SPRING/SUMMER NEWSLETTER
April-July 2018, Vol. 9, Issue 1
In This Issue



 
 




Premium Corporate Sponsor 2018-2019
Arizona Psychiatric Society
Newsletter Committee
Mona Amini, MD, MBA, FAPA, Editor-in-Chief

Gagandeep Singh, MD

Brian Espinoza, MD, FAPA, CME Features

Robin Reesal, MD, FAPA,
Global Psychiatry Features

A NOTE FROM INCOMING PRESIDENT AND OUTGOING NEWSLETTER EDITOR-IN-CHIEF

Mona Amini, MD, MBA, FAPA


Dr. Amini at Women_s Tea
Dear Psychiatric Colleagues:
 
The spring and early summer have brought with them a whirlwind of local and global activities, news, and events. As the incoming President, it is my hope to help us build positive connections and make an impact on our community that will help celebrate the best, heal in times of sorrow, and support our members in their ever-changing professional journeys. 
 
Over the last year, we celebrated our best and deepened our connections at the APS Friday Social, the APS Annual Meeting, the Women's Group Afternoon Tea, and the APA Annual Meeting & Assembly in New York City.  We hope you enjoy the updates and reports shared here. 
 
With regards to advocacy, your membership and voice make the work we do possible. As the recent media reports on the increased rate of suicide, the two recent highly publicized celebrity suicides, the decision to not defend the patient protections in the ACA, continued concerns over the separated families seeking asylum at the U.S. border, and the opioid epidemic, our voices are essential more than ever. The advocacy we promote and participate in support of mental health parity, early interventions, and education are vital to our community.  
 
A part of our community was lost with the tragic shooting of forensic 
Steven Pitt_ DO
psychiatrist and APS member, Dr. Steven Pitt.  the Society recently shared a special commemmorative Newsletter with regard to that event.    If you did not see that issue, you can still view it here.  I would like to give a special thanks to Dr. Elizabeth Kohlhepp, Dr. John DeQuardo, and Dr. Roland Segal for their personal tributes to Dr. Pitt and his work. 
APS will be accepting proposals for a forensic lecture topic and/or speaker that will honor Dr. Pitt and the field of forensic psychiatry at our 2019 Annual Meeting.  I would also invite you to contribute your ideas or thoughts for additional topics in our Annual Meeting, Newsletter, or social events. Submissions may be made directly to Teri Harnisch at  teri@azmed.org

On a more personal note, this is an exciting time for my family and I as we welcomed our second son in this past June. Like all of you, I strive to find the right work-life balance for my family and my professional responsibilities.  As such, recent themes in the field of medicine that focus on physician wellness are inevitably a crucial component of our profession and lives. As President, I hope to help peers adjust to their roles as independent physicians, strive to promote mentorship, educate others on the role of psychiatry within the medical community, engage our membership, and organize new networking and educational events.
 
Thank you for the opportunity to lead in the coming year and make sure to follow us on Twitter @AZPsychSociety or on Facebook through the group page "AZ Psychiatric Society."    

HIGHIGHTS FROM THE ARIZONA PSYCHIATRIC SOCIETY ANNUAL MEETING


The Arizona Psychiatric Society 2018 Annual Meeting kicked off with the Friday Social and 100 Year Reception sponsored by American Professional Agency, Inc.  Joined by Annual Meeting speakers, Dr. Michael Myers (upper left) and Dr. Ipsit Vahia (left in the bottom photograph), members and friends came together to celebrate 100 years and counting for Dr. Martin Kassell (photographed in the center of the middle photograph, with daughter Stephanie to the far right), our favorite (and eldest known practicing) Arizona psychotherapist!  
POSTER PRESENTATIONS AT THE 2018 APS ANNUAL MEETING

The Annual Meeting included poster presentations by Resident-Fellow Members, Medical Students, and Physician Peer submissions, as follows:

