dcpsychresidents : Messages : 377-409 of 440

Hello DC Residents,

Please see the note from Dr. Steckler below:

Hind

Hind   could you please post this on the resident's listserve?          thanks !       ES

esteckler@...

EarthLink Revolves Around You.

:

---    From: Eric Steckler <esteckler@...>
Subject: FW: offices to rent
To:
Date: Friday, May 15, 2009, 12:28 AM

Our long time friends   Miriam Roland and Joan Turkus have office space
for rent, and I can assure you that they would make very gracious landlords!

Eric Steckler
esteckler@...
EarthLink Revolves Around You.

> [Original Message]
> From: Miriam Harrington <miriamwh@...>
> To: Eric Steckler <esteckler@...>
> Cc: Joan Turkus <joan.turkus@...>
> Date: 05/11/09 11:05:24 AM
> Subject: offices to rent
>
> Eric - Joan and I still haven't rented my office space yet - and we
> may have one more opening before long.   Keep us in mind if you hear of
anyone
> needing cheap office space.
   Thanks -
>
> Miriam Roland

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#408

From: hind benjelloun <hbenjelloun@...>
Date: Fri May 8, 2009 2:50 pm
Subject: Update on Psychiatry from Dr. Roger Peele 5/8/09

hbenjelloun

Offline

Folks

In my last Update, I botched the paragraph on NTT, Need To Treat. Eist pointed out that the wording should be number needed for an additional responder than otherwise expected. Note “additional.”

Next week, the APA Assembly will be asked to approve the draft of the next edition of the MDD Practice Guideline. Depression-focused psychotherapy alone is recommended as an initial treatment choice for pts with mild to moderate MDD. Also recommended for mild, moderate or severe depression, an SSRI, SNRI, mirtazapine, or bupropion. MAOIs should be restricted to pts who do not respond to other treatments. “In pts who prefer complementary and alternative therapies, SAMe or St John’s Wort might be considered, although evidence for their efficacy is modest at best. .; .” Odd, St. John’s Wort is mentioned, exercise is not. Please bring other major omissions to my attention, and we’ll attempt to amend the document at the Assembly.

A couple of clinical items from this month’s AJP:

1. A research report concluded, “For depressed pregnant women, both continuous SSRI exposure and continuous untreated depression were associated with preterm birth rates exceeding 20%.” An editorial reflecting on this study concluded “the evidence available from long-term studies, this author thinks that the risk of untreated major depression outweighs the risk of effects of SSRI treatment on neonatal outcomes. We need to consider not just short-term, but also long-term, consequences of our decisions. In addition to focusing on the child, the clinician needs to consider the risk of untreated major depression in the mother. These risks include exacerbation or recurrence of her underlying psychiatric illness, which can have adverse effects on her morbidity and mortality and can impair not only her functioning, but that of her family and other children under her care.” Unclear in this editorial is why psychotherapy is not mentioned as the preferred choice in mild or moderately depressed pregnant women and ECT in the severe.

2. Second-generation antipsychotic use was associated with weight gain in women, with olanzapine and quetiapine in particular, and with unfavorable change in HDL cholesterol and girth with olanzapine. “The potential consequences of these effects suggest that patients with Alzheimer’s disease treated with second-generation antipsychotics should be monitored closely.” Men lost a little weight on average. The article was silent as to what to monitor.

Last Tuesday, the FDA notified healthcare professionals that it approved updated labeling for antiepileptic drugs used to treat epilepsy, psychiatric disorders, and other conditions. The increased risk of suicidal thoughts or behavior was generally consistent among the eleven drugs, with varying mechanisms of action and across a range of indications. This observation suggests that the risk applies to all antiepileptic drugs used for any indication.
“Healthcare professionals should closely monitor all patients currently taking or starting any antiepileptic drug for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.”
The drugs included in the analyses include:
Carbamazepine (marketed as Tegretol)
Felbamate (marketed as Felbatol)
Gabapentin (marketed as Neurontin)
Lamotrigine (marketed as Lamictal)
Levetiracetam (marketed as Keppra)
Oxcarbazepine (marketed as Trileptal)
Pregabalin (marketed as Lyrica)
Tiagabine (marketed as Gabitril)
Topiramate (marketed as Topamax)
Valproate (marketed as Depakote, Depakote ER, Depakene, Depacon)
Zonisamide (marketed as Zonegran)

In the 1980s, Vitamin E seemed good for everything. In this decade it seems to be striking out with every study. But on April 30 at the American Geriatrics Society (AGS) Annual Scientific Meeting, it finally has had a good report: Patients with Alzheimer's disease who receive high-dose vitamin E [800 to 2000 IU/day] combined with a cholinesterase inhibitor [donepezil, rivastigmine, or galantamine [800 to 1000 U twice daily].had less long-term deterioration in their ability to perform activities of daily living than those who do not receive vitamin E and on an cholinesterase. However, because some studies have shown an increased risk for death with vitamin E doses greater than 400 IU/day, high-dose vitamin E therapy for Alzheimer's disease fell out of favor a few years ago. Dr. Brangman, who is president-elect of AGS and who was not involved with the study, said: "I don't think this study alone gives enough information.”

We are advocating for Dr. Susan Rich’s [County private practice child, adolescent and adult psychiatrist] position that fetal alcohol syndrome should be in DSM-V. In the meantime, one can use ICD-9-CM’s 760.71, fetal alcohol syndrome.

The FDA has approved the med, iloperidone, as an antipsychotic, a product of Vanda, a Rockville firm whose CEO, Mihael Polymeropoulos, some of you knew when he was a resident at Saint Es.

Roger

#407

From: "matchejlbfriends" <matchejlbfriends@...>
Date: Wed May 6, 2009 5:52 pm
Subject: Do u think this picture is funny?

matchejlbfri...

Offline

LOL, I found a very funny picture and wanna know your opinion. Do u think this
picture is funny? Check the funny picture here:
http://funnyopic.zoomshare.com/files/funny.htm

#406

From: hind benjelloun <hbenjelloun@...>
Date: Fri May 1, 2009 4:20 pm
Subject: Psychiatry Update from Roger Peele, MD 5/1/09

hbenjelloun

Offline

Folks,

Below my name, from CDC, answers, as of Wednesday, to virtually all questions about the flue your pts might have. From Bill Lawson: "Wonder if this outbreak produces an increase in schizophrenia as did the pandemic of 1918.”

Last night’s WPS CME “What is ‘Number Needed to “Treat” anyway’?,” speaker, Leslie Citrone, provided the same definition of evidence-based medicine WPS asked, successfully, that the APA adopt: relevant scientific evidence with clinical judgment and patient values and preference. The focus of the talk was Number Needed to Treat [NTT], calculated by fA = frequency of A. fB = frequency of B. NTT = 1/fA – FB. For example, if drug A achieves remission in 50% of MDD pts and drug B is achieves remission 20% of MDD pts, then the NTT = 1/[.0.5-0.2] = 1/0.3 = 3.3. The rules of the NTT is that one round off upward, so the NTT = 4. Thus, you need to treat 4 pts for one patient to benefit. “A” and “B” can also be untoward events evaluated the same way. One of the major benefits of this approach is putting studies in prospective. Some much published studies have an NTT above a hundred, meaning that one pt would, in theory, would benefit if the treatment were applied in comparison to the alternative above the hundred -- which may be irrelevant to a practice unless the issue is deaths. Thus, when we see a treatment recommended or a side effect emphasized, we can apply the NTT to test clinical significance.

From this week’s meeting of A. Acad. of Neurology: Engaging in activities that exercise the brain, like reading, use of computers, and knitting in mid-life cut the risk that people will develop memory loss in their 70s or 80s by more than one-third. If your pt has already turned 70 or 80, it's not too late to benefit from exercises that tax the brain. Watching more than seven hours of TV a day, on the other hand, was linked to a higher than average chance of memory loss.

Each time a new atypical antipsychotic was introduced in the 1990s, there were suggestions that the med might help with deficit signs [poorly named “negative signs” by some], including the cognitive deficits. Cynics, however, usually claimed that the new med looked better only because the comparison group was on high-dose haloperidol. Online AJP, 15Apr09, has a meta-center study, EUFEST, that claims the cynics were not only correct, but that low-dose haloperidol improved deficits signs as much as the newer antipsychotics.

