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.)

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

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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. 

I Feel Your Pain

The relationship between physical and emotional illnesses is a really complex one. There's nothing easy about this, and there are psychiatrists who specialize (like Roy) in consultation-liason psychiatry: the interface where psychiatrists deal with psychiatric issues in patients who are hospitalized on med/surg units. There are psychiatrists and neurologists who specialize in pain management.

It's probably no surprise that people with known psychiatric disorders are more easily dismissed by their primary care docs-- their chest pain is assumed to be 'anxiety' and their GI symptoms are due to "stress." It drives me nuts.

This shrink's rule of thumb for medical workups [I hope Dinah doesn't mind me sticking in my 2 cents :-Roy] :

• All symptoms which may be indicative of medical illness should be assumed to be so until proven otherwise. I don't want to see a patient for "panic attacks" until after a thorough work up to rule out cardiovascular or pulmonary disease. What's the work up? Well, it's one thing for an 18 year old girl with no risk factors and a primary complaint of "I feel panicky" and another work-up for a 55 year old smoker with hypertension and a father who died at 54 of an MI who presents with chest pain and shortness of breath on exertion. Don't send the 55 year old smoker with chest pain to see a psychiatrist until after he has a cardiac catheterization! [It's not uncommon to get a consult request to "rule out" conversion disorder when they cannot find a cause for symptoms. Sometimes it is appropriate; others I tell to keep looking.]
  
  
• Elusive symptoms are elusive symptoms and should be worked up completely, even if the patient has a psych history.
  
  
• Bizarre, non-biologically founded symptoms may require less of a work up--- the classic being "My hair hurts when I pee" or "the machine the aliens inplanted in me is squeezing my thighs." [Though this last example reminds me that people with psychosis get sick, and sometimes interpret their symptoms in a psychotic manner. Don't blow off the alien machine guy's complaint until you've ruled out a blood clot, fracture, or compartment syndrome.]
  
  
• Pain syndromes often respond to psychiatric treatments: it doesn't mean the pain wasn't real. Unfortunately, people take this to mean "it was all in your head," and who ever came up with that phrase is not my friend. You can have back pain. It can be real pain and it can really be in your back. Psychiatric treatments may make your pain go away. It was still real pain and it was still in your back. [e.g., tricyclic antidepressants reduce sensitivity to visceral pain]
  
  
• Some people have known medical/anatomical reasons for their symptoms and adding psychiatric treatment to the medical regimen helps.
  
  
• Some people have extensive workups for an assortment of symptoms: pain, weight loss, diarrhea, migraines, you name it. These can be really extensive work ups running tens of thousands of dollars (or more) with many invasive procedures and nothing is revealed that explains the symptoms. These patients become depressed (this is a very frustrating scenario), and sometimes when the depression is treated, the rest of the symptoms go away. Yes, this really happens, it's profound and it's remarkable. How do you explain this, given that the physical symptoms preceded the depression? I'm left to say that in some people, their stress gets funneled into their body, it's just how they're wired. It doesn't mean their symptoms weren't real, it doesn't mean they are crazy, it doesn't mean it was all in their head, it just means that for them, Depression starts with physical symptoms. Some of these patients do amazingly well, get off their narcotics, and resume normal lives that are no longer controlled by pain/medication regimens/doctor's appointments and tests. If you can't figure out the physical causes for an illness, there should be no shame to looking for a psychological cause. It's sad that there is.
  

Midwife With A Knife: Infertility, Stress, and Psychotherapy

Okay, so I'm behind the times, here's a cool post from Midwife With A Knife from 2 months ago-- an interesting post on fertility, stress, and psychotherapy. Oh, and lemurs and monkeys and all kinds of critters, fertile and otherwise. I'm even stealing her lemur photos. I can't quite get the link right but it's the post called "Are you reading my blog?"

MWAK asks how to tell stress-susceptible people they may benefit from psychotherapy without making it sound like you think they are wusses (her word, isn't it great?!). What do you think?

I've never seen anyone for a primary complaint of "I can't conceive" but I face this problem regularly with pain patients. I'm left to say that some people's depression gets funneled into their body as pain or physical symptoms, and it's remarkable how treating the depression can alleviate the other symptoms. I could have sworn I once wrote a post called "You Need a Psychiatrist" about how to talk to people about getting care without sounding judgmental, but I can't seem to find it---must have been a dream.

