psychostimulant, Antidepressant Side Effects 

13. Linking Attention-Deficit/Hyperactivity Disorder Ratings and Clinical Global Impressions Scores in Studies of Lisdexamfetamine Dimesylate in ADHD Richard Weisler, M.D. 

14. Antidepressant-Induced Excessive Sweating (ADIES): Measurement and Treatment Rajnish Mago, M.D. 

15. Armodafinil Once Daily Sustains Wakefulness Throughout the Day in Patients With Excessive Sleepiness Associated With Narcolepsy Thomas Roth, Ph.D. 

Session 6. Bipolar Disorder 

16. Who Receives Guideline-Based Pharmacotherapy for Bipolar Depression? Megan Ehret, Pharm.D. 

17. Psychiatric Admissions and Hospitalization Costs in Bipolar Disorder in Sweden Anne Tiainen, M.P.H., R.N. 

18. Symptoms and Treatment of Bipolar Disorder in Sweden Mats Adler, M.D. 

Session 7. The Broad Reach of Psychiatry: Studying History, Peacekeeping, and the Role of Spirituality in Schizophrenia 

19. The Modern History of American Psychiatry: Unintended Consequences Milton Kramer, M.D. 

20. Is Peacekeeping Peaceful? A Systematic Review Jitender Sareen, M.D. 

21. Spiritual and Religious Coping in Schizophrenia: Clinical Implications Philippe Huguelet, M.D. 

Session 8. Studies in Psychotherapy 

22. Follow-Up Psychotherapy Outcome of Patients With Dependent, Avoidant, and Obsessive-Compulsive Personality Disorders—a Meta-Analytic Review Witold Simon, M.D., Ph.D. 

23. The Effectiveness of Evidence-Based Treatments for Major Depressive Disorder in a Routine Clinical Setting: Results From an Observational Study Frenk Peeters, M.D., Ph.D. 

24. The Effectiveness of a Group-Oriented Inpatient CBT Program Katherine Lynch, Ph.D. 

Session 09. Child and Adolescent Psychiatry 

25. Medication Trends in New-Onset Pediatric Bipolar Disorder Among Medicaid-Insured Youth Aloysius Ibe, B.S., M.S. 

26. Physical Activity and Fitness in Adolescents at Risk for Psychosis Jenni Koivukangas 

27. Metabolic Symptoms in Adolescent Psychiatric Inpatients Michael Stevens, Ph.D. 

Session 10. Cross-Cultural Psychiatry 

28. Genes, Memes, Migration, and Mental Illness Hoyle Leigh, M.D. 

29. One-Year Follow-Up Study of the Culturally Sensitive Collaborative Treatment (CSCT) for Chinese Americans With Depression Adrienne van Nieuwenhuizen, B.A. 

30. Prevalence of Childhood Trauma in Psychiatric and  Mexico Border Alejandra Postlethwaite, M.D.

Session 11. Diagnostic Issues 

31. Heterogeneity of the Jealousy Phenomenon in the General Population: An Italian Study Donatella Marazziti, M.D. 

32. Olfactory Reference Syndrome (ORS): A Systematic Review of the World Literature Millia Begum, M.B.B.S., M.Eng. 

33. Dimensionality and Etiology in Psychiatric Research Stephen Shanfield, M.D. 

Session 12. Metabolism, Metabolic Syndrome, and Cardiovascular Disease in Schizophrenia 

34. Schizophrenia-Spectrum Disorders Were Associated With Cardiovascular Disease Symptoms, Independent of Known Risk Factors for Symptoms Stephen Woolley, D.Sc., M.P.H. 

35. Ultra Rapid Metabolizers Are in a Pilot Study in Two Different Clinics Over-represented in Court-Ordered Psychotic Patients Carel de Blécourt, M.D., Ph.D. 

36. Oatmeal vs. Donuts: Treating Metabolic Syndrome/Obesity Using CBT/DBT in an Inner-City SPMI Population Joanne Caring, M.D. 

Session 13. Diagnostic Issues in the Schizophrenia Spectrum 

37. Is Schizoaffective Disorder a Distinct Clinical Entity? John Goethe, M.D. 

38. Diagnostic Stability in Patients With Schizoaffective Disorder Compared to Schizophrenia and Bipolar Disorder Bonnie Szarek, R.N. 