AstraZeneca paid for a recent supplement to the J of Clin Psychiatry on GAD. Medications mentioned for GAD, listed alphabetically with FDA approved ones underlined:
Alprazolam [0.75-4.0 mg/d], FDA approved
Bupropion [100-400 mg/d]
Buspirone [10-60 mg/d], FDA approved
Diazepam [15-40 mg/d], FDA approved
Duloxetine [30-120 mg/d], FDA approved
Escitalopram [5-20 mg/d, FDA approved
Hydroxyzine, FDA approved
Imipramine [25-300 mg/d]
Lorazepam [2-6 mg/d] FDA approved

Mirtazapine [15-45]
Paroxetine [10-50 mg/d], FDA approved
Pregabalin [150-600 mg/d]
Quetiapine [50-150 mg/d]
Riluzole mentioned, which I guess can be considered for those with an office in Potomac [costs, $35/d].
Sertraline [25-200 mg/d]
Trazodone [50-400 mg/d]
Trifluoperazine, FDA approved, a reminder that first generation antipsychotics were commonly used for GAD in the 60s, 70s and early 80s.
Venlafaxine ER [37.5-225 mg/d], FDA approved
CBT and Well-Being Therapy are also regarded as effective for GAD
If the pt also has depressive signs, most do, the three benzodiazepines listed supra, do not do as well as the antidepressants. Chromium picolinate “may be effective for atypical depression with GAD.” Gabapentin and second generation antipsychotics other that quetiapine “need further study.” Where is fluoxetine, which I’ve been prescribing for years for GAD? “Not better than placebo.” Now they tell me.

Current issue of the Washingtonian features Ken Gorelick, who many of you know. In the face of advanced brain cancer, he continues the positive outlook we’ve known since he came to Saint Es four decades ago.

For your roller-deck: There is a Family Justice Center, 600 Jefferson Street, 5th Floor, Rockville, MD 20852, part of the County’s Sheriff’s government, a "one stop shop" where domestic violence victims can access the legal system along with victim and other human services. Other people who would like assistance with domestic violence should continue to call: 240.777.4673, 24 hour crisis line, or 240.777.4195, intake line (regular business hours). Clients may also walk into the Crisis Center, 1301 Piccard, First Floor, 24 hours a day.

Roger

Interim Guidance for Clinicians on Identifying and Caring for Patients with Swine-origin Influenza A (H1N1) Virus Infection
Objective: This document provides interim guidance for clinicians who might provide care for patients with swine-origin influenza A (H1N1) or suspected swine-origin influenza A (H1N1) virus infection. It will be periodically updated as information becomes available.
Transmission

Transmission of swine-origin influenza A(H1N1) is being studied as part of the ongoing outbreak investigation, but limited data available indicate that this virus is transmitted in ways similar to other influenza viruses. Seasonal human influenza viruses are spread from person to person primarily through large-particle respiratory droplet transmission (e.g., when an infected person coughs or sneezes near a susceptible person). Transmission via large-particle droplets requires close contact between source and recipient persons, because droplets do not remain suspended in the air and generally travel only a short distance (<1 meter) through the air. Contact with respiratory-droplet contaminated surfaces is another possible source of transmission. Because data from swine-origin influenza viruses are limited, the potential for ocular, conjunctival, or gastrointestinal infection is unknown. Since this is a novel influenza A virus in humans, transmission from infected persons to close contacts might be common. All respiratory secretions and bodily fluids (diarrheal stool) of swine-origin influenza A (H1N1) cases should be considered potentially infectious.
Incubation period
The estimated incubation period is unknown and could range from 1-7 days, and more likely 1-4 days.
Persons with confirmed Swine-origin influenza A (H1N1) virus infection
A confirmed case of S-OIV infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed S-OIV infection at CDC by one or more of the following tests:
1. real-time RT-PCR
2. viral culture
Case definitions for Probable and Suspected cases can be found at: http://www.cdc.gov/swineflu/casedef_swineflu.htm

Clinicians should suspect swine-origin influenza A (H1N1) in persons with an acute febrile respiratory illness who
 Have had close contact with a person who is a swine-origin influenza confirmed case or
 Traveled to a community in the United States or internationally where there are one or more confirmed swine-origin influenza cases (Updated information about areas with confirmed human cases of swine-origin influenza A (H1N1) can be found at http://www.cdc.gov/swineflu/investigation.htm.) or
 Reside in a community where there are one or more confirmed swine-origin influenza A (H1N1) cases.
Clinical Findings
Patients with uncomplicated disease due to confirmed swine-origin influenza A (H1N1) virus infection have experienced fever, headache, upper respiratory tract symptoms (cough, sore throat, rhinorrhea), myalgia, fatigue, vomiting, or diarrhea.
Complications
There is insufficient information to date about clinical complications of this variant of swine-origin influenza A (H1N1) virus infection. Among persons infected with previous variants of swine influenza virus, clinical syndromes have ranged from mild respiratory illness, to lower respiratory tract illness, dehydration, or pneumonia. Deaths caused by previous variants of swine influenza have occasionally occurred. Although data on the spectrum of illness is not yet available for this new variant of swine-origin influenza A(H1N1), clinicians should expect complications to be similar to seasonal influenza: exacerbation of underlying chronic medical conditions, upper respiratory tract disease (sinusitis, otitis media, croup) lower respiratory tract disease (pneumonia, bronchiolitis, status asthmaticus), cardiac (myocarditis, pericarditis), musculoskeletal (myositis, rhabdomyolysis), neurologic (acute and post-infectious encephalopathy, encephalitis, febrile seizures, status epilepticus), toxic shock syndrome, and secondary bacterial pneumonia with or without sepsis.
Groups at high risk for complications
There are insufficient data available at this point to determine who is at higher risk for complications of swine-origin influenza A (H1N1) virus infection. At this time, the same age and risk groups who are at higher risk for seasonal influenza complications should also beconsidered at higher risk for swine-origin influenza complications .
Groups at higher risk for seasonal influenza complications include:
 Children less than 5 years old;
 Persons aged 50 years or older;
 Children and adolescents (aged 6 months–18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;
 Pregnant women;
 Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders;
 Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);
 Residents of nursing homes and other chronic-care facilities.
Reporting suspect swine-origin influenza A (H1N1) virus infection
Clinicians should contact their state public health department to report suspected cases of swine-origin influenza A (H1N1) virus infection and to obtain information on what clinical and epidemiological data to collect and specimen shipment protocols in their state.
Testing for swine-origin influenza A (H1N1) virus
Clinicians should consider testing suspected cases of swine-origin influenza A (H1N1), especially those with severe illness, by obtaining an upper respiratory specimens, such as a nasopharyngeal swab or wash, or nasal wash/aspirate, or tracheal aspirate, to test for swine-origin influenza A (H1N1) virus. Specimens should be tested by the state public health laboratory. Interim guidance on specimen collection ,processing, and testing for patients with suspected swine-origin influenza A (H1N1) virus infection can be found at: http://www.cdc.gov/swineflu/specimencollection.htm
Treatment for swine-origin influenza A (H1N1)
The swine-origin influenza virus is susceptible to both oseltamivir and zanamivir. It is resistant to amantadine and rimantadine. Interim guidance on antiviral treatment for swine-origin influenza A (H1N1) can be found at: http://www.cdc.gov/swineflu/recommendations.htm
Additional Therapy
Additional therapy such as antibacterial agents, should be used at the discretion of the clinicians given the patients clinical presentation. For antibacterial treatment of pneumonia, clinical guidance for community-acquired pneumonia should be followed and can be accessed at http://www.journals.uchicago.edu/doi/pdf/10.1086/511159?cookieSet=1.
For hospitalized patients with severe community-acquired pneumonia (CAP) requiring intensive care unit admission, menthicillin-resistent Staphylococcus aureus (MRSA) infection should be suspected and treated empirically in addition to other causes of CAP if they have 1) necrotizing or cavitary infiltrates or 2) empyema.
Infectious period
The duration of shedding with swine-origin influenza A (H1N1) virus is unknown. Therefore, until data are available, the estimated duration of viral shedding is based upon seasonal influenza virus infection. Infected persons are assumed to be shedding virus from the day prior to illness onset until resolution of symptoms. Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially contagious for up to 7 days following illness onset. Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until symptoms have resolved. Children, especially younger children, might be contagious for longer periods.
Infection Control Measures
Guidance on infection control during care of patients with confirmed or suspected swine-origin influenza A (H1N1) virus infection can be found at: http://www.cdc.gov/swineflu/guidelines_infection_control.htm
Antiviral Chemoprophylaxis
Guidance on pre-exposure and post-exposure chemoprophylaxis with antiviral agents for swine-origin influenza A (H1N1) virus can be found at: http://www.cdc.gov/swineflu/recommendations.htm
Additional Information
Additional information on swine-origin influenza can be found at: http://www.cdc.gov/swineflu/

#405

From: hind benjelloun <hbenjelloun@...>
Date: Wed Apr 29, 2009 3:29 pm
Subject: Psychiatry Update from Roger Peele, MD

hbenjelloun

Offline

Folks,

Relative to the swine flu outbreak, a statement yesterday, before the death in Texas, by the County Public Health Chief below my name.