So for tags we have pregnant pigs, bears, turtles, vultures, fish, glow in the dark cats, but no lemurs or monkeys. What kind of blog is this anyway?

In Treatment: Season 2 Oliver,Walter, and Gina: RAGE!

Poor little Oliver: his mom wants to move to upstate NY to take a teaching position. She wants to leave him with his dad. Dad says they'll kill each other, so okay, mom will take Oliver. Paul thinks this is a bad idea. Everyone is mad and Oliver doesn't want to move with his mom. He runs off and all three adults chase him to a playground. Oliver asks Paul if he can come live with him. This is pretty sad. Paul feels badly saying no, Oliver really has no one who really wants him. He leaves Paul feeling sad and rejected, and saying he'll never see him again.

Paul can't take Oliver, it's just a big therapeutic boundary violation to let your patients come live with you. Paul feels the boy's anguish-- sadness about leaving his own children, perhaps, or angst about his own inadequate and abandoning parents. But he tells Oliver he will always be his friend; oh, we grown up shrinks don't talk to our patients this way and I don't see kids, so I don't know what to say here. Paul tries to spare Oliver's feelings, he tells him they have fun together, but his reasons why he can't keep him feel inadequate: you have your own parents who want you---hmmm, this isn't really true, they might be thrilled to give Oliver to Paul. Oh, it's just sad.
----------
Cashmere Walter is on a pass from the inpatient unit-- he hates it there. Nothing to do, everyone is beneath him, no one is as good as Paul. Paul sees through the flattery and he doesn't mince words: "Why are you sucking up to me?" He tells Walter to stop bullshitting him. They talk about the personas of Walter--the busy CEO who needs to be important, the small child who lost his brother and can no longer play, which one crumpled, will he try to kill himself again. Walter sobs. I'm not sure I got all this, it was a bit heavy on the hypothetical constructs and I wasn't so sure what exactly made Walter sob so. Maybe it was supposed to be Walter's breakthrough and catharsis.
-------------
Paul is angry and agitated and he rants at Gina. He's decided that therapy doesn't work, "Absolutely I want to make them happy, what do you want to do, F*** them up even more?"
Now Paul wants to be a Life Coach and tell his patients to go live in Napa Valley in the sunshine, get dogs, and bike (not bad suggestions, if you ask me). Paul screams at Gina, he calls Gina a coward and he's vaguely threatening. "Unlike you, I actually give a s*** about my patients!"
It's one hell of a therapy session. Okay, I'm ready to give Paul some medication here. If I were Gina, I'd ask him to leave. He asks Gina what she really thinks and she screams at him that he's acting like an a**hole and he has remarkably little insight, is self-absorbed, and she's furious. "You got me to play the role you cherish." I have to give it to Gina, she thinks quickly when on the spot-- I want her script writer. They walk, they pace, they curse, someone please tell these people to sit down. "Somehow you have to tolerate that we don't save people." They sit down finally, and talk about Walter's suicide attempt. Paul sounds dismal and Gina wonders if Paul is suicidal. Somehow they've gone from a place of rage to a place of poignant sadness, they both talk about their grief, their dark moments. Paul apologizes for not coming to Gina's husband's funeral, maybe he apologizes for a multitude of sins. Gina ends the session by doing what Paul wants her to do: she offers to have coffee with him, and she tells him exactly what to do next.

Stuff. Like iPhones. For Peacocks.

It made me think about Roy, this article I read today in The New York Times. Roy is at APA in San Francisco. I miss him. My inbox is practically empty. He texts, and he left me a voicemail, but it's not the same. I want him to come home to be with me and ClinkShrink.

Okay, so the article, it was about stuff, and why we buy it and why we care about brands. Stuff, like iPhones. Roy loves his iPhone. He can talk about "apps" for hours.

In Message in What We Buy But No One's Listening, John Tierney writes:
Instead of running focus groups and spinning theories, he says, marketers could learn more by administering scientifically calibrated tests of intelligence and personality traits. If marketers (or their customers) understood biologists’ new calculations about animals’ “costly signaling,” Dr. Miller says, they’d see that Harvard diplomas and iPhones send the same kind of signal as the ornate tail of a peacock.

In Treatment: Rethinking Family

Mia is no longer pregnant (oh, soon we find out she never was). She's tired and she wants to go home or maybe have the session in the waiting room. This troubles Paul, but he sits down anyway.