39. Depression and Its Treatment in Patients Presenting With Late-Onset Delusional Disorder (LODD) Rebecca Anglin, M.D. 

Session 14. Psychiatric Issues Related to Pregnancy and Breast Feeding 

40. Postpartum Depression and Breast Feeding in an Urban Population of Women in Malaysia Nor Zainal, M.B.B.S., M.Psy. 

41. Psychotic Denial of Pregnancy: Ethical and Legal Considerations for Treating Physicians Melissa Nau, M.D. 

42. Posttraumatic Growth and Quality of Life in Breast Cancer Patients Derya Iren Akbiyik, M.D., Ph.D. 

Session 15. Exploring Suicidality: Assessment and the Impact of Spirituality and Economic Conditions 

43. Meeting the Challenge of Risk Assessment: Toward a New Scale of Suicide Assessment: The Scale for Impact of Suicidality Management and Assessment Amresh K. Shrivastava, M.D., D.P.M. 

44. Economic Factors and Suicide Rates—Associations Over Time in Four Countries Alfonso Ceccherini-Nelli, M.D. 

45. Religion, Spirituality, and Suicide in a Large Community Sample Daniel Rasic, B.S., M.D. 

Session 16. Panic and Anxiety Disorder 

46. Frequency and Clinical Correlates of Adult Separation Anxiety Disorder in 508 Outpatients With Mood and Anxiety Disorders Stefano Pini, M.D. 

47. Long-Term Treatment of Panic Disorder With Clonazepam or Paroxetine: A Randomized, Naturalistic, Open Study Antonio Nardi, M.D., Ph.D. 

48. Effectiveness of a Mindfulness-Based Cognitive Therapy Program as an Adjunct to Pharmacotherapy in Patients With Panic Disorder Borah Kim, M.D. 

Small Interactive Sessions (~1.5 hr each) 

SI01. Safety Issues in Child Psychopharmacology. Barbara Coffey, M.D. 

SI02. Antipsychotic Polypharmacy: An Evidence-Based Perspective. Donald Goff, M.D.

SI03. Psychiatric Issues Related to Returning Vets From Iraq Charles Hoge, M.D. 

SI04. A Discussion and Open Forum About Drug Interactions Gary H. Wynn, M.D. (Meet the Author) 

SI05. Neuropsychiatric Assessment for General Psychiatry Sheldon Benjamin, M.D. 

SI06. Palliative Care and Psychiatric Issues at the End of Life William Breitbart, M.D. 

SI07. When a Physician Is Your Patient Michael Myers, M.D. 

SI08. Approach to the Psychiatric Patient John W. Barnhill, M.D.

SI09. Brain Stimulation Therapies for Clinicians Ned Higgins, M.D. 

Special (1.5 hr)

Opening Session and Presidential Address 

Symposia (~0.5-0.75 hr each; ~3 hr for each session) 

S1. Spotting the Wolf in Sheep's Clothing: Clinical Challenges Identifying and Treating Unpresented Comorbidity National Institute on Drug Abuse 

A. The Prevalence of Substance Use Disorders Among Psychiatric Populations Carlos Blanco-Jerez, M.D. 

B. Screening for Substance Use Disorder Among Individuals With Severe Mental Illness Stanley D. Rosenberg, Ph.D. 

C. Motivational Interviewing for Substance Abuse Among Adolescents With Psychiatric Comorbidity Richard A Brown, Ph.D. 

D. Diagnosis Challenges for Co-Occurring ADHD and Substance Use Disorders Frances Levin, M.D. 

E. The Treatment of Co-Occurring Mood and Anxiety Disorders in Addictions Kathleen Brady, M.D. 

S2. Adjustment Disorders: Problems in Conceptualization, Conundrums in Classification 

A. Adjustment Disorders and DSM-V: Considerations for Dimensional (Spectrum Diagnoses) Versus Categorial James J. Strain, M.D. 