Oseltamivir Induced Mania In A 52 Year Old Male With History Of Depression, Yana Alekseeva, MD, Resident, UofA Phoenix; Jeffrey Burrow, MD, Larry Mecham, DO;
Lithium Exposure Through Breastmilk In A Premature Newborn, Jeffrey Burrow, MD, Resident, UofA Phoenix; Sarah Detlefs MD, Charles Phillips DO;
Identifying Early Psychiatric Symptoms In The Detection Of Huntington's Disease, Matthew Erisman MD, Resident, UofA Tucson; Lalanthica Yogendran MD, MPH and Jason Curry, DO.
Nicotine Liquid As A Potential Poison: Surveying Providers On The Risks Of A Dangerous New Fad, Maya Heck, MD, Resident, MIHS; Regan O'Brien, MD & Gwen Levitt, DO.
Triptan-Induced Serotonin Syndrome: A Case Study, Larry Mecham DO, Resident, UofA Phoenix; Rachel Antol MS3, Shehzad Ayub DO.
Post-Concussion Syndrome In The Adolescent Population: An Active Rehab Protocol And The Improvement Of Neuropsychiatric Symptoms In A Cohort, Lorin Mowrey, Medical Student, UofA College of Medicine, Tucson; Zachary Oleskey, Mohammed Mortazavi, M.D., Jennifer Andrews, PhD.
Bang For Your Buck: Choosing Cognitive Tests For Seriously Mentally Ill Patients With HIV, Gwen Levitt DO, Physician Peer Submission, MIHS; Jennifer Weller, PhD.
It's More Than Gut Feelings - Probiotics And Mood In Irritable Bowel Syndrome, Shabnam Sood, MD, Physician Peer Submission, MIHS; Rajan Khosla MD; Dhruv Khosla; Gilbert Ramos MA; Bikash Bhattarai PhD.

The Resident-Fellow Member and Medical Student submissions were judged by a volunteer panel of judges. The Society thanks Drs. Michael Brennan, Gagandeep Singh, Michael Stumpf, Kathy Smith, and Neeta Jain for their contributions as the same. For the RFM presentations, Drs. Matthew Erisman and Larry Mecham tied for first place and Dr. Maya Heck was awarded third place. For the MS presentation, Loren Mowrey was recognized as first place.

Corporate Sponsor 2018-2019

Dr. Cynthia Stonnington
MEET FELLOW APS MEMBER:
CYNTHIA STONNINGTON, MD, DFAPA


Cynthia Stonnington, MD, DFAPA
Mayo Clinic Arizona
Chair of Psychiatry and Psychology
Wellbeing Director for Medical Students and Trainees

It wasn't until my fourth year at Mayo Medical School in 1985 that it dawned on me to go into Psychiatry.   I conducted the following thought experiment:  in 20 years' time, which specialty of medicine would remain fascinating enough to keep learning and also enable a life outside of medicine?   Bingo-psychiatry suddenly was the obvious choice!  Almost everything-going to a play or movie, reading a novel, or listening to music-is relevant to psychiatry. And given the intricacies of neurobiology, epigenetics, and human behavior, I knew I would remain stimulated by one of the most complex and interesting medical specialties.  

I chose Stanford for my psychiatry internship and residency because of their faculty (especially Irv Yalom and David Spiegel), emphasis on science and research, and its famously favorable location.   As much as I loved Northern California, my life took a turn after meeting my now husband who teaches at ASU.  I got a job at the Menninger Clinic at St. Joseph's Medical Center, which afforded me the opportunity to do inpatient and outpatient psychiatry, C/L psychiatry, collaborate with some fantastic neurologists, and teach psychiatry to non-psychiatric residents.  

After my first child was born, I moved into private practice with a fantastic group of mental health practitioners (especially role model Judy Engelman) and cut back my hours.  With supervision from Bill Offenkrantz (who at the age of 90-something tells me he continues to learn something new every day when he goes to work), I honed my psychotherapy skills and even got to co-teach a class on psychoanalytic psychotherapy with him.  

After my second child was about 8 years old, Lee Ann Kelley lured me to Mayo Clinic Arizona.  Then, in 2006 thanks to Eric Reiman, support from my chair, Lois Krahn, and a grant from Mayo Clinic, I did a brain imaging fellowship at University of College London-strategically timed during my husband's sabbatical at Trinity College, Cambridge and when our son and daughter could appreciate a year in the UK.  Despite initially feeling like a deer in headlights with PhD students running circles around me, I can now read a brain imaging paper and understand it, be PI or co-investigator in Alzheimer's disease research, and remain inspired by mentors Eric Reiman and Rick Caselli.  

In 2011, I became Chair of Psychiatry & Psychology and in 2017 I became Wellbeing Director for medical students and trainees.  In those capacities, I have had the good fortune to lead workgroups and research programs focused on resilience-which remains my passion. Mayo Clinic has been incredibly supportive of our efforts to understand and foster resiliency not only for patients, but also for students, trainees, staff, and employees.  Psychiatrists are uniquely positioned for this effort.  I feel blessed by the opportunity to develop healing connections with patients, hear their stories, and be a collaborator in their recovery.  Given the challenges of our current environment, we must focus attention on the joy in medicine and more generally find ways to maintain meaningful human connections.  