Mia's mom came to visit her when she thought she was miscarrying--- suddenly mom is repainted in a more sympathetic light. She feeds Mia and she tells her about her own severe post-partum depression after Mia's birth. The events of the family's past-- where mom was always horrible and dad was always wonderful-- are now cast differently. Mia is angry-- her mom is just re-writing history in a way that makes her look better and makes her idealized father villainous. But Paul-- coming from his own father's funeral where he learned that his own evil, abandoning, philandering father had some virtues-- encourages Mia to be open to the possibility that mom wasn't all bad.
Paul tells Mia he knows from experience.

So what did I think? I often feel that when people paint another person as all evil with evil motives, that they may be missing something--- most people don't seem to want to willfully injure others. So I understood that Paul jumped on the opportunity to point out that some of Mia's mother's persona may have been something other than all bad---here she's the sympathetic mom with a tray full of food, confessing all sorts of family secrets, taking her daughter to the doctor. But when Mia doesn't want to see it all this way, Paul pushes the reinterpretation on her a little more strongly than I'm comfortable with. It's as though he's talking to himself, and not considering his patient's story.
====================
April is angry with Paul. She was feverish and delerious and he called her mother and had mom come to the hospital. Paul points out to April that she has high standards and people let her down. She's quick to write them off for a single mistake, Paul included, even though his intent was for her wellbeing. They bicker. April talks about her childhood, about being the perfect child, about hiding her accomplishments from her mother. Paul wonders if she's repeating a pattern with him. She doesn't like this, but somehow, they come to a place of peace. The session ends and he helps her up. There's something vaguely tragic about it all.

You Have To Try This First!

The patient is agitated and intrusive. He shows up without an appointment, and when I say I'll see him, but he'll have to wait, he is not pleased. He knocks on the door while I'm with another patient. He's been off his medicines, and he's decided he felt better with them. I think we both felt better when he was on them. Oh, but he didn't like those medicines. He wants something else. He needs something else. Maybe he needs to be in the hospital? He won't hear of it.

Okay, go back on Old Medicine you've been on before.

No.

How about Medicine X?

No. That stuff made his see dead bodies floating in space.

How Medicine Y?

No. Friend is on that stuff and it's awful.

How about Medicine Z?

No. Oh, you think that will help? Okay, he'll take that.

I think it will help. Oh, but then I remember that the state requires pre-authorization forms and I'm already behind here and there's all sorts of other issues, this patient isn't really in a great place for a detailed risk/benefit discussion, he's demanding something that will make him feel better now and I'm starting to feel his pain.

How about Medicine ZZ? I suggest a similar medicine.

Okay, he'll take that. In fact, he likes the name.

I write a prescription, he leaves and I resume my regularly scheduled clinic morning.

And then there's yet another knock at the door.

"But if you think that other medicine is better, I'll pay for it."

No, no, it costs hundreds of dollars, Just take the other stuff. Really, he's so bouncing off the walls that anything will take the edge off. The morning goes on. Yup, another knock at the door. The pharmacy couldn't fill the medication, not sure why. I've now drowned. I don't have pharmacies and calls to the state, and finding the right form, and pre-authorization phone calls and faxes...and whatever else it might take, in me right now and oh, he's not sure his insurance is even active. I surrender and grab samples (in the clinics, we save these for patients who have no other means of getting meds). He takes them and he actually leaves.

Next clinic day: Thank you, that medicine helped. The patient is much calmer, I don't once utter a word about hospitals. No side effects. And his insurance is now active. I write a prescription.

Fast forward to the next day. My cell phone rings, it's the pharmacy--- remember that patient (I do, but I see him at a clinic and I don't have access to his chart and why are you calling this number?). His insurance requires documentation that he's failed two other medications in the same class (and yes, those two medications both cost a small fortune as well, they aren't even asking if he's failed cheap meds!). I don't have a chart, but I think one of those meds made him see dead bodies floating in the air.

So let me get this right, I have a patient who was really sick, who's been in the hospital before, who is now better, and I'm supposed to take him off that medicine that's causing no side effects and put him on another, equally expensive medication---actually two-- and watch him maybe get sick twice, before I can put him back on the medication that is currently working just fine?

And how was your day?

Music is Good Stuff...