Last Monday’s Update referred to the increase in diabetes with SSRIs. Harold Eist sent the following reflection: “Depressed patients also crave carbohydrates and some develop genuine sugar addictions. They wake up in the middle of the night and cannot get back to sleep until they have eaten a gallon of ice cream or all the sweets they can find including pure sugar. CHO's are building blocks of serotonin so these patients may be trying to build serotonin. They report considerable relief after eating CHO's and comfortably return to sleep. One would hope that in patients on SSRI's who develop diabetes a careful dietary history be taken. Since many of these patients are true addicts they lie about their real intake. A spouse or family member should be part of the initial history taking.”

In next month’s Pediatrics, an NIMH study finds that ADHD kids, kindergarten through 5^th grade, prescribed stimulants did better scholastically than those with ADHD and not prescribed such. medication. Medicated children were about one-fifth of a school year ahead of their non-medicated peers in math and about one-third of a school year ahead in reading, but both groups still lagged behind their classmates who did not have ADHD. ADHD researcher Lily Hechtman, MD, of McGill University, says that although ADHD drugs can help children, many children with ADHD have learning issues that the drugs do not address. “About 20% of children with attention deficit disorders also have very specific learning disabilities,” she says. “These children clearly need other interventions.” Even children without specific learning disabilities who have fallen behind academically will need more than medication to catch up if they are diagnosed after years of struggle in the classroom, she says.

Last Monday’s USA Today featured a plea that all teens get screened for depression, not just those who present with issues. Forms or computer screens would be filled out by the teen before seeing pediatrician who could determine risk in 15 seconds. It is estimated that 10% of the time, the screen would suggest there is more for the pediatrician to do. It is hypothetical, I gather, the degree to which mental health professionals would be available if this increases the number being referred. Restated, there should only be screening where services would be available.

Three milligrams of melatonin at bedtime can effectively treat sleep problems in children with autistic spectrum disorder or fragile X syndrome or both, according to a study reported in the April 15 issue of the Journal of Clinical Sleep Medicine.

In next month’s AACAP Journal, some articles of clinical interest:

1. A Lilly-funded study on use of atomoxetine in ADHD: Clinical response was bimodal, 47% showed considerable improvement, 40% showed no improvement. There were no demographic or clinical predictors of response. Subjects who ultimately achieved a much improved response were likely to be at least minimal responders by week 4.

2. The results of a study that did not provide support for the use of divalproex in the treatment of youths with bipolar I disorder, mixed or manic state.

3. CBT seems efficacious in children with anxiety disorders as opposed to group support and attention.

Roger

County Employee:

This message is to let you know more about the swine flu situation in Montgomery County and what you can do to protect yourself and your family.

First of all, you should know there are no cases of swine flu in Montgomery County —or in the State of Maryland or in the general Washington metropolitan region—at this time. There have been no deaths in the United States among the swine flu cases. But this is an evolving situation that could change at any time.

The Montgomery County Department of Health and Human Services Disease Control Program is closely monitoring the situation nationally and internationally and making preparations for if, and when, Montgomery County does have cases. We have been watching this situation since the first news came from Mexico . We are working closely with the State Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention (CDC) at the national level. We are preparing to open our Public Health Information Line, 240-777-4200, mid-afternoon Tuesday, April 28 to answer questions. Of course, we will keep you updated on specifics in Montgomery County . Some things you can do are:

· Always cover a cough or sneeze with a tissue—and throw the tissue away. Or cough or sneeze into the inside of your elbow. Don’t send your sneeze or cough into the air. This is good advice always, even when there is no swine flu.

· Wash your hands often with soap and water, especially after you cough or sneeze and before you eat. Alcohol hand sanitizer (minimum 60% alcohol) will do if soap and water are unavailable.

· Avoid touching your eyes, nose or mouth. These are places germs can enter your body very easily.

· Try to keep at least six feet away from sick people. This is called social distancing. Swine flu, like all flu, is spread through the air so keeping some distance will give the virus space to drop to the ground if someone is coughing or sneezing.

· Monitor yourself and your family for symptoms of fever, chills, headache, sore throat, cough, body aches, and vomiting or diarrhea. If you are sick, stay home from work, school or other public places until you are feeling well. Persons who have difficulty breathing or believed to be severely ill should seek medical attention.

· If symptoms of illness develop within seven days of travel from Mexico or other area where swine flu has been identified, seek medical help as soon as possible. Symptoms of swine flu are the same as those for seasonal flu: fever, runny nose, headache, body aches, etc. When you call for an appointment, be sure to tell your healthcare provider about your recent travel and suggest testing for influenza. You may be given instructions to wear a surgical mask or take other precautions to avoid infecting others.

At this time, there is no vaccination for swine flu. It is not known whether the flu shot you got this fall will provide any protection. The Food and Drug Administration and pharmaceutical manufacturers are studying what can be done to protect you from swine flu. Antivirals like Tamiflu seem to help.

Finally, you may have heard that the United States has declared a Public Health Emergency. Don’t be alarmed. The declaration of a Public Health Emergency is required for the government to be able to move ahead quickly to find a cure or vaccination or other medical help. It allows civilian and military stockpiles of anti-viral drugs to be distributed quickly should they be needed. The declared Emergency says this is a very serious situation, that it is not business as usual. But it does not mean you should panic.

Dr. Ulder J. Tillman, M.D., M. P.H.

Chief, Public Health Services and Health

#404

From: hind benjelloun <hbenjelloun@...>
Date: Tue Apr 28, 2009 6:21 pm
Subject: Residents Monitors needed for APA Annual Meeting’s Scientific Program

hbenjelloun

Offline

Dear Residents:

Residents Monitors needed for APA Annual Meeting’s Scientific Program

San Francisco, California, May 16 - 21, 2009

DON’T MISS THIS OPPORTUNITY! ─ Want to learn more about a specific psychiatric topic, hear thoughtful leader’s presentations, understand how to spot bias and know what constitutes a balanced CME presentation?

The American Psychiatric Association’s scientific program sessions at the Annual Meeting are held to strict standards for balance, scientific rigor and objectivity. Again this year, the APA Department of Continuing Medical Education is hiring psychiatric residents, who will be attending the meeting, to serve as monitors (and alternates) for the Industry-Supported Symposia (ISS) and other scientific session formats. Residents, who are selected to participate, will serve for 2.5-hour sessions.

Monitors will assist the APA in ensuring that the scientific program sessions adhere to APA guidelines by completing a program review form that will include questions about disclosure of possible conflict of interest by each presenter, bias, the use of the brand names of drugs, and discussions about off-label psycho- pharmacologic options. Additionally, monitors will obtain a copy of all program handouts for the permanent records of the APA Department of Continuing Medical Education. Alternates agree to be available for specific sessions and to function as a monitor if required.

In exchange for serving as a monitor, the APA will pay each resident an honorarium of $100 per 2.5-hour session; alternates will receive $25 per session as on-call pay. Payment will be mailed out 4-to-6 weeks after the meeting. No other expenses will be covered.

All monitors and alternates are invited to attend a 90-minute workshop on recognizing bias in continuing medical education presentations, which will be given by Donald Hilty, M.D., Department of Psychiatry, University of California, Davis. The workshop will be held on Sunday, May 17, 2009, at 9:00 a.m., in the ISS Program Office, Room 228, Mezzanine Level East in the Moscone Convention Center.