B. Recent Advances in the Study of Adjustment Disorders Andreas Maercker, M.D. 

C. Can Adjustment Disorder and Depressive Episode Be Distinguished? Results From the ODIN Study Patricia P. Casey, M.D. 

D. Posttraumatic Embitterment Disorder Michael Linden, M.D. 

S3. Delivering Psychiatry in Rural Peru: The Ayacucho Mental Health Project 

A. The Ayacucho Mental Health Project James Phillips, M.D. 

B. Constructing a Formulary for a Psychiatric Clinic in the Developing World Mark D. Rego, M.D. 

C. Psychiatric Treatment in a Trilingual Setting Stephen J. Bittner, M.D. 

D. The Use of Skype by the Ayacucho Team in Follow-Up, Supervision, and Other Contacts With Patients and Staff Galen W. Stahle, M.D. 

E. Evaluation of Change in Indicators of Mental Health in an Andean Region of Peru Luis E. Bedregal, Ph.D. 

S4. Stalking: Risk Management and Treatment of Offenders and Victims 

A. A Comprehensive Approach to the Treatment of Stalking Victims Gail E. Robinson, M.D. 

B. Stalking of Health Care Professionals Karen M. Abrams, M.D. 

C. Treatment of Stalking Offenders Werner Tschan, M.D. 

D. Workplace Assessment of Violence Risk Stephen G. White, Ph.D. 

E. Stalking Threat Management Jeffrey Dunn, M.D. 

S5. Understanding and Addressing Adolescent Alcohol Consumption and Alcohol Use Disorders in the Context of Overall Development National Institute on Alcohol Abuse and Alcoholism 

A. Early Development and Continuity of Risk for Early Drinking, Problem Drinking, and Alcoholism From Early Childhood to Adulthood Robert A. Zucker, Ph.D. 

B. Applying a Developmental Framework to Alcohol-Related Behaviors: Ages 10-15 Michael Windle, Ph.D. 

C. Applying a Developmental Framework to Alcohol-Related Behaviors From Middle to Late Adolescence Sandra A. Brown, Ph.D. 

D. Developmentally Informed Research on the Effectiveness of Clinical Trials (DIRECT) With Adolescents With Alcohol Problems Eric F. Wagner, Ph.D. 

E. Evidenced-Based Treatments for Alcohol Use Disorders in Adolescents Deborah Deas, M.D., M.P.H. 

S6. "In or Out?": A Discussion About Gender Identity Diagnoses and the DSM (DSM Track DM03) 

A. The DSM-V Revision Process: Principles and Progress William E. Narrow, M.D. 

B. Beyond Conundrum: Strategies for Diagnostic Harm Reduction Kelley Winters, Ph.D. 

C. Aligning Bodies With Minds: The Case for Medical and Surgical Treatment of Gender Dysphoria Rebecca Allison, M.D. 

D. The Role of Medical and Psychological Discourse in Legal and Policy Advocacy for Transgender Persons in the U.S. Shannon P. Minter, J.D. 

S7. Relationship of Subthreshold Psychiatry to Axis II (Personality Disorders) 

A. Relationship of Subthreshold Psychiatry to Personality Disorders Ahmed Okasha, M.D. 

B. Personality Disorders, Their Thresholds, and Public Health Norman Sartorius, M.D. 

C. Schizophrenia/Schizotaxia: A Genetic Predisposition of Schizophrenia Ming T. Tsuang, M.D. 

D. On the Shared Diathesis of Borderline Personality and Bipolar Hagop S. Akiskal, M.D. 

E. Generalized Anxiety Disorder and Avoidant Personality Disorder Juan J. Lopez-Ibor, M.D. 

S8. Educating a New Generation of Physicians in Psychiatry: Reports From Winners of APA Innovative Teaching Grants APA Corresponding Committee on Medical Student Education 

A. Changing Perspectives: Reducing the Stigma of Mental Illness in Medical Students Through the Living Museum Project Janis Cutler, M.D. 

B. A School-Based Medical Student Curriculum for Education in Child and Adolescent Psychiatry Justine Larson, M.D. 

C. Teaching Third-Year Medical Students Brief Motivational Interviewing Skills to Use in Counseling Patients With Mental Illness on Smoking Cessation Brenda J.B. Roman, M.D. 

D. Preventing and Managing Metabolic Syndrome Among the Seriously Mentally Ill: Teaching Behavioral Medicine to Medical Students Jason B. Rosenstock, M.D. 

S9. Effective Assessment and Treatment of Sexual Dysfunction in Adults and the Elderly 

A. Clinical Presentation and Assessment of Sexual Dysfunction in Patients With Psychiatric Illness Jeffrey D. Raynor, M.D. 

