Ad: Janssen Neuroscience (Resource: Summary of the Journey of Adult Patients with Schizophrenia)

Summer marks major transitions in the world of medicine. It is a time filled with hope, aspirations and many dreams. This year marked ten years of my own arrival to Arizona with my hopes, aspirations and dreams. I had come to train in Psychiatry, stating in my residency personal statement: “It is my life's ambition to help people plagued by psychiatric disorders and to increase awareness regarding the same in society.” It was my ‘why’ for leaving my home country.

As we attempt to emerge from one of the most challenging years for the medical community, a year in which a record number of physicians are stepping away from clinical medicine, I find myself reflecting on my reasons for being here. These reflections have caused me to refocus how I spend my time, and where I put my energy. In the words of Viktor Frankl, “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.“

As ‘healthcare heroes’ we along with other medical professionals have been given the overt and covert message that we cannot step back, cannot stand down. The ‘hero’ ethos is deeply ingrained within the medical community. Now if we are depleted, beat down by the many wounds, many may believe they need to keep going. Frankl’s words remind us that we get to choose our next step. Whether we stay, take a break, re-prioritize or walk away - the choice is ours.

As a society, with support from ArMA, we have been working with the Arizona Medical Board to advocate a change in health/confidential questions on licensing applications. The new language will focus only on current impairment from a health condition, with a goal to reduce fear and stigma for physicians seeking mental health treatment. Our heroes also need healing. As we heal, we can see new dreams and aspirations take hold.

This summer we welcome new interns into the practice of psychiatry and share congratulations with graduating residents and fellows as well as our amazing awardees from the annual meeting. In this time of renewal and celebration, I hope you can take some time to reflect and (re)connect with the reasons you choose to be here. In a year that has taken a lot from us as a world, a country, a community and individuals, staying connected with our values and our “why” has become even more important.

We need ‘whys’ that both challenge us and fulfill us. Be they legislative advocacy, clinical excellence, educational achievement, community service, financial security, family connections, self-awareness, togetherness, stigma reduction, or any other ‘why’ that brings us solace. Again the words of the wise Dr. Frankl, “Those who have a 'why' to live, can bear with almost any 'how’.”

Click the photo above to view the video of the presentation of the 2021 Howard E. Wulsin Excellence in Education Award by the Arizona Psychiatric Society to James B. McLoone, MD, DLFAPA. Nathan Jones, MD presented the award as the RFM Representative for the University of Arizona College of Medicine, Phoenix Psychiatric Residency Program.

Dr. McLoone has been involved with the University of Arizona College of Medicine Phoenix Campus since its inception including roles as Director of the statewide Psychiatry Clerkship since 1994, Associate Chief of Psychiatry for Academic and Clinical Affairs and Chair of Psychiatry since 2017. His academic title is Professor in the Clinical Scholar Track. He remains active as a lecturer, seminar leader, clinical supervisor and career advocate for the U of A COM-P medical students and residents. Awarded this award first in 2008, he becomes the first two-time recipient of the Howard E. Wulsin Excellence in Teaching Award with the 2021 award. Please join the Society in extending your congratulations and thanks for exemplary contributions to education and psychiatry to Dr. McLoone.

2021-2022 Corporate Sponsor

At the Arizona Psychiatric Society Annual Business Meeting on May 20, 2021, the following executive officers were elected to serve for 2021-2022.

President: Jasleen Chhatwal, MD

President-Elect: Stephen (Larry) Mecham, DO

Vice President: Yazhini Srivathsal, MD

Treasurer: Nicholas Ahrendt, MD

Secretary: Srinivas Dannaram, MD

Co Resident-Fellow Member Representatives:

Nathan Jones, MD (UACOM – Phoenix)

Reema Chopra, DO (Creighton University Arizona Health Education Alliance at Valleywise Phoenix)

Kailee Marin, DO (UACOM - Tucson)

APA Assembly Representatives: Jason Curry, DO (Term Through 2023), Gretchen Alexander, MD (Term through 2022)

We thank each of these officers for their contributions to excellence in leadership and psychiatry. If you are interested in joining a Committee of the Society or in being considered for nomination as an executive officer in 2022-2023, please complete this interest form.