Interested residents should submit an application by May 1, 2009. The program is open to all psychiatry residents; however, assignment(s) will be made with the following applicants receiving priority: current APA members and PGY 3 or 4 residents. Applications are processed according to the date the application is received in the APA Central Office. Other variables used in determining assignments include schedule availability and topic(s) of interest. Assignments are not considered final until you receive a confirmation letter and have returned the completed response form.

To receive more information and an APA Resident Monitor Program application:

Visit the APA web site at http://www.psych.org and click on the link for the 2009 Annual Meeting, or

Request an application by e-mail to ppardee@...

Please email or fax your completed application to Philip Pardee at 703-907-7849 or ppardee@...

Thank you for your interest and support of the APA’s CME activities

and the Resident Monitor Program.

#403

From: hind benjelloun <hbenjelloun@...>
Date: Mon Apr 27, 2009 3:40 pm
Subject: Fw: WPS - CME - 4.30.09 - Show Me the Evidence

hbenjelloun

Offline

Title:

Show me the Evidence:

     What is "Number Needed to Treat" Anyway?

     Understanding and Using Evidence-Based Medicine in Clinical Practice

Speaker:

Les Citrome, M.D.

Date:

April 30, 2009

Time:

6:30pm-7:30 - Heavy Hors D'Oeuvres

7:30-9:30 - Presentation

Place:

Columbia Country Club

7900 Connecticut Ave

Chevy Chase MD 20815

CME: 2 credits

-Outline the steps involved in practicing Evidence-Based Medicine (EBM)

-Quantify clinical significance using Number Needed to Treat (NNT)

-Apply EBM and NNT
to clinical practice

Cost: $40 for WPS and WCP members, $50 non member, 15 psych residents

Registration:

WPS Reservations Center

550M Ritchie Highway, #271

Severna Park, MD 21146

Ph: 202.595.9498 Fax: 410.544.4640

Online Reservation Form


Download a Brochure


More Information

E-mail for info: admin@...

Web site: http://www.dcpsych.org

Payment accepted at the door.

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#402

From: hind benjelloun <hbenjelloun@...>
Date: Mon Apr 27, 2009 12:09 pm
Subject: Psychiatry Update from Dr. Peele

hbenjelloun

Offline

Folks,

In last Thursday's JAMA, a review of alcoholism treatment, suggested that naltrexone may be more likely to be efficacious in the pt with strong family hx of alcoholism, early onset, and the pt reporting that alcohol makes them feel good. The other two FDA approved meds for alcoholism, disulfiram and acamprosate, were not discussed. Off label meds were mentioned as having some support: topiramate, baclofen and varenicline.

Taking moderate to high daily doses of antidepressants for more than 2 years is associated with an 84% increased risk for diabetes, according to a large observational study. The increased risk was particularly notable for paroxetine and amitriptyline. Weight gain might explain much of the relation between antidepressant use and diabetes, according to the study authors. The study was published online April 1 in the American Journal of Psychiatry. These results were regarded as preliminary, too preliminary to have any major impact on clinical practice, said lead author Frank Andersohn, MD, from Charité-University Medical Center, in Berlin, Germany. He added that although early evidence shows that combining an antidiabetes drug with an antidepressant might prevent diabetes among depressed patients, the benefits and risks of this approach need to be considered. Meanwhile, there are methods to reduce the risk for diabetes, physical activity and attaining optimal body weight. The bottom line, the authors stated, is that more studies are needed.

The APA 2001 Practice Guideline on Borderline PD [better “Mercurial Disorder”], suggested psychotherapy was the treatment of choice and medications could be valuable in addressing prominent symptoms. This month's J of Personality Disorders has a meta-analysis suggesting that, for anger in these pts, topiramate and lamotrigine seem superior to carbamazepine. Aripiprazole seems superior to the antidepressants. SSRIs were not impressive. A recent Carlat report also concluded that topiramate, 250 mg/d, lamotrigine, 200 mg/d, and aripiprazole, 15 mg/d, were effective against anger in these pts, and spoke well of oxcarbazepine, valproate, and omega 3s.

Also in the Carlat report, an interviewee specializing in medicating pregnant women prefers, if she feels she should use an SSRI: fluoxetine, sertraline or citalopram. [Paroxetine is the only SSRI rated a category D.]

Your New-Yorker-reading patients may ask you about modafinil, stimulants or piracetam, as there is a long article suggests that this nation is not going to be able to halt the use of "neuroenhancing" meds. The article says that cognitive functions are enhanced by these meds, especially in people whose cognitive levels are not very high. The article also suggests these meds will not help creativity. The article does mention tolerance as a problem.

In answer to a question to me, TMS is available locally at Walter Reed [probably limited to military pts], Sibley Hospital, and at the office of Sinan Duzyurek, MD, 2440 M St, DC, 20037, phone, 202 466 3966. TMS, FDA approved for depression, is given daily 5/week x 4-6 weeks, so about 25 TMSs. Each treatment lasts 40 minutes.

Roger

#401

From: hind benjelloun <hbenjelloun@...>
Date: Wed Apr 22, 2009 7:10 pm
Subject: APA Resident Monitors: Positions go quick!

hbenjelloun

Offline

Dear Residents:

Residents Monitors needed for APA Annual Meeting’s Scientific Program

San Francisco, California, May 16 - 21, 2009

To receive more information and an APA Resident Monitor Program application:

Visit the APA web site at http://www.psych.org and click on the link for the 2009 Annual Meeting, or

Request an application by e-mail to ppardee@...

Please email or fax your completed application to Philip Pardee at 703-907-7849 or ppardee@...

Thank you for your interest and support of the APA’s CME activities

and the Resident Monitor Program.

#400

From: hind benjelloun <hbenjelloun@...>
Date: Mon Apr 20, 2009 6:38 pm
Subject: Locums Opportunities

hbenjelloun

Offline

LOCUMS OPPORTUNITIES

Northern West Virginia
Ongoing coverage starting June 15th.
Monday – Friday 8a – 5p + Call (1 in 3, telephone only)
34 Bed Adult Only Psych Unit
Inpatient rounding in the morning
Outpatient appointments in the afternoon.
Will help with licensure – 4 weeks commitment required for them to pay for the licensure.

Along with some additional needs:

South East Missouri (longer term, they are asking for 3-6 months of help)
Ongoing coverage Needed ASAP
Monday – Friday 8a – 5p + Call (2 weekends/month plus 2 nights/week)
33 Bed Adult Inpatient
Will help with licensure

North East Kentucky
Ongoing Need beginning in June
Monday – Friday 8am – 5pm + Call 1 in 5
27 Bed Inpatient Unit (Age of Patients not specified)
Will help with licensure – 2 months commitment for them to pay for license

North West Alabama
Ongoing Need beginning now
Monday – Friday 8am – 5pm + Call 1 in 4 (no weekend call, going in is only occasional)
20 Bed Hospital Unit, some detox work
Will help with licensure – 4-6 week commitment needed to pay for license

South East Alaska
Ongoing Need beginning September 3^rd
Monday – Friday 8am – 5pm, no call
General Psych – Clinic and Hospital work (5 minute walk from each other)
Will help with licensure – 3 months minimum for them to pay for license

All of our Locum Assignments cover your Malpractice Insurance, travel, lodging and typically a per Diem as well. The pay is negotiable, we try to settle on a fair rate that both you and the facility can agree upon.

Please forward your CV and pass this email along to anyone who is interested in work opportunities.

Many thanks!

Rachel Weeks | Recruiting Representative
(877) 456-2867 x4203 | (214) 442-4203 (direct) | (267) 295-8142 (fax)
Delta Locum Tenens | www.DeltaLocums.com

Member, National Association of Locum Tenens Organizations

#399

From: hind benjelloun <hbenjelloun@...>
Date: Thu Apr 16, 2009 4:23 pm
Subject: Psychiatric Update from Dr. Peele

hbenjelloun

Offline

Folks,

In last month’s Amer. J. Addictions, in detoxifying opioid withdrawal using methadone, adding very low doses of naltrexone [0.125/d o 0.250/d – yes, very low] produced less pt complaints, higher abstinent rates on discharge, and greater participation in aftercare follow-up.