 CELEBRATING AWARD RECIPIENTS FROM THE APS ANNUAL MEETING 


The APS Annual Meeting gives us a chance to celebrate the outstanding contributions of our members.  Recognized in 2018, in the photographs above (clockwise from upper left):   Shehzad H. Ayub, DO, as the 2018 recipient of the Howard E. Wulsin Excellence in Teaching Award, presented by Ernest Cochran, MD; Michael Edward Brennan, MD, DLFAPA,  Career Achievement in Psychiatry Award , presented by Dr. Carol Olson; Dr. Aaron Wilson, on behalf of each of the Psychiatric Resident Programs, awarded the Outstanding Resident Recognition Awards to Ernest (Trace) Cochran, MD, UACOM Phoenix, and Maya Heck, MD, MIHS; Dr. Jasleen Chhatwal presented to George Hadeed, MD, UACOM Tucson; and Presidential Commendation Awards were presented to Edwin Kim, MD (by Dr. Mona Amini); Jasleen Chhatwal, MD; and Tariq Ghafoor, MD (not photographed); and Dr. Mona Amini presented the President's Service Award to Aaron Wilson, MD. 

AZ Psych SocietyAPS BUSINESS MEETING HIGHLIGHTS FOR OUR MEMBERS
Legislative Report by APS Lobbyist Joseph F. Abate, Esq.
Election of 2018-2019 Officers
 

Health Care Legislative Report

The 2018 session began full force with a special session on the opioid crisis, out of which was quickly passed the Governor's Opioid Act. The Act has far-reaching impacts and later legislative efforts have been to the fine-tuning and clarifying of the provisions with the same. The first provisions of the Act go into effect at the end of April.

2018 was a busy legislative session, with one of the most major legislative issues relating to health care being efforts to end the Sunrise process in our state (S1470). The legislation, as first introduced, contained some very potential harms to patient safety and the process that protects it. The bill was subject to a robust stakeholder process, with a negotiated amendment moving forward in S1034 that removes the harms contained in the first versions and provides a path to the continued use of the Sunrise process as an effective protection for patient safety in Arizona.

For the house of medicine as a whole, credentialing (the subject of H2322), was considered a landmark piece of legislation. Efforts lead largely by the Arizona Medical Association contributed to the adoption of this legislation without a negative vote being cast. The legislation helps facilitates the timely credentialing of physicians by insurance companies.

Efforts at the state and national level contributed to KidsCare funding being restored. S1087, a late introduced striker amendment, has been introduced to remove the trigger that would automatically freeze KidsCare program if federal matching drops below 100%.

The Society was part of a stakeholder group participating in the commentary upon HCR2038 which establishes May 2nd as Maternal Mental Health Awareness Day. Dr. Saira Kalia both provided commentary upon the resolution and attended the press conference and House proclamation held in February.
There were bills of note, some of which did not move forward for a vote. S1160 and H2594 would ban or prohibit the defined professionals from providing any "conversion therapy" (defined as any practice or treatment that seeks to change the sexual orientation or gender identity of a person) to a person who is under 18 years of age regardless of the willingness of the person or the person's parent or legal guardian to authorize the conversion therapy. Almost a dozen states have adopted laws of this nature, two of which were signed into law by conservative Governors. It was introduced in Arizona to begin the discussion and consideration for the future.

To the relief of our behavioral health partners, H2406 did not move forward, which would have repealed the Board of Behavioral Health Examiners. Nonetheless, in the future expect more legislation that is aimed at finding efficiencies within the regulatory board system in Arizona.

The Society submitted a comment raising concerns regarding the AHCCCS plans to apply for a CMS waiver for prior quarter coverage, and signed on with the APA to an appeal to Arizona's congressional delegates in Washington, DC to work towards bipartisan solutions that ensure early intervention and access to mental health and substance use treatment.

If you would like any additional information regarding the legislative session, please contact the APS Lobbyist, Joe Abate, at 602-380-8337. If you are interested in being a part of the Legislative Committee of APS, chaired by Dr. Gretchen Alexander, please contact teri@azmed.org.   For more information on health care legislation relevant to psychiatry included in the 2018 legislative session, see the 2018 Health Care Legislative Report distributed at the Annual Meeting.  

Executive Officers 2018-2019

We thank the following members for their leadership and contributions as executive officers for 2018-2019 (voted in at the APS 2018 Annual Meeting):  
 
President:  Mona Amini, MD, MBA
President-Elect:  Don J. Fowls, MD
Vice President:  Jasleen Chhatwal, MD
Treasurer:  Gagandeep Singh, MD
Secretary:  Saira Kalia, MD
Co Resident-Fellow Member Representatives:  Matthew S. Erisman, MD, Maya Heck, MD, and Larry Mecham, MD
APA Assembly Representative:  Payam Sadr, MD*
APA Deputy Representative:  Don J. Fowls, MD (as President-Elect)**
 