B. Treatment of Psychotropic-Induced Sexual Dysfunction Travis O. Bruce, M.D. 

C. Sexual Dysfunction in Late Life: Beyond "Vitamin V" Shilpa Srinivasan, M.D. 

S10. The Neurobiological Evidence for Transgenderism 

A. Brain Gender Identity Sidney W. Ecker, M.D. 

B. Transsexuality as an Intersex Condition Milton Diamond, Ph.D. 

C. Novel Approaches to Endocrine Treatment of Transgender Adolescents and Adults Norman Spack, M.D. 

S11. Comprehensive HIV Psychiatry Update 

A. HIV/AIDS Medical Update Paul Volberding, M.D. 

B. Neuropsychiatric Overview of HIV/AIDS Robert Daroff Jr., M.D. 

C. Neurocognitive Decline Karl Goodkin, M.D. 

D. Psychopharmacology Gabrielle Marzani-Nissen, M.D. 

S12. The OC Spectrum in the Athlete: Psychopathology or Competitive Edge? International Society for Sport Psychiatry 

A. An International-Level Athlete's Struggle With Obsessive-Compulsive Disorder David O. Conant-Norville, M.D. 

B. Athletes and Superstition Thomas S. Newmark, M.D. 

C. The OC Spectrum in the Athlete: Psychopathology or Competitive Edge Saul I. Marks, M.D. 

S14. Increasing the Likelihood of Achieving Remission in Depression 

A. Medication Algorithms for Antidepressant Treatment: Lessons Learned From STAR*D and Other Practical Clinical Trials Madhukar H. Trivedi, M.D. 

B. Strategies for Medication Management of Treatment Resistance: Lessons From STAR*D Maurizio Fava, M.D. 

C. Use of EEG Biomarkers to Direct Selection of Antidepressant Medication Andrew F. Leuchter, M.D. 

D. Collaborative Care Approaches to Depression Jurgen Unutzer, M.D. 

E. Can Genetic Biomarkers Help Direct Treatment for Depression? Gonzalo Laje, M.D. 

S15. The Transmission of Borderline Personality Disorder 

A. The Aggregation of DIB-R and DSM-IV Borderline Personality Disorder Mary C. Zanarini, Ed.D. 

B. Familial Coaggregation of BPD With Axis I Disorders James I. Hudson, M.D. 

C. Familial Aggregation of Attachment in Borderline Personality Disorder Lois W. Choi-Kain, M.D. 

D. Familiality of BPD's Component Phenotypes John G. Gunderson, M.D. 

E. An Endophenotypic Approach to Borderline Personality Disorder Larry J. Siever, M.D. 

S16. Contributions of Neuroscience to Medications Development for Alcohol Use Disorder. National Institute on Alcohol Abuse and Alcoholism 

A. Novel Targets From the Dark Side of Dependence on Alcohol: Focus on CRF, Norepinephrine, and Vasopressin George F. Koob, Ph.D. 

B. Activation of the Nociceptin/Orphanin FQ System Reduces Alcohol Abuse–Related Behaviors in Rats With Innate Predisposition to Excessive Alcohol Intake and Elevated Anxiety Roberto R.C. Ciccocioppo, Ph.D. 

C. N-Type Calcium Channel Blockers for Alcohol Use Disorders: From Cells to People Robert O. Messing, M.D. 

D. New Array of Potential Treatments for Alcohol Use Disorders: From Drosophila to Electophysiology and More Predictive Animal Models Selena E. Bartlett, Pharm.D. 

E. The Emerging Role of Pharmacogenetics in Medications Development for Alcoholism: the Case of the Mu-Opioid Receptor Vijay A. Ramchandani, Ph.D. 

S17. Monitoring Equity in Mental Health From a Cross-National Perspective 

A. Equity in Determinants of Health and Health Policies Influencing Mental Health: A Cross-National Perspective Donna Stewart, M.D. 

B. Monitoring Equity in Mental Health in Lower-, Middle-, and High-Income Countries Natalia Diaz-Granados, M.S.C. 

C. Sociodemographic Factors Affect Mental Illness Rates Differently Across Countries Marta B. Rondon, M.D. 

D. Factors Associated With Inequities in Mental Health Care Use in a Developing Country Javier E. Saavedra, M.D. 

E. Income-Related Inequity in Mental Health Service Utilization in Colombia and Canada Marie DesMeules, M.S.C. 

S18. Recovery and Rehabilitation: From the Provider and Patient Points of View in France and the U.S.: Vive la Difference! 