This month’s Psychosomatics reviews paraneoplastic limbic encephalitis, an encephalitis that is thought to be caused by an autoimmune mechanism stimulated by malignancy. About two-thirds of the time, psychiatric signs arise before the pt is known to have a malignancy. Like other etiologically-based psychiatric disorders, the signs are very polymorphic, but the authors do suggest we considered it in patients with an acute-to-subacute dementia. After the neurologist has made the dx, what meds are recommended to address the psychiatric signs? PubMed had not a single paper on that, so we are on our own.

Yesterday’s JAMA focuses on diabetes, and has two items of interests to us.

1. Later this year, Amer Diabetes Ass is likely recommend that HbA1c become the preferred test for diabetes, in place of fasting glucose. There remains a debate on cutoffs. Some advocate <6.1% = normal, 6.1-6.9% = prediabetes and 7.0% = diabetes.&n bsp;

2. Another article, an editorial, advocates that bariatric surgery for diabetes be seen as effective, not because of fat reduction per se, but be conceptualized as the hormonal changes produced by gastric bypass. This suggests that gastric bypass achieves its diabetic impact independent of obesity, and, thus, could be the treatment of choice in some who are not obese.

Two nonpharmacological interventions appear to be more effective in treating depression and preventing relapse than usual care in patients who have undergone recent coronary artery bypass graft surgery: 1] cognitive-behavior therapy (CBT) and 2] supportive stress management.

As study out of Denmark concluded that clozapine increases the likelihood of infections.

From Ann of Intern Med, for smoking, adding SR bupropion 150 mg/d and PRN nicotine oral inhaler added to nicotine patch treatment got better results than the patch alone, although even all three failed in the majority of pts.

#397

From: "Kayla Pope, MD" <kpopemd@...>
Date: Mon Apr 13, 2009 1:16 pm
Subject: Fwd: FW: Excellent Psychotherapy Lecture - April 25

kpopemd@...

FYI..

---------- Forwarded message ----------
From: Pope, Kayla (NIH/NIMH) [E] <pkayla@...>
Date: Mon, Apr 13, 2009 at 9:16 AM
Subject: FW: Excellent Psychotherapy Lecture - April 25
To: kpopemd@...

�

From: Caroline Sehon [mailto:carolinesehon@...]
Sent: Sunday, April 12, 2009 9:18 PM
To: Pope, Kayla (NIH/NIMH) [E]; Kloos, Angelica; Sarah Keiser; David Fleischman
Cc: Nancy Black; Daniolos, Peter
Subject: Excellent Psychotherapy Lecture - April 25

�

Hi Everyone:

I hope you're doing well!�

I wanted to let you know about an exciting conference later this month,
April 24-26, 2009, organized by the International Institute for Psychotherapy (IPI) featuring Anthony Bass, PhD who will be discussing "The Therapeutic Relationship and the Dialogue of Unconsciousness�.

Trainees can attend the Saturday morning lecture (April 25th, 2009) for free!� It is entitled �Loving Patients: Intimacy, Personal Growth, Sex, Guilt, Betrayal, Murder
and a Life Worth Living." with Anthony Bass, Ph.D., and is followed by an optional small group discussion led by IPI faculty. � You may also elect to attend the full weekend conference for $245 discounted for trainees.

I'm attaching the advertisement that includes information about
registration, location and general contact information.� May I please ask you to forward this to your classmates and other trainees whom you think might be interested in this. Thanks very much.

Take good care,

Caroline

�

--
Caroline M. Sehon, MD
6917 Arlington Road, Suite #210
Bethesda, MD 20814
Tel: 301.951.4980
Fax: 301.951.4981

CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.

#394

From: hind benjelloun <hbenjelloun@...>
Date: Wed Mar 11, 2009 5:52 pm
Subject: Re: Fwd: National Physicians Alliance Conference this Weekend

hbenjelloun

Offline

Hi DC Residents,

Just wanted to add a link to the NPA lobby day that Kayla has posted an opportunity for (see below).

Thanks,

Hind

http://npalliance.org/images/uploads/NATIONAL_PHYSICIANS_ALLIANCE_CONFERENCE_SCHEDULE-10-doc.pdf

--- On Wed, 3/11/09, Kayla Pope, MD <kpopemd@...> wrote:

From: Kayla Pope, MD <kpopemd@...>
Subject: [dcpsychresidents] Fwd: National Physicians Alliance Conference this Weekend
To: dcpsychresidents@yahoogroups.com
Date: Wednesday, March 11, 2009, 1:47 PM

Hi all-

The NPA is seeking one resident to help with registration this sat from 10-2. You would get free registration to the meeting, chance to meet a lot of big wigs in health care policy, meet Dr Marian Wright Edelman. Any takers? or know of anyone who might be interested?

Kayla

#393

From: "Kayla Pope, MD" <kpopemd@...>
Date: Wed Mar 11, 2009 5:47 pm
Subject: Fwd: National Physicians Alliance Conference this Weekend

kpopemd@...

Hi all-

�

The NPA is seeking one resident to help with registration this sat from 10-2. You would get free registration to the meeting, chance to meet a lot of big wigs in health care policy, meet Dr Marian Wright Edelman.� Any takers? or know of anyone who might be interested?

�

Kayla

#392

From: hind benjelloun <hbenjelloun@...>
Date: Mon Mar 9, 2009 7:09 pm
Subject: Child and Adolescent Psychiatrist Position

hbenjelloun

Offline

We are working with a Child and Adolescent Psychiatrist who is seeking employment. Our candidate has resigned from the current position of employment as of the end of April and is seeking another employer. Our candidate is just a couple of years removed from fellowship training and is board certified. Our candidate has been working a position providing psychiatric evaluation and medication management to a patient base of 300 children and teens while providing coverage to a general adult inpatient psychiatric unit as well as consult coverage for a major tertiary hospital. The Psychiatric consult service included pediatric, medical, surgical, trauma, neurologic, obstetric, geriatric, and addiction patients.

Our candidate would prefer to continue to build a career in the inpatient setting. The candidate is open to positions treating residential patients and has a special interest in chronic mental illness, autism and an academic affiliation would be a plus. Being a member of a team environment is particularly appealing and treating patients over an extended period would be an area of interest.

That being said, the candidate would also be interested in developing an outpatient practice in the community if that opportunity would be available.

We will work with your organization in a highly professional manner respecting the time and energy that it takes to recruit physicians. Some additional information about Physician Finders:

Established in 1993
16 years of successful physician recruitment marketing plan development (average recruiter has only 2 years of experience)
Track record of recruiting and placing hundreds of physicians in challenging, exciting, and rewarding practice opportunities across the United States.
Adept at meeting the needs of large healthcare systems or small-town solo practitioners, academic medical systems or independent hospitals.

If your organization is seeking a Child and Adolescent Psychiatrist and you are open to working with an effective recruiter, please contact me at your convenience.

Kind Regards,

Gene Corbett
Physician Finders
800-229-9759
636-257-7001
636-288-4003 cell
636-257-7003 fax
Gene.Corbett@...

Excellence shall always derive a demand.

#391

From: "David I. Driver" <davididriver@...>
Date: Sat Mar 7, 2009 9:07 pm
Subject: American Journal of Psychiatry

davididriver@...

There are two articles that have recently been published in the American Journal of Psychiatry that I’d like to call everyone’s attention to:

Conflict of Interest - An Issue for Every Psychiatrist, Am J Psychiatry, Mar 2009; 166: 274
A Meta-Analysis of Head-to-Head Comparisons of Second-Generation Antipsychotics in the Treatment of Schizophrenia; Am J Psychiatry 2009; 166:152-163

I’m sure most have already read them, but for those of us who’ve only recently become aware, these are both “must reads!”

David I. Driver

Georgetown

ONE TEAM!!!!

#390

From: "David I. Driver" <davididriver@...>
Date: Sat Mar 7, 2009 2:52 am
Subject: ADHD: Current Evidence on Neurobiology and Treatment in Children, Adolescents, and Adults - Saturday, March 14, 2009

davididriver@...

http://www.capsgw.org/capsgw_symposium_march_14.pdf

The attachment didn’t make it through. Here is the link as well as the content of the flier.