Terms of office for the Arizona positions begin at the close of the Annual APA Meeting (May 2018) and end at the close of the 2019 Annual APA Meeting (May 2019).   *APA national positions are for two years.  The current APA Assembly Representative, Payam M. Sadr, MD, FAPA, is concluding his second two-year term, which will end at the close of the 2019 Annual APA Meeting (May 2019).   **Pursuant to the Bylaws of the Society, the President-Elect (Don J. Fowls, MD), will serve as the APA Deputy Assembly Representative for a one-year term that will end at the close of the 2019 Annual APA Meeting (May 2019).
ASSEMBLY NOTES FROM APA ANNUAL MEETING 
Dr. Sadr and Dr. Chhatwal at APA Annual Meeting NYC 2018


Payam Sadr, MD, DFAPA, Arizona Assembly Representative
Jasleen Chhatwal, MD, Acting Arizona Assembly Representative

Dr. Payam Sadr, Arizona Assembly Representative, was joined at the APA Annual Meeting by Dr. Jasleen Chhatwal, serving as Acting Arizona Assembly Representative.  At the conclusion of the APA Annual Meeting, Dr. Chhatwal began serving a two-year term as the Area 7 ECP Deputy Representative.  The Society is excited at what she will bring to this task in representing Early Career Psychiatrists in the Area 7 discussions and at the national level.  


Of particular note, the Assembly was asked to ratify a recommended change to the APA Bylaws regarding the current "Rule of 95."  Under the proposed change, this Rule would be replaced by two new categories based on numbers of hours continued work as psychiatrist.  There are opportunities to be grandfathered into the "old Rule of 95" retired category by different mechanisms if a member achieved "life status" (by the Rule of 95) before 1993 or between 1993 and 2021.  Position statements approved by the Assembly were on a wide variety of topics from Risk of Adolescents' Online Activity to Psychiatric Services in Adult Correctional Facilities; and similarly, Action Papers/Items were voted upon a wide spectrum of topics from enforcement of parity laws with insurance companies to removing MOC as a barrier to credentialing and hiring of psychiatrists.  
HAPPINESS & WELLBEING
 

Robin T. Reesal MD FAPA DABPN
Psychiatrist and Educator
2018

The purpose of this column is to help healthcare professionals get well and stay well using prevention methods based on lifestyle changes. The idea is to minimize suffering by reducing personal distress, interpersonal conflict, sadness, anxiety and substance use. Ultimately, better health can improve practice efficiency.  

The wellness of healthcare professionals is an international issue. There is now a realization that self-care and replenishment is essential to sustain a happy and rewarding personal and professional life. Communicating, exchanging and integrating ideas about what it means to be well, healthy and happy is being absorbed into our collective conscientiousness, a terrific change from past practices. In my view, healthcare professionals are a human resource which needs to be treated in an ecologically friendly way applying the principles of conservation and sustainability.

There is so much that can be said about how the changing healthcare landscape contributes to provider stress. A quick glimpse reveals a multitude of policy and procedure changes at many levels in both administration and clinical care. The intent of these changes is to improve health outcomes and promote patient satisfaction. The level of vigilance and oversight to achieve these goals and objectives is far greater than it once was. The expectations by the system we work in and the people we serve have changed with a greater emphasis on quick and positive outcomes. The rapid and ubiquitous rate of change in our professional and personal lives, is unprecedented. Keeping up and excelling in this environment can be a challenge and energy draining.

The risk reward ratio for being a health provider may be less favorable due to diminished autonomy and diminished control over decision making. There is a system shift in workplace activities in which more physicians are working for others. Despite the use of the term "personalized medicine", meaning that genetic tests can individualize treatments through science, some believe that medicine is "depersonalized" due less emphasis on the "art" of care delivery. An emphasis on patient volume and short appointment times puts pressure on the patient/healthcare provider relationship. Perhaps the patient/healthcare provider dyad needs more attention. There are more concerns that system priorities override the natural ambiance, understanding and therapeutic alliance between healthcare providers and their patients.
The previously mentioned health system organizational changes represent a new reality. Should we be pessimistic about this? Absolutely not. There are reasons to be excited and optimistic about our future role in healthcare. This column and future columns wrap around themes of excitement and optimism to build personal resilience.

The big picture advice in today's column involves two words, simple and imperfection. Invest time in keeping life simple. Start by addressing the fear of missing out, FOMO. It is impractical and unfeasible to agree to all requests, prioritize them. Having the skill to do a task does not mean one needs to say "yes". Multiple "easy" commitments lead to time pressure and sacrificing self and family time.
While making changes, consider the following technique. Integrate five minutes of quiet time daily for contemplation and relaxation. This practice is about self-replenishment, like drinking water to remain hydrated.

Imperfection, no matter how hard a person tries, no matter how many hours they spend at work, no matter how much they chastise themselves or the system chastises them, a simple truth remains, human beings are imperfect. Being imperfect is a reality and accepting this is part of mindfulness and wellbeing. Learning how to minimize our imperfections and managing them is a favored approach. The mind shift is acceptance and moving on versus denial and moving on.