A. Recovery From Disability of Serious Mental Disorders: A Phase-Linked Rehabilitation Process Robert P. Liberman, M.D. 

B. Can We Implement Recovery and Rehabilitation?: What Do We Know and What Are the Implications for Services? Marianne D. Farkas, Sc.D. 

C. An Individualized Cognitive Remediation Therapy for Patients With Schizophrenia: The RECOS Program Pascal Vianin, Ph.D. 

D. Functional Remission in Schizophrenia: A Specific Tool for Evaluation Pierre Michel Llorca, M.D.   

S19. Suicide Without a Psychiatric Disorder 

A. Had Gary Powers Killed Himself Norman B. Levy, M.D. 

B. Differentiating Suicide From Other Life-Ending Acts: A Model Illustrated With Chronic Kidney Disease and Dialysis John M. Bostwick, M.D. 

C. Oregon's Death With Dignity Act: Who Chooses Physician-Assisted Suicide Linda Ganzini, M.D. 

D. Desire for Death in Terminally Ill Cancer and AIDS Patients: Hopelessness and Loss of Meaning as Contributing Factors, Independent of Depression William Breitbart, M.D. 

E. Ethics in Suicide That Is Not Associated With Psychiatric Illness James J. Strain, M.D. 

S20. Biological Basis of Sex Differences in Drug Addiction: Translational Perspectives National Institute on Drug Abuse 

A. Sex Differences in Biological Sensitivity to the Reinforcing Effects of Drugs of Abuse in Preclinical Models of Acquisition, Escalation, and Relapse Wendy J. Lynch, Ph.D. 

B. The Role of Dopamine in Sex Differences in Drug Abuse Jill B. Becker, Ph.D. 

C. Gonadal Steroid Hormones and Neural Mechanisms of Cognition and Emotion in Women Karen Faith Berman, M.D. 

D. Sex Differences in fMRI Correlates of Stress and Drug Cues in Cocaine Dependence Marc N. Potenza, M.D. 

E. Sex Differences in Amygdala-Based Emotional Memory Processes: Relevance for Addiction Larry F. Cahill, Ph.D. 

S21. Co-occurring Disorders in HIV Positive Patients 

A. HIV and Hepatitis C Co-Infection Elizabeth Ryan, M.D. 

B. Metabolic Disease and HIV Marshall Forstein, M.D. 

C. PTSD and HIV Antoine Douaihy, M.D. 

D. Update on Severe Mental Illness and HIV Francine Cournos, M.D. 

E. Substance Use Disorders and HIV Steven Batki, M.D. 

S22. Starting Out on the Right Foot: Securing Your First Job and Establishing a Psychiatric Practice APA Committee of Residents and Fellows 

S23. Social Stress Increases Vulnerability to Drug Abuse and Disease National Institute on Drug Abuse 

A. Adverse Effects of Stress on Drug Addiction Julie Blendy, Ph.D. 

B. Social Stress and Vulnerability to Substance Abuse: Genes, Environment, and Neural Correlates Huda Akil, Ph.D. 

C. Interactions of Social Stressors and Enrichment With Social Rank on Dopamine D2 Receptors and the Reinforcing Strength of Cocaine in Monkeys Michael A. Nader, Ph.D. 

D. Social Stress and Simian Immunodeficiency Virus Disease: Behavioral and Physiological Mechanisms That Affect Disease Progression John P. Capitanio, Ph.D. 

S24. What's New in Pharmacotherapy for Alcohol Dependence? National Institute on Alcohol Abuse and Alcoholism 

A. Neurokinin 1 Receptor (NK1R) Antagonism: A Novel Anti-Stress Mechanism for the Treatment of Alcoholism David Ted George, M.D. 

B. Human Laboratory and Clinical Trial Evidence for Gabapentin Treatment of Alcohol Dependence Barbara J. Mason, Ph.D. 

C. Update on New Clinical Trials for Alcohol Dependence: Opiate, Dopamine, and GABA/Glutamate Acting Medications Raymond F. Anton, M.D. 