Here's a story about a cardiologist who says music does good things for us....helps your heart, helps your mood, slows the aging process (really?). Roy likes music and he's young at heart. I like music, especially when I exercise--the boppy stuff that keeps me from falling asleep in my tracks. CNN's Val Wilmingham writes:
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"If you didn't catch the white coat and the stethoscope, you might take Dr. Mike Miller for a middle-aged rocker, roaming the halls of the University of Maryland Medical Center in Baltimore.

Playing or listening to music can create a feeling of well being, which affects the vascular system.

For years, Miller, a research cardiologist, has been studying the effects of happiness -- or things that make people happy -- on our hearts. He began his research with laughter, and found watching funny movies and laughing at them could actually open up blood vessels, allowing blood to circulate more freely.

Miller thought, if laughter can do that, why not music? So, he tested the effects of music on the cardiovascular system. "Turns out music may be one of the best de-stressors -- either by playing or even listening to music," said Miller.

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Oh, so Dr. Miller's real claim to fame is that I'm Facebook (and real life, too) friends with his wife and she linked to this story, so here's my Shrink Rap plug!

Wash Those Paws!

Oh where oh where can my co-bloggers be? Can someone send a Tweet to Roy and see if he's still alive? And you'll need a search team and a helicopter to fetch ClinkShrink these days.

Well, you know how I love those Support Pet stories? Bad news: according to the New York Times Well blog, it seems Therapy Dogs can bring germs from one person to the next while bringing good cheer. Wash those paws!

Going Public With the Private

In the past week, I've heard Kay Jamison and Judith Werner speak, and yesterday I read the preview of a New York Times Magazine article by Daphne Merkin-- it will be published on Sunday. So I'm trying to figure out what draws these three events together, and all these people talk about there personal feelings in a public forum.

Kay Redfield Jamison is a scholar of bipolar disorder--- she co-authored the textbook on it. She moved from the academic world to the popular world when her memoir, An Unquiet Mind, was published in 1995-- with this she described her personal struggles with bipolar disorder. Dr. Jamison spoke on "Uses of Adversity" and part of her talk included mention of her personal struggles-- the idea that personal suffering can be the fuel for creative endeavors.

Yesterday, I heard New York Times blogger, Judith Warner, speak. Ms. Warner writes Domestic Disturbances, a blog about family life, and is the author of Perfect Madness: Parenting in the Age of Anxiety. Ms. Warner talks about the differences she noted in parenting when she moved from France to the United States, and talks quiet openly about what it's like to be the mother of two pre-teen daughters. She talks about the loneliness and isolation of being an American mom, of the crazy busy lives we struggle with. And she talks about her relationships with her daughters and with her own mother.

Both women are captivating speakers, and there is something very compelling about someone who talks openly about their own struggles.

So I didn't hear Daphne Merkin speak)....but do check out her on-line, to-be-published account of her episode of major depression in A Journey Through Darkness. Everything about Merkin's writing is hard-- she has an edge to her, one I don't always find to be sympathetic, but in this piece she simply oozes pain.

In Treatment: Oliver/Luke, Cashmere Walter, & Gina

Oliver shows up early, a runaway from school. His dad comes in and talks about his frustration with parenting and the fears that he's repeating his own father's sins. What timing, now that Paul has closed the circle on his father's mistakes and he's still grieving the death last week-- sounds like Paul is lecturing to himself when he tells Luke he has a choice to be a better father. Oliver may be the saddest looking child actor I've ever seen.
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Walter is in the hospital with "food poisoning." Or rather, for a suicide attempt by overdose. Paul comes to assess him, and while he denies the overdose at first, he soon gives details, and it's clear he wanted to die. Paul will have him committed, and Walter is angry. The pilot who died comes up, and Paul is clear that he can't take a chance like that. Walter is angry and tells him to leave, which Paul does. Paul mentions that Walter can have a hearing before a judge if he's still in the hospital in 2 weeks---hmmmm, in Maryland it's usually less than one week. Clink will know exactly how long.

There are continued family parallels----Walter's daughter looks strangely like Paul's daughter. Walter is laid out in the hospital bed just like Paul's father was and Paul reaches for his arm in the same motion that he reached for his father's hand.

I was surprised when Paul left and shut the door, leaving the potentially suicidal Walter alone. He's on 15 minute checks, and someone who wants to commit a desperate final act can do it in less than that. Why would Paul close the door--- why isn't Walter under constant observation? Ah, TV....
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Paul has a rather intense session with Gina the week after his father's funeral. He thanks Gina for the orchid she sent, and says he wishes she'd come to the funeral. She says it wasn't her place. She pushes Paul to talk about the funeral and his father, and redirects him from discussing other things he wants to discuss. Interesting....I might have let a distressed patient do what they wanted with the session, but Paul is surprisingly agreeable about going where Gina directs him.