Summary: The health and wellbeing of health providers is now a mainstream topic. A healthcare professional is not alone if she/he believes that rapid and widespread health system changes and societal changes contribute her/his stress level. Simplifying one's life, personal replenishment and managing imperfection are energy creating ideas that can build excitement and life satisfaction.
Resource: The American Psychiatric Association recognizes the need to address wellbeing and burnout by providing a site that offers an opportunity for a self-assessment and to access more resources.
Ideas, thoughts and questions can be sent to me at reesalclinic@gmail.com.  
2018 Az Psychological Association Annual Convention
ARIZONA PSYCHOLOGICAL ASSOCIATION 2018 ANNUAL CONVENTION
September 27-29, 2018: Hilton El Conquistador - Tucson, Arizona
Invitation to Prescribers


The Arizona Psychological Association (AzPA) invites you to join leading psychopharmacology experts, Jessie Chambers, PhD and James Woods, DPh, MD, ABPN, ASCP, for live workshops on state-of-the-art information about the role of pathophysiology in mental illness and the use of Vraylar, Viibryd and other psychotropics in the treatment of Schizophrenia, Bipolar Disorder and Major Depressive Disorder. These premier workshops are offered on Saturday, September 29, 2018, as part of AzPA's Annual Convention, Professional Excellence: Taking it to the Next Level, held in Tucson, AZ, on September 27-29, 2018, at the Hilton El Conquistador Hotel.
 
Prescribers may also be interested in programming offered on Friday, September 28th, including a keynote presentation by one of the fathers of cognitive-behavioral therapy, Donald Meichenbaum, PhD, or some of our other options on Saturday, such as the keynote presentation by Shauna Shapiro, PhD, author and mindfulness expert. Overall, the two-day Convention offers a wide range of mental health topics including substance use and addiction, consulting and coaching, equine-assisted therapy, ethics, child abuse and trauma, OCD, body image disturbances, social media & bullying, emotion-focused family therapy, disability accommodation evaluations, nutrition, sexuality, suicide, executive skill development, psychopathy, and diversity-informed ethical decision-making-to mention only a few.  
 
And, if you provide supervision, our Pre-Convention Workshop on Thursday, September 27th, featuring supervision expert and author, Carol Falender, PhD, is for you.
 
Don't miss out on this opportunity to take your professional skills to the next level, meet referral sources, and share information about yourself and your practice. CLICK HERE for the full Agenda and meeting registration information or CLICK HERE to register.   We look forward to seeing you in September!  
 
Jennifer Dvoskin, Psy.D., and Marisa Menchola, Ph.D.
AzPA 2018 Convention Committee Co-Chairs
FROM THE ARMA HOUSE OF DELEGATES:
Arizona Psychiatric Society Resolution on KRATOM
Update on KRATOM Article from Winter Newsletter


Drs. Espinoza and Herman joined by other ArMA HOD Attendees

Drs. Brian Espinoza and Stephen Herman served as the Arizona Psychiatric Society Delegates to the Arizona Medical Association House of Delegates.  Authored by Dr. Stephen Herman with contributions from Dr. Robert Orford and endorsed by the Executive Council of the Arizona Psychiatric Society, a Resolution was offered on Kratom supporting the conduct of ethically and scientifically sound research to evaluate beneficial or harmful effects of Kratom and its pharmacologically active derivatives and to prohibit the sale or distribution of Kratom or its derivatives in Arizona until it is deemed safe by the FDA.  That Resolution was adopted and submitted to the American Medical Association by the ArMA Delegates to the AMA Annual Meeting.  

For the benefit of our readers, Dr. Herman also prepared an update to the Winter Newsletter article on Kratom, being made available here.  The Society thanks Dr. Herman for his extra efforts on the Kratom education and resolution, and thanks both of Drs. Espinoza and Herman for their leadership at the ArMA House of Delegates.  

STEPPING UP: AN ARIZONA UPDATE ON A NATIONAL INITIATIVE!
PLAN TO ATTEND STEP UP ARIZONA - AUGUST 23-24, 2018

Dawn Noggle, PhD, CCHP
Mental Health Director
Maricopa County Correctional Health Services

The Arizona Psychiatric Society thanks Dr. Noggle for her comprehensive efforts to continue to keep our community informed about the progress made by Maricopa County, counties across Arizona, and community organizations, including David's Hope, NAMI Arizona, Mental Health America Arizona, and many others, to advance Stepping Up initiatives to reduce people with mental illness in our jails.  We greatly value and hope you enjoy Dr. Noggle's comprehensive update and several additional linked resources provided for your benefit.  We look forward to continued updates on progress made in Arizona and hope you will be a part of this important initiative.  