D. An Analysis of Two Promising Medications, Topiramate and Ondansetron, for Treating Alcohol Dependence: Results From Recent Large-Scale Clinical Trials Bankole A. Johnson, D.Sc. 

E. Pharmacogenetics and Alcohol Dependence Henry R. Kranzler, M.A. 

S25. Autism in Adults—Toward a Better Clinical Approach Through Understanding: Recent Insights From Research 

A. Neurodevelopmental Correlates of Social Impairment in Autism: From Infancy to Adulthood Ami Klin, Ph.D. 

B. Diffusion Tensor Imaging in Autism and Asperger Syndrome: Evidence for Impairment of Long Range White Matter Integrity Wouter Groen, M.D. 

C. Neurocognitive Correlates of Substance Use Disorder in Adults With Autism Spectrum Disorder or ADHD Bram B. Sizoo, M.D. 

D. Comorbidity in Adults With ASD: Evidence From Data From Cross-Sectional and Prospective Case-Controlled Cohort Samples Patricia J. van Wijngaarden-Cremers, M.D. 

E. ASD in Parents and Siblings of Early Diagnosed Infants With ASD Rutger J. Van der Gaag, M.D. 

S26. The Effects of City Life on Mental Health Around the World Royal College of Psychiatrists 

A. The Impact of Urban Living on Mental Health and Illness in Egypt Nasser N. Loza, M.D. 

B. Mental Disorders and Quality of Life in Large Metropolitan Areas in Mexico Maria E. Medina Mora, Psy.D. 

C. Metro-Urban Mental Health in Developing Countries: From Origins to Outcome: An Indian Experience Amresh K.A. Shrivastava, M.D. 

D. A Population-Based Study of First Episode Psychosis in São Paulo, Brazil Paulo Menezes, M.D. 

E. Chinese Elderly in Singapore: Comparing the Mental Health of an Urban and a Suburban Population Ee-Heok Ehk Kua, M.B.B.S. 

F. The Practice of Mental Health Promotion in Urban Planning and City Administration Helen E. Herrman, M.B. 

S27. Recent Research in Eating Disorders 

A. Psychopathology and Eating Pathology in Bariatric Surgery Candidates James E. Mitchell, M.D. 

B. Disordered Eating and Psychiatric Symptoms in Adolescents Presenting for Bariatric Surgery Michael J. Devlin, M.D. 

C. Recent Mortality Studies in Eating Disorders Scott J. Crow, M.D. 

D. A Model of Allostasis for Conceptualizing Eating Disorders Katherine A. Halmi, M.D. 

E. Are Anorexia Nervosa and Bulimia Nervosa Really Eating Disorders: New Understanding of Puzzling Symptoms Walter H. Kaye, M.D. 

S28. Publication Bias and the Effectiveness of Antidepressant Treatment and Psychological Interventions in Depression: Should We Care? 

A. Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy Erick H. Turner, M.D. 

B. Publication Bias Is Not Restricted to Reporting Outcomes of Pharmacotherapy Trials Willem W.A. Nolen, M.D. 

C. Nonresponse to CBT and Antidepressants in the Treatment of Depression in Myocardial Infarction Patients Elisabeth Martens, M.D. 

D. How Well Do We Treat MDD? Claudi C.L.H. Bockting, Ph.D. 

S29. Borderline Personality Disorder: The Role of Neurobiology and Genes 

A. Opioid Receptor and Oxytocin Genotypes in BPD Larry J. Siever, M.D. 

B. Dysregulation of Endogenous Opioid System Function in Borderline Personality Disorder Jon-Kar Zubieta, M.D. 

C. Pain Processing in Borderline Personality Disorder: Functional and Genetic Approach Martin Bohus 

D. Neurobiology of Self-Injury in Borderline Personality Disorder Barbara H. Stanley, Ph.D. 

S30. Current and Future of the Emergent Field of Therapeutic Brain Stimulation and Neuromodulation in Psychiatry 

A. Neurosurgery for OCD: Focus on Deep Brain Stimulation Benjamin D. Greenberg, M.D. 

B. Feasibility Study of an Implantable Cortical Stimulation System for Patients With Major Depressive Disorder Darin D. Dougherty, M.D. 

C. Deep Transcranial Magnetic Stimulation: Comparison Between Effects of Unilateral and Bilateral Prefrontal Cortex Stimulation in Depressive Patients Abraham Zangen, Ph.D. 