After the session, Paul goes to meet with Alex's father, the man suing him. People don't usually go to restaurants to meet people they are engaged in litigation with, and for a moment, I wondered if the furious father might kill Paul (oh, the season has more episodes, so we need Paul to remain alive). My guess is that Paul's attorney wouldn't be happy about diner negotiations, and the waitress if strangely agreeable to letting the men stay there without placing an order. Alex's father says he will drop the lawsuit if Paul gives him a letter accepting full responsibility for Alex's death. He doesn't just want to believe Paul was negligent and should have done more to prevent Alex's death; he believes Paul killed Alex. Seems a bit of a stretch from negligence to murder.

Add it to the Drinking Water

So Roy sent me the link, but he couldn't post it?
Mind Hacks tells us that where there are higher levels of naturally occurring lithium levels, the suicide rate is lower. Referring to a study in the British Journal of Psychiatry, Mind Hacks states:

"This new study suggests that even trace amounts might have an influence on the whole population level, and this is not the first time this link has been made."

What do you say, should it be pumped in?

With Love to ClinkShrink: More In Treatment: Mia & April

Paul is a wreck--he's unshaven, uncombed, and his eyes sink deeper in his head than ever before. Mia is intrusive (so what else is new?) and grills him on how much he must be distressed--she's talked to his lawyer and knows his father died. She repeatedly asks him how he's doing? Is he lonely? And she speculates on aspects of his personal life and tells him it shows in his eyes that he's lonely. Oh, and she's pregnant by an unknown man. She asks Paul to celebrate with her, asks him if sex with his wife was as good after she gave birth, fantasizes about meeting Paul in a bar and running off to Las Vegas with him to get married. She wants to know if he'll be there for her, as she debates the pros and cons of becoming a mother.

Mia is cloying. I want to go home. Paul is good about distancing himself from her intrusions, but she is right that he's not ready to be back at work, and I can't help but wonder if he should continue treating her (or if he ever should have re-started after their first meeting in her legal office). She would be devastated if he refused to treat her, and her devastation would be understandable. But, is he safe with a patient who is asking questions of his lawyer, fantasizing marriage, and repeatedly asking if he'll be there for her in a way that sounds like she wants so much more than a therapist? And is he safe with such a patient, given that he's already professed his love for another patient last season, and admitted to his therapist that he could see himself with a woman like Mia? Not sure where the plot is taking us, but if this were real life, it would be going no where good.
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April is now getting chemo and she tells Paul she loves his eyes and they are "bottomless." What a life, women falling all over him. Apparently Paul was in the OR when they put in April's port. I don't think they let visitors in the OR in real life. They smile at each other a lot and the session has a flirtatious edge--- is this my imagination>? April falls apart when she hears that Paul doesn't plan to keep taking her to chemo-- one more patient he isn't there enough for-- and she puts it back together when he tells her his father died last week. Enough, it's bedtime.

Unusual Treatment Settings

A psychiatrist colleague is learning to do Cognitive Behavioral Therapy. He's treating a patient with agoraphobia, and goes to the patient's home to work with the patient on slowly coming out of his comfort zone.

It got me thinking about treating patients in their homes, or in places other than the office.

I've been to the homes of patients a few times-- none were my on-going therapy patients. As a resident, I rotated through an Outreach Team. These teams provide treatment to people with severe and persistent mental illnesses who have a history of non-compliance-- these patients don't keep their appointments, and they repeatedly get sick and end up in the hospital, sometimes many, many times. As the doctor on the team, I never went alone, always with a nurse or social worker who knew the patient, and mostly I was an observer. It was a great experience. As a clinic medical director, I went with our case manager a few times to see patients she was worried about.

So I'm thinking about the colleague who visits the patient in his home to help him negotiate the world. Is this a feasible way of treating people? The psychiatrist stays for an hour, and there's transportation time (I don't know how long that takes)....so financially, this could be an expensive endeavor. In this case, I believe the doc is salaried, and the patient is being seen pro bono as part of the learning experience. And what about the boundary issues involved in being in a patient's home?

I'm writing without really having a point I want to make. Does anyone else do Home Visit Psychiatry and what thoughts can you share?