Stepping Up and Tidbits from the RWJ Foundation 2018 Sharing Knowledge to Build a Culture of Health Conference
 
May 16, 2018 was the Stepping Up National Day of Action.  With Arizona as the first state to have all counties stepping up, activities were held across Maricopa County and the state to  share successes and identify further steps.  

Maricopa County partners with Connections Arizona's Urgent Psychiatric Center to provide treatment for those in crisis, including the mentally ill. Diverting people from jail to treatment can help lower jail costs and reduce recidivism.   View this video on how ConnectionsAZ functions as initial diversion.
 
Stepping up Principle #4: Engagement in comprehensive process analysis and inventory of services:
Maricopa County is currently inventorying interventions and programs across Smart Justice agencies (criminal justice, human services, health and community partners) and doing in depth analysis of level of program development and outcomes. A stated Stepping Up principal, this analysis is necessary to increase awareness of existing programs across agencies to optimize utilization, to further develop existing programs, to determine if programs are evidence based and are having the intended impact. Importantly, we can't know what we need yet to develop or how to prioritize services without such a comprehensive, cross system analysis.
 
Housing is health care and necessary to reduce criminal justice involvement:
One new program, Hand in Hand, is in full swing. This is a collaborative among various Maricopa County, Housing and MMIC partners to identify our homeless "Familiar Faces" (individuals with multiple jail bookings), often SMI or with other significant behavioral health needs, who are caught in the revolving criminal justice door. Studies across the country show that housing these individuals, often homeless due to the negative impact of justice system involvement, is far cheaper than costs to cities and counties for continued jail bookings. Health and wellbeing are the most important outcomes, with some individuals able to engage in employment. CHS identifies these individuals when they come into custody and works with the housing providers (ABC, Maricopa County Housing Authority and supportive housing service providers (e.g. CBI) to engage these individuals and pair them to a housing resource.

Robert Wood Johnson Foundation 2018 Sharing Knowledge to Build a Culture of Health:
March 7-9 at the Sheraton Wild Horse Pass, RWJF brought together a cross sector group of researchers, grantees (including ASU) and "end users"/provider stakeholders from across the country for meetings and discussions intent on building a culture of health, examining health equity with a wide lens. Taking evidence (research to action); engaging impacted/communities to build social cohesion and health equity; addressing the needs of immigrants, marginalized communities, the criminal justice involved and the opioid epidemic from a systemic approach, incorporating the evidence were just some of the topics. And here's what's clear: we have to more meaningfully address the social determinants of health in our provision of care at the patient, health system and larger policy level. Current social policies, some of which stretch across decades, lead to communities with concentrations of justice involved people, higher disease burdens, lack of affordable housing, lower income households and lack of opportunity. We now can clearly see the impact of these social determinants on the health of these community members, impacts that often span generations. Our health system cannot provide care without understanding and addressing these issues. The connection between mortality and residing in high poverty neighborhoods is indisputable when you see the "heat map" overlays. Zip code versus genetic code as the determiner of quality of life and life span isn't a euphemism. In our own community, life span can vary by decades depending on which zipcode or census track we live in.
Arizona can be proud that one of the most powerful RWJF plenaries was provided by our local Diane Yazzie Devine, CEO of Native American Connections. She presented the compelling work of NAC over the decades developing a system of whole person care, within a culturally informed context, addressing physical, behavioral, and spiritual health that includes a range of substance use treatment services from traditional native practices to "traditional" evidence based programming. NAC is also providing the gamut of supportive housing, affordable housing and its latest addition, Home Base, Inc, shelter for homeless youth.
 

Step Up Arizona - August 23-24, 2018
Mental Health Criminal Justice Summit  
Davids Hope AZ

On August 23-24, 2018, David's Hope will host its third annual Mental Health Criminal Justice Summit.   The event will be held at Embassy Suites in Tempe.  The awards dinner will be held on the evening of Thursday, August 23, 2018. The David's Hope Awards honor law enforcement officers for outstanding service to people in mental health crisis, judicial officers for outstanding service in criminal justice mental health collaboration, and community members who have shown outstanding leadership in growing mental health criminal justice collaboration in Arizona.  

The Step Up Arizona David's Hope Mental Health Criminal Justice Summit will feature as the keynote speaker,
Major Sam Cochran (ret.) Co-Chairman Crisis Intervention Team International Board of Directors,  nationally known for his work developing the CIT model. Major Cochran is passionately engaged in many services promoting CIT as a community program - more than just training. In addition to receiving the City University of New York (CUNY) John Jay College of Criminal Justice, Law Enforcement News Person of the Year Award (2000), the National Alliance on Mental Illness named an annual law enforcement advocacy award after Major Cochran.  For more information on registering, view the flyer or visit this direct registration link.  
 