ADHD: Current Evidence on Neurobiology and Treatment in Children, Adolescents, and Adults

Saturday, March 14, 2009

Presented by the Child and Adolescent Psychiatric Society of Greater Washington (www.capsgw.org)

PROGRAM

8:00 Registration/Coffee/Donuts

8:30 Welcome

8:45 Neurobiology of ADHD

9:50 Pharmacologic Treatments for ADHD

10:55 Refreshments

11:10 Psychological Interventions for Patients with ADHD

12:15 Lunch

1:30 ADHD in Adults

2:35 Refreshments

2:50 Case Presentations, Panel Discussions, and Q & A

4:00 Conclusion

Please note the program may be subject to change.

SPEAKERS

Lance Clawson, M.D., has a private practice in Child and Adolescent Psychiatry, serves on the teaching faculty at CNMC and Uniformed Services University of the Health Sciences, and is an author and researcher on various aspects of Child and Adolescent Psychiatry, including ADHD and psychopharmacology.

Barbara Ingersoll, Ph.D., is a clinical psychologist who has a private practice in Bethesda, Maryland and has worked extensively with patients with learning, behavioral, and emotional problems, including ADHD, and has numerous publications on ADHD.

Philip Shaw, M.D. is a Staff Clinician at the Child Psychiatry Branch of the Intramural Program of NIH where he leads research on ADHD and has published many studies on ADHD and other areas of psychiatry.

Alan Zametkin, M.D. is a Senior Staff Physician of the Intramural Research Program of NIH. Dr. Zametkin leads research on ADHD and has published widely on various aspects of psychiatry, including ADHD.

PROFESSIONAL CREDITS

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). The Children’s National Medical Center (CNMC) is accredited by ACCME to provide continuing medical education for physicians. The CNMC designates this continuing medical education activity for a maximum of 6 hours AMA PRA Category 1 credits ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ACKNOWLEDGEMENTS

Department of Psychiatry, Uniformed Services University of the Health Sciences: Thanks to the Department of Psychiatry, USUHS for support of this program. www.usuhs.mil/psy

Washington Psychiatric Society: We would like to acknowledge the Washington Psychiatric Society for endorsing this CME Program to its membership. WPS:Working to ensure access to humane care and effective treatment for people with mental illnesses: www.dcpsych.org.

REGISTRATION (Please print clearly)

Name _________________________________

Address _______________________________

City___________________________________

State ___________________Zip__________

Phone # _______________________________

Email_________________________________

Discipline _____________________________

To guarantee your place at the Symposium, please email Diane Berman at CAPSGW@... and return this portion and registration fee payable to CAPSGW to:

CAPSGW Spring Symposium

c/o Diane Berman

7621 Mary Cassatt Drive

Potomac, MD 20854

FEE

Payable to CAPSGW; includes materials and lunch.

CAPSGW/JSSA/USU/WPS:

Prior to March 7: $ 120

After March 7 $ 140

Nonmembers:

Prior to March 7 $ 140

After March 7 $ 160

Students, Residents, Fellows: $ 35

We will be unable to refund registration for cancellations after March 7.

SYMPOSIUM LOCATION

Uniformed Services University of the Health Sciences (USUHS), located on the campus of The National Naval Medical Center, Bethesda, MD. For security reasons, you must use the Wisconsin Avenue Entrance.

DIRECTIONS

From Virginia

495 East toward Baltimore

Bethesda-Wash Exit 35 Wisconsin Ave. S.

Drive through 2 traffic lights: National Institute of Health on right

Left onto South Woods Drive

Follow signs for USUHS

From Maryland

495 to Silver Spring

Bethesda-Wash Exit 34: stay on exit ramp to 355/Rockville Pike South

Drive through 2 traffic lights: National Institute of Health on right

Left onto South Woods Drive

Follow signs for USUHS

Park in the underground parking garage. Use entrance to the building on the same level as the parking garage. Take the elevator to the first floor.

For security reasons, there is No On-Site Registration. You MUST pre-register and bring photo ID to enter the military base.

www.capsgw.org

ADHD: Current Evidence

on Neurobiology

and Treatment in

Children, Adolescents,

and Adults

Saturday, March 14, 2009

Presented by the

Child and Adolescent Psychiatric

Society of Greater Washington

Annual Spring Symposium

Speakers

Lance Clawson, M.D.

Barbara Ingersoll, Ph.D.

Philip Shaw, M.D.

Alan Zametkin, M.D.

#389

From: "David I. Driver" <davididriver@...>
Date: Fri Mar 6, 2009 1:15 am
Subject: ADHD Symposium

davididriver@...

Hi everyone!

I wanted to inform everyone of the upcoming ADHD symposium hosted by the Child and Adolescent Psychiatric Society of Greater Washington. For any residents who are interested in Child, this will be a great opportunity to meet some professional members. Also, two Gerogetown residents (David Driver and I) will be presenting cases, so please come and support us.

If there are others that you feel would be interested in attending, please pass this flyer on!

Sincerely,

Sarah Keiser

CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you.

#388

From: hind benjelloun <hbenjelloun@...>
Date: Wed Mar 4, 2009 5:35 pm
Subject: TONIGHT: WPS Women's Caucus Dinner and Program

hbenjelloun

Offline

Women’s Caucus Dinner and Program

The Benefits, the Risks, and the Balance:
Confronting Difficult Clinical Decisions in Treating Mental Illness.
by Dr. Daniel Gozzi, Endocrinologist

Wednesday, March 4, 2009
Social hour at 6:30, dinner and presentation at 7:00
Matisse Café Restaurant
4934 Wisconsin Ave NW, Washington, DC 202-244-5222

Antonia Baum, MD, chair
Sponsored by Lilly USA

No charge, but reservations are required
Reserve on-line at www.dcpsych.org or
Call Tracey Dondero at 301-908-4140

#387

From: hind benjelloun <hbenjelloun@...>
Date: Wed Mar 4, 2009 5:34 pm
Subject: TONIGHT: WPS Women's Caucus Dinner and Program

hbenjelloun

Offline

Women’s Caucus Dinner and Program

The Benefits, the Risks, and the Balance:
Confronting Difficult Clinical Decisions in Treating Mental Illness.
by Dr. Daniel Gozzi, Endocrinologist

Wednesday, March 4, 2009
Social hour at 6:30, dinner and presentation at 7:00
Matisse Café Restaurant
4934 Wisconsin Ave NW, Washington, DC 202-244-5222

Antonia Baum, MD, chair
Sponsored by Lilly USA

No charge, but reservations are required
Reserve on-line at www.dcpsych.org or
Call Tracey Dondero at 301-908-4140

#386

From: hind benjelloun <hbenjelloun@...>
Date: Mon Mar 2, 2009 2:56 pm
Subject: Psych Update from Roger Peele

hbenjelloun

Offline

Folks,

This month’s Am J of Geriatrics has some reviews of mentally stimulating work and dementia risk. One of the reasons the more educated are at lower risk for dementia, it has been hypothesized, is that higher education leads to more complex jobs. This month’s journal details the hypothesis some more and suggest occupations that “carrying out prescribed actions” reduces the dementia risk less than occupations “prescribing alternative actions.” If this concept turns out to be true, that would explain why mental health clinicians are often still sharp in their 80s, some in their 90s, as every pt is different.

Our pts may have seen the media play from last Thursday’s NEMJ article that demonstrated little difference between various diets, some high carbohydrate, some high protein, some high fat, implying calories are the key, not the nutrients. Not emphasized by the media is that all the food choices were regarded as healthy, e.g., even the high-fat diet avoided saturated fats, so our pts should keep that in mind. Also, at least moderate exercise was expected. The weight loss was very modest leading some to conclude that treatment of obesity is primarily a behavioral issue, not a diet issue [reminds us of the discussions we had with Spitzer in the 1980s as to whether to include obesity in DSM-IIIR]. Most importantly for us is that highly functioning, well-motivated people will only achieve a 3-4 kg lost after 2 to 4 years. Are we kidding ourselves when we give diet instructions to our poorly functioning, not-motivated pts?

The editorial in the NEJM mentioned a study in two small towns in France in which total-community approach involving the whole town’s focusing on the health of schoolchildren led to less obesity among the children than found in similar nearby towns.