D. Current and Future Therapeutic Uses of rTMS Mark S. George, M.D. E. Current and Future of Other Brain-Stimulating Techniques Alexander Bystritsky, M.D. 

S31. Pediatric Bipolar Disorder: A Critical Look at an American Phenomenon 

A. Australian and New Zealand Child and Adolescent Psychiatrists' Views on Bipolar Disorder Prevalence and on Rates of Pediatric Bipolar Disorder in the USA Peter I. Parry, M.B.B.S. 

B. Changing the Treatment Culture in a Residential Agency for Youth: Broadening the Role of Psychiatry Edmund C. Levin, M.D. 

C. Pediatric Bipolar Disorder: A Dispassionate Review of the Literature Glen R. Elliott, M.D.  

D. Bioethics and "Pediatric Bipolar Disorder" Mary G. Burke, M.D. 

S32. Working With Lawyers 

A. Values of Medicine and the Law Roger Peele, M.D. 

B. Brownlee v. Me: A Good Lawyer Directs the Process and Gets a Favorable Summary Judgment Lawrence K. Richards, M.D. 

C. New Opportunities for Attorney/Psychiatrist Collaborations Bruce J. Winick 

D. Beyond "Get the Money Up Front" Thomas G. Gutheil, M.D. 

E. Working With Lawyers Harold I. Eist, M.D. 

S33. Empirically Validated and Effective Psychotherapies for Borderline Personality Disorder 

A. Evidence-Based Versus Effectiveness Studies: The Randomized, Controlled Trial and Psychotherapy Research Kenneth R. Silk, M.D. 

B. Mentalization Based Treatment: A Discussion of Theory and Evidence Anthony W. Bateman, M.R.C. 

C. Transference-Focused Psychotherapy for BPD: Aiming for Change in Personality Structure Frank E. Yeomans, M.D. 

D. Dialectical Behavior Therapy for Complex, Multi-Diagnostic Patients—A Review of DBT's Evidence Base to Date Linda A. Dimeff, Ph.D. 

E. CBT for Personality Disorders (CBT-PD) Kate M. Davidson, Ph.D. 

F. Schema Therapy for Borderline Personality Disorder Jeffrey E. Young, Ph.D. 

S34. Advances in Neuropsychiatry and Clinical Neurosciences 

A. Windows to the Brain: Clinical and Functional Imaging in Psychiatry Robin A. Hurley, M.D. 

B. Current Controversies and Research Oportunities in the Neuropsychiatric Aspects of Delirium Paula Trzepacz, M.D. 

C. Neuropsychiatry of Traumatic Brain Injury Jonathan Silver, M.D. 

D. Advances in Neuropsychiatric Disorders Associated With Cerebrovascular Disease Robert G. Robinson, M.D. 

S35. PTSD and Alcohol Use Disorder (With Special Emphasis on Returning Veterans) National Institute on Alcohol Abuse and Alcoholism 

A. Psychotherapy Treatments for PTSD and Alcohol Use Disorder Lisa M. Najavits, Ph.D. 

B. Neurobiological Determinants of the Comorbidity of PTSD and Substance Abuse Thomas R. Kosten, M.D. 

C. Pharmacotherapeutic Treatment of PTSD and Co-Occurring Alcohol Use Disorders Kathleen Brady, M.D. 

D. Outcomes for Alcohol-Misusing Women With PTSD in the Women and Trauma Multisite Study in NIDA's Clinical Trials Network Denise Hien, Ph.D. 

E. Impact of Childhood Trauma on Hypothalamic-Pituitary-Adrenocorticol (HPA) Activity in Alcohol-Dependent Patients Ingo Schäfer, M.D. 

S36. Psychiatric Patients' Overcrowding in Emergency Departments: A Call for Actions APA 

Council on Healthcare Systems and Financing 

A. Overview of Psychiatric Patient Overcrowding in Emergency Departments Scott L. Zeller, M.D. 

B. Health Care Delivery System Influences and Impacts—Strategies for Improvement Joseph J. Parks, M.D. 

C. Innovative Methods to Decrease Psychiatric Patient Overcrowding of Medical Emergency Departments Avrim B. Fishkind, M.D. 

D. Behavioral Health Service Gaps and the Role of Emergency Departments Alan Q. Radke, M.D.