RISK MANAGEMENT CONSIDERATIONS WHEN PRESCRIBING

Moira K. Wertheimer_ Esq.


Psychiatrists have an important role in helping to ensure the safe and effective use of prescription medication and the avoidance of drug diversion. Utilizing prescribing best practices can help to reduce the risk of patient misuse, abuse or overdose of prescription medications, specifically controlled substances. Although not an exhaustive list, prescribing best practices include the following:
  • Prior to prescribing, perform a comprehensive evaluation and clearly document a treatment plan. Ensure you ask about substance use history.
  • Prescribe lowest effective dose and quantity needed for the expected treatment duration
  • Document informed consent. Ensure you discuss risks of taking prescriptions with patients
  • Provide patients with information on how to safely use, store and dispose of prescription medication
  • Avoid prescribing combinations of prescription opioids and sedatives unless clinically indicated. If you have concerns of misuse by a patient, seek guidance from an attorney or risk management professional.
  • Participate in your state prescription drug monitoring program to identify potential misuse and/or drug diversion
  • Document clinical rationale for medication prescribed
  • Order urine toxicology screening and follow up laboratory screening when indicated. Document results and any necessary follow up
  • Never sign incomplete prescriptions or provide patients with post-dated prescriptions
  • Lock up prescription pads
  • Use tamper-resistant prescription pads that cannot be photocopied
  • Write quantity and strength of medications in both letters and numbers
  • Ensure compliance with federal and state regulations when prescribing. Refer to DEA Practitioner's Manual and state prescribing regulations for more detailed information
  • Consult with your local attorney or risk management professional if you have questions
 
This article is reprinted from  Consider This published in July 2017.   This inf ormation is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to you. Consult your professional advisors or legal counsel for guidance on issues specific to you. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, GmbH, a Fairfax company ("Allied World"). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2018 Allied World Assurance Company Holdings, GmbH . All rights reserved.
JANSSEN UPDATE
J&J and Janssen Logo
Landmark Schizophrenia Data That Bring Hope In Breaking Cycle of Hospitalization and Incarceration Receive FDA  Approval For Inclusion In INVEGA SUSTENNA® (paliperidone palmitate) Label

INVEGA SUSTENNA® is the first and only antipsychotic to demonstrate superior effectiveness in delaying time to relapse versus a group of seven commonly prescribed oral antipsychotics in adults with schizophrenia who face common real-world circumstances.  For the full Press Release issued in early 2018, CLICK HERE.  

PRACTICE OPPORTUNITY - CENTRAL PHOENIX

Well-established general adult psychiatric practice in Central Phoenix looking for psychiatrist colleague with buprenorphine waiver to join the practice setting.  Same practice looking for an in-house therapist.  Contact Dr. Karnail Dhillon at 480-862-2981 (cell number) for more information.

CME AND EVENTS:  APA JULY COURSE OF MONTH AND TELEPSYCHIATRY TOOL-KIT; INTEGRATED CARE - GET-AWAY TO COLORADO; 2018 ANNUAL WOMEN PHYSICIAN CONFERENCE IN SCOTTSDALE; OPIOID-MAT TRAINING FLAGSTAFF; SAVE THE DATE UofA CENTER FOR INTEGRATIVE MEDICINE, INTEGRATIVE MENTAL HEALTH CONFERENCE, SFO 2019

APA FREE COURSE FOR JULY
Each month APA makes available a free CME course exclusive to members only through its Learning Center. July's course is  PTSD: Pathophysiology, Treatment, and Military Aspects.  This course discusses the pathophysiology, treatment, and military aspects of PTSD including the unique characteristics of combat operational stress as well as the currently available treatment modalities for PTSD. Presented by David Benedek, MD, COL, MC, USA, Associate Director, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences.

TELEPSYCHIATRY TOOL-KIT
The APA and the American Telemedicine Association (ATA) recently released "Best Practices in Videoconferencing-Based Mental Health," a guide for mental health providers who want to begin using interactive videoconferencing to offer services to their patients.  This guide is the latest telepsychiatry resource to the APA's Telepsychiatry Tool-Kit.  The guide broadly considers administrative, technical, and clinical considerations of videoconferencing-based telemental health practice.  

APPLYING THE INTEGRATED CARE APROACH:  PRACTICAL SKILLS FOR THE CONSULTING PSYCHIATRIST AND PRIMARY CARE PROVIDERS (Faculty Lori Raney, MD and John Kern, MD)
July 20, 2018, Grand Junction, Colorado
View the flyer
for more information or CLICK HERE to register.  