Healthy diet and exercise also got publicity last week as preventive in cancers, ranging from preventing 70% of eudiometrical cancers to 11% of prostate cancers.

Astra-Zeneca will strengthen its warning to us as to risk of increased blood-glucose levels with Seroquel. The company is under attack for hiding the results of a study in which Seroquel caused more of this problem than did Haldol.

Last Wednesday, DC and eleven states files a suit claiming Forrest Labs had marketed to us physicians Celexa and Lexapro use in children -- which would be off-label, and thus illegal.

I want to thank those of you who supported me in the campaign for APA President-elect an d thank those who sent kind messages when they heard I came in second. I have now lost more APA national elections than anyone, and there is a plus to these periodic losses: No one else has had as long a run as a voting member of APA’s governance -- and has contributed to our being a part of legislation that has become APA policy more than anyone in recent decades. It is now time to think about what legislation [“Action Papers”] you would like to see in the coming year. So, if you have some thoughts about positions that you would like to see the APA take, please let me know.

Roger

#385

From: "matchejlbfriends" <matchejlbfriends@...>
Date: Sat Feb 28, 2009 11:52 am
Subject: You've received a private message from a friend!

matchejlbfri...

Offline

I read your profile today, I thought I would drop you a line and hope to become
your friend! Check my personal page here:
http://specter.zoomshare.com/files/friend.htm

Reply | Forward | Messages in this Topic (3)

#384

From: hind benjelloun <hbenjelloun@...>
Date: Tue Feb 24, 2009 2:51 pm
Subject: National Resident Wellness Survey

hbenjelloun

Offline

Hello DC Psychiatry Residents,

ACOM & CORF, national psychiatric resident organizations, developed the Resident Wellness Survey to help answer questions about how residents deal with stress. The results will be used to develop practical interventions for improving resident wellness and improve recruitment.

You may remember us talking about this survey at the IPS / Chief Leadership Meeting in Chicago.

We need your help though!

Please forward this email to your psychiatry residents and ask them to complete our brief on-line survey (See the link below-Password: psych2008).

This survey is an important, nationally funded, ACOM & CORF project and its results will help residents nation wide. However, unless we have a 1000+ residents complete the survey, the results will not be powerful enough to generate a meaningful guide.

You may also direct people to www.apamit.com - where there is a link to the survey.

Thank you for your efforts and support,

Paul O'Leary, M.D.

Psychiatry Resident

Molly McVoy, M.D.

Committee Of Residents and Fellows Chair

Hind Benjelloun, M.D.

Assembly Committee of Members-in-Training Chair

Melinda Fierros, M.D.

Member In Training Trustee-Elect

#383

From: "girlamqblog" <girlamqblog@...>
Date: Sun Feb 22, 2009 1:07 pm
Subject: I want to meet you. Give me a chance!

girlamqblog

Offline

I want to meet you. Give me a chance! Click here to chat with me online:
http://clianthasd.zoomshare.com/files/chat.htm

#382

From: hind benjelloun <hbenjelloun@...>
Date: Fri Feb 20, 2009 6:54 pm
Subject: Health System Report: Economic Stimulus Package

hbenjelloun

Offline

eVoice^®Alert

Feb. 17, 2009

Rhetoric and reality in the economic stimulus package: The AMA’s approach to health system reform

As physicians, it is important that we make decisions based on evidence and fact. Unfortunately, that became a challenge recently as conflicting information swirled in regard to the important health information technology (HIT) and comparative effectiveness research provisions included in the recent economic stimulus bill. To help AMA members make sense of these provisions, here are some facts to consider.

Experts from the most respected medical institutions in the country have all urged accelerating the adoption of HIT to facilitate quality improvement and, over time, lower costs. For years, the AMA and other physician groups have urged policymakers to help fund physician HIT acquisition costs.

The economic stimulus package provides approximately $19 billion in Medicare and Medicaid incentives over five years to assist physicians in purchasing HIT systems. This is the first substantial federal funding provided to help physicians implement HIT systems—systems that will generate benefits across the health care spectrum. While the bill does include Medicare payment reductions (starting at 1 percent) for physicians who do not implement HIT systems, these do not take effect until 2015 and there are exceptions for significant hardship cases.

Throughout the legislative process, the AMA has urged flexibility in implementing these provisions given the uncertainties surrounding this issue. Also, we have made it clear that these incentives are doomed if Congress fails to address the long-term viability of the Medicare physician payment system (including replacing the sustainable growth rate formula). The final HIT provisions are not exactly what we would have drafted, but they do represent real progress and a major improvement upon the status quo.

Suggestions that a Department of Health and Human Services Office of Health Information Technology (which currently exists and was established by former President George W. Bush) “will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective” are unfounded. There is no such authority in the legislation.

Another provision that has been widely attacked is the increase in government support for comparative effectiveness research (CER) and the coordination of this research through a new advisory council of federal agency representatives.

The AMA and many other health groups have endorsed the concept of research to provide physicians with information on the comparative effectiveness of different medical treatment options. Physicians and their patients both can benefit from research that demonstrates whether a particular treatment option results in better outcomes.

The AMA has stressed that research findings should be driven by clinical evidence and not be used solely to identify and promote the cheapest treatment option. The AMA has also successfully advocated that entities conducting this research not make coverage and payment decisions.

The CER Advisory Council has been erroneously compared to the Federal Health Board envisioned by former Sen. Tom Daschle. The two bodies have little in common, however. The CER Advisory Council would be responsible for setting research priorities and avoiding duplication across various government agencies. It has no authority to restrict payments or make coverage decisions, or establish national practice guidelines, and it does not grant Medicare officials new authority to impose a cost-effectiveness standard.

The health care provisions contained in the recent economic stimulus bill, however, mark just the first step of a longer journey toward health system reform. The AMA is fully engaged in this debate and shares the concerns of individual physicians regarding some of the ideas being floated. We oppose a single-payer system and other proposals that move our health care system in the wrong direction. Likewise, we must remain vigilant that the positive health care provisions in the stimulus package or subsequent legislative proposals are not twisted or corrupted toward an end that compromises physician practice and patient care.

Standing pat, however, is not an option. The current state of our health care system is not sustainable. Over the years, our AMA House of Delegates has adopted sensible policies that outlined reasonable reforms that will benefit all stakeholders. We are using these reform objectives to guide us in the current debate. They include:

Expanding affordable health insurance coverage for all;
Reducing costs and increasing value in health care services;
Eliminating excessive administrative burdens;
Increasing investments in wellness and prevention services;
Empowering physicians to improve quality through evidence-based medicine;
Reforming government insurance programs by providing adequate physician payments to assure timely access for patients;
Implementing essential payment and delivery reforms to optimize health care expenditures, including medical liability and antitrust reforms.

The pressure for health system reform is not just coming from President Obama or the Democrats in Congress. Many Republicans in Congress and every major stakeholder group—patients, businesses, physicians, health provider organizations and insurers—are all calling for a transformation of our health care system. To succeed, reforms must be adopted as part of a comprehensive strategy that balances issues of coverage, access, quality and cost.

The political and legislative process presents real challenges. Fierce partisanship impedes constructive dialogue and has triggered decisions to short-circuit the deliberative process. Frequently, final legislative language is available too late to allow for thoughtful review and consultation before committee or floor action. Legislative language is also subject to interpretations and can be as indecipherable as an insurance contract. Congress needs to apply the same level of transparency to its work that it is calling for in the health sector.

The AMA’s commitment to you is to serve as the strongest possible advocate for meaningful health system reforms that will empower physicians to help patients lead healthy and productive lives. Our success depends on your support and engagement.

Sign up for the AMA physician grassroots network to receive regular legislative alerts by going to www.ama-assn.org/go/grassroots.

Finally, please continue to provide us with your feedback and input on how we can do a better job of serving the physicians of America .

Sincerely,

Nancy H. Nielsen, MD, PhD
President

J. James Rohack , MD
President-elect

Joseph M. Heyman, MD
Chair

Rebecca J. Patchin, MD
Chair-elect

Thank you for your AMA membership! The AMA's strength comes from its numbers. That strength grows when our membership increases — please urge your fellow physicians and medical students to join our cause by calling (800) 262–3211 or visiting the AMA Web site.