PSYCHIATRY NETWORK 2018 ANNUAL WOMEN PHYSICIANS CONFERENCE - SEPTEMBER 13-16, 2018; SCOTTSDALE, AZ (ONSITE REGISTRATION ONLY AFTER AUGUST 1)
Women psychiatrists are invited to join the Women's Psychiatry Group at its first ever conference September 13 - 16, 2018 at the JW Marriott in Scottsdale, Arizona. The conference will offer 10+ hours of live CME with topics focused on career development and self-care; and a bonus 15 hours online on suicide risk assessment. This conference is ideal for those looking to rejuvenate and renew their passion for psychiatry and for those looking to make changes and provide care in new settings. There will be plenty of time for socialization and relaxation, too! For more information, CLICK HERE.  After August 1st, registrations will only be accepted on-site.  CLICK HERE for registration.  

SATISFY YOUR NEW OPIOID EDUCATION REQUIREMENTS

MAT Training for Opioid Use DisorderMAT TRAINING, HIGH COUNTRY CONFERENCE CENTER, FLAGSTAFF
JULY 28, 2018.  
CLICK HERE to register.   

ACP AZ OPIOID EDUCATION FOR PRESCRIBING CLINICIANS -
AUGUST 25, 2018 (MULTIPLE LOCATIONS)

The Arizona Chapter of the American College of Physicians will be hosting:
Tackling the Opioid Crisis: A Practical Approach to Understanding And Addressing the Problem on Saturday, August 25, 2018 from 9:00 am to 12:00 pm.  The target audience for this no cost event is prescribing clinicians.  Event will be live in Phoenix(U of A College of Medicine) with broadcasts to Flagstaff (North Country Healthcare), Tucson (U of A College of Medicine), and Yuma (Yuma County Main Library).   CLICK HERE for more information on the event and registration links for each location. 

ARIZONA OPIOID PRESCRIBING GUIDELINES CME
Free Online Opioid Prescribing Course for Arizona clinicians that meets the three-hour CME requirements for continued licensing that took effect on April 26, 2018 is made available by the University of Arizona College of Medicine - Tucson at http://vlh.com/AZPRescribing.  

JANUARY 20, 2018 OPIOID USE DISORDER WORKSHOP SATISFIES ANNUAL REQUIREMENT
If you attended the Arizona Psychiatric Society Opioid Use Disorder Treatment Essen��als Workshop on January 20, 2018, the continuing medical education provided at the Workshop can be used to satisfy the opioid education requirements for licensure in Arizona, provided you attended at least 3.0 hours of the workshop.  Society planning efforts are underway to bring an additional opioid training to our members, which is planned to be made available online for the benefit of our members located throughout the State of Arizona.

INTEGRATIVE MENTAL HEALTH CONFERENCE - APRIL 15 TO 17, 2019, SAN FRANCISCO, CA.  Save the date for the University of Arizona Center for Integrative Medicine Integrative Mental Health Conference, April 15-17, 2019, in San Francisco, CA at the Hilton SF Union Square.  
Las Vegas NV CME REPORT FROM NEVADA PSYCHOPHARMACOLOGICAL CONFERENCE
The 23rd Nevada Psychiatric Association National Psychopharmacology Update:  February 15-17, 2018

Brian Espinoza, MD, FAPA
Interventional Psychiatry
APS CME Contributing Editor

This was my eleventh year in attendance, and this conference continues to grow, and remains the largest psychopharmacological conference in the country, with over 1600 attendees this year.  

CLICK HERE to review or print out notes taken of highlights from educational presentations relating to How Antidepressants Work (Alan Shatzberg, MD, Stanford University Medical School); Brain Stimulation Devices (Alan Shatzberg, MD, Stanford University Medical School); Ketamine (David Feilfel, MD, UCSD); Medical Marijuana (Kevin Hill, MD, Harvard Medical School); Towards Precision Medicine & Pharmacogentics (Stephen Spielberg, MD, Phd); Cardiac Side Effects of Psychotropic Meds (Carrie Ernst, MD, Mount Sinai); Treatment of Refractory Anxiety (Mark Pollack, MD, Rush University Medical Center); Clozapine: The Good, The Bad & The Ugly (Raymond Love, PharmD, University of Maryland); Cognition (Roger McIntyre, MD, University of Toronto); Bipolar Disorder (Michael Gitlin, MD, UCLA); Perinatal Mood Disorders (Marlene Freeman, MD, Harvard Medical School); and Treatment of Obesity (Carlos Grillo, MD, Yale University School of Medicine).  

Next Report: The 28th Annual International Society for ECT & Neurostimulation (held in conjunction with the Annual APA meeting in NYC); May 6, 2018

Dr. Espinoza is an APS Member and an Interventional Psychiatrist specializing in 
Electroconvulsive Therapy (ECT), IV Ketamine for Depression, Genetic Testing, Enhanced Medication Management, and Pharmaceutical Research.