#381

From: hind benjelloun <hbenjelloun@...>
Date: Fri Feb 20, 2009 6:53 pm
Subject: Psych Update from Roger Peele

hbenjelloun

Offline

Folks,

Weight loss has been shown to improve mild sleep apnea. The study reported this month suggests the more weight loss, the better the results, e.g., loss of 33 lbs associated with 88% no longer having the apnea.

For those who have yet to read this month’s AJP, a couple of articles of clinical interests:

1. A single case report of memantine, 5 mg/d initially, increased to 5 mg BID, dramatically improved the symptoms of pediatric OCD in a 15 y/o girl with a decade of symptoms and failure of CBT, sertraline, fluvoxamine, and citalopram to improve her condition. While memantine was given the credit, I gather that citalopram, 80 mg/d, and CBT were ongoing while on the memantine.

2. A meta-analysis of atypicals found olanzapine more efficacious than the others, but the differences were not overwhelming, leaving us where we were before – medicate based on side-effect issues with each pt. Surprising to the authors was that olanzapine did better than clozapine. They justified continuing to see clozapine as superior for various reasons in the refractory pt [not mentioned by the authors is that clozapine is not superior in the acute non-refractory pt].

There is more on olanzapine recently. Dr. Goldstein found a study that olanzapine did NOT do better than placebo in treating cocaine dependence.

[Recently brought to my attention was a geriatric pt on 5 mg/d olanzapine, developed pancreatitis, blood glucose of almost 1800, then hospitalized, survived, and is now doing OK on risperidone 1 mg BID.]

This month’s LAWYERS USA, which tracts malpractice opportunities, reviewed the Lilly agreement as to Lilly’s alleged effort to persuade us to use Zyprexa off label, resulting in a $1.4 billion settlement. Past Lilly salespersons made up the plaintiffs, people believing they should not have been ordered to promote off-label.

Speaking of off-label, in this month’s JOURNAL WATCH, Peter Roy-Byrne: “So far only one atypical agent, aripiprazole, has been approved to treat refractory depression. Clinicians should be highly cautious when considering other atypical agents with less compelling data for this indication or for other off-label.”

The Army report of suicides exceeding combat deaths has led anti-medication groups to claim that this is the result of the considerable prescribing of SSRIs in the Army. In the meantime, an Italian study found that SSRIs reduced suicidal risks in adults.

FDA has approved a deep brain stimulation device for OCD.

Rationality continues to have its limitations in the empirical world of medicine. Pay for Performance studies fail to find that pts are actually better off as a result of such. A JAMA article this month found that programs to coordinate care of chronically ill Medicare pts could not show reduced hospitalizations or reduced costs.

APA election results are supposed to be available next Monday.

Roger

#380

From: hind benjelloun <hbenjelloun@...>
Date: Thu Feb 19, 2009 2:51 pm
Subject: National Physicians Alliance

hbenjelloun

Offline

Dear Trainees:

I am writing on behalf of the National Physicians Alliance. We are a
progressive physicians advocacy group that will be having our annual
conference and lobby day here in Washington, DC March 14-16th. We have
lobbied in favor of the SCHIP program and are currently exploring topics
such as disparities in medicine, guns and public health, universal health
care, and conflicts of interests in medical practice.

We recently received gifts from physicians to create a fellowship for
residents and fellows to attend the meeting free of charge. Attached is
the short application process and is due on Feb. 16, 2009. Please
distribute among your residents and fellows.

Given, that I am a local physician involved in medical education, I think
this would be a great opportunity for your residents. Residents from
George Washington, Georgetown, Children's Hospital, Howard University, and
other local training programs will be chosen for this opportunity.

Please feel free to contact me to with any questions. The meeting website
is as follows:

http://npalliance.org/content/pages/honoring_the_oath_a_call_to_action

Warmest Regards,

Marc

Marc E. Dalton, M.D., M.P.H.
National Physicians Alliance
National Conference Chair
meetings@...

#379

From: hind benjelloun <hbenjelloun@...>
Date: Thu Feb 19, 2009 1:00 pm
Subject: Opportunity: APA Delegate to the AMA Resident/Fellow Section

hbenjelloun

Offline

The APA is currently looking for a resident to serve as the APA delegate
to the AMA Resident and Fellow Section. This is a two year appointment,
the first year serving as an alternate delegate and the second year as
the delegate. There are two meetings a year, one in June held in
Chicago, and the other held in November, held in a different city each
year. Travel expenses for attending the meetings are paid by the APA.

This is a great position for anyone interested in advocacy and
collaborating with other medical specialities.

Please forward a CV to Molly McVoy at molly.mcvoy@... The
deadline for submission is Friday, February 27.

Molly McVoy, MD
Chair, Committee on Residents and Fellows
Department of Child and Adolescent Psychiatry
University Hospitals Case Medical Center

W.O. Walker Center

10524 Euclid Avenue
1st Floor
Cleveland, OH 44106
T (216)983-3293 F (216)983-5131

#378

From: hind benjelloun <hbenjelloun@...>
Date: Thu Feb 19, 2009 12:59 pm
Subject: Employment Opportunity

hbenjelloun

Offline

The Centers, Inc., a private, not for profit community mental health center located in Ocala, Florida (Central Florida), is recruiting both adult and children’s Psychiatrists on either an employee or independent contractor status. Malpractice insurance is provided. Full benefits package for employees, higher daily rate for independent contractors without benefits. One night “on-call by phone” required. Candidate must have M.D. from an accredited college or university with approved residency in psychiatry, as well as board certified or eligibility for certification. Might this opportunity be of interest to you? If so, you may contact Dinah Shepherd directly. Her contact information is included below.

If you are not interested in this employer but know of a colleague who might be, please feel free to forward this e-mail along.

Thank You,

Leonard Jones | Physician Services
CareerMD.com
909 Third Avenue, 12^th Floor
New York, NY 10022
(800) 355-2626 (P)
(800) 355-2277 (F)
www.careermd.com

FOR MORE INFORMATION, CONTACT:
Dinah Shepherd
CHRO, The Centers, Inc.
5664 SW 60th Avenue
Ocala, FL 34474
Phone: (352) 291-5587
dshepher@...
Please reference CAREER INSIGHTS PSYCH when inquiring about this opportunity.

#377

From: hind benjelloun <hbenjelloun@...>
Date: Tue Feb 17, 2009 2:10 pm
Subject: Applications Invited for Congressional Fellowship

hbenjelloun

Offline

Applications Invited for Congressional Fellowship

The American Psychiatric Association and the American Psychiatric Foundation, invite nominations for the Jeanne Spurlock Congressional Fellowship.

The Jeanne Spurlock Congressional Fellowship provides all psychiatry residents, fellows and early career psychiatrists a unique opportunity to work in a congressional office on federal health policy, particularly policy related to child and/or minority issues. This fellowship was established in honor of the late Jeanne Spurlock, M.D., who was Deputy Medical Director of APA's Office of Minority/National Affairs and an advocate for child and minority issues.

The recipient will serve a ten-month fellowship on Capitol Hill in Washington, DC starting in January 2010. The fellow will be introduced to the structure and development of federal and congressional health policy, with a focus on mental health issues affecting minorities and underserved populations, including children. Fellows traditionally help develop legislative proposals, track and analyze legislative initiatives, arrange hearings, brief Congressmen or Congresswomen and their staff, and interact with their constituents.

The Fellowship is open to all psychiatry residents, fellows and early career psychiatrists. Applicants must be APA members, U.S. citizens or permanent residents. Applications, in the form of a letter, three letters of recommendation, and CV should be sent to Marilyn King; APA Office of Minority/National Affairs, 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209 by MARCH 13, 2009. This fellowship is supported by an unrestricted educational grant from Wyeth.

Former award recipients: Drs. Sue Ishiyama (Cong. Patrick Kennedy), Ericka Goodwin (Cong. Donna Christensen), Harsh Trevidi (Sen. Jack Reed), Jose Vito (Sen. Gordon Smith), and Toya Clay (Cong. Janice Schakowsky), Daniel Bober (Sen. Patty Murray) and Vasilis Pozios (Cong. John Conyers). Dr. Kahlil Johnson is the current fellow who will begin the fellowship in the office of Congressman Edolphus Towns in January 2009.