Thank you to all who attended the 2021 Annual Meeting of the Arizona Psychiatric Society. Registered attendees can continue to access the virtual meeting platform, including the hand-outs from each speaker and biographical information for the same, risk management videos from each of American Professional Agency, Inc. and PRMS, and exhibitor contact and product information. Exhibitor contact and schedule information can be viewed by members who did not register for access to the virtual platform by clicking here. For a printable Program from the Annual Meeting, which includes the awards and special member distinctions for 2021, CLICK HERE. If you did not register for the Annual Meeting, but are interested in the recordings from any of the presentations, please contact Teri.

Join us in thanking our exhibitors for their support. With thanks to our members and attendees who participated in the exhibitor scavenger hunt challenge, the winner of the $300 gift card drawing was Dr. Tiffany Best, with $100 gift card awards to Drs. Aimee Schwartz and Traci Wherry for top scavenger points, and the drawing winners for hosted overnight stay at the 2022 Annual Meeting (planned to be in person) were Dr. Heather Boyle and Dr. Nima Jahanforouz (the RFM drawing winner).

The presentation by Dr. Carol Olson and Attorney Josh Mozell on "How to Get Help for your Patient Who Doesn't Want It: Process and Law of Involuntary Psychiatric Evaluation and Treatment in Arizona," is available on demand for CME credit. For additional information on the presentation, its learning objectives, and continuing medical education, visit the Society webpage.

Upon completing the registration below, you will receive an auto response with instructions on accessing the webinar and claiming your certificate of participation for continuing medical education. If you do not wish to access the education for continuing medical education, contact the Arizona Psychiatric Society for a courtesy video link.

In light of the COVID-19 pandemic surge, contingency planning is more important than ever. Fortunately, there are some simple steps psychiatrists can take to ensure that patients and your members' practice are protected in the event of sudden unavailability. CLICK HERE to access our downloadable contingency planning tool, which is designed to allow psychiatrists to quickly and easily gather necessary information to aid those assisting the doctor in the event of his/her absence.

The 2021 Legislative Session adjourned sine die on June 30, 2021 after 171 days in session, two days shy of breaking the record for longest session and tying the year 1992 for the third longest. There were a total of 1774 bills introduced, 473 passed into law, and 27 vetoes (which includes a grouping of 22 bills that were vetoed by the Governor to bring the legislators to the table to finish up the budget talks, most of which were reintroduced and voted into law as new bill numbers). If there were no emergency clause or other statutory provisions in the legislation regarding effective date, the general effective date for these newly adopted laws is September 29, 2021.

With the narrow voting margins for the session of one Republican member in the House (31 to 29) and in the Senate (16 to 14), party lines could have been more blurred, but many issues came down to those narrow margins and votes along the party lines. The Legislature in its final days came together to adopt the flat tax proposal and the proposed budget after negotiations with Arizona cities and towns to ensure they were not negatively impacted by the flat tax system. With the budget talks resolved, SB1270 Step Therapy legislation moved forward, was adopted, and was signed into law by the Governor this week, together with reintroduced versions of SB1030, SB1716, and HB2298 (bills that were included in the Governor’s veto).  CLICK HERE for an overview of SB1270 and the patient and physician organizations that were part of Arizonans for Step Therapy Reform, which includes the Society.

SB1029 and SB1030, which related to the Psychiatric Security Review Board (PSRB), were amended into one bill. The combined bill includes reforms to the PSRB and the eventual sunset of the PSRB with the court system taking over the responsibilities of the same in 2023.

Overall, it was a very productive session for the Society with eleven of the Society’s priority bills passing and only one that the Society actively opposed passing, SB 1457, Abortion; Unborn Child; Genetic Abnormality. In terms of the Society’s bill priorities, the bills supported by the Society that passed in this session include:

HB 2298 Medical Marijuana; Research: Grants

HB 2454 Telehealth; Healthcare Providers; Requirements

HB 2621 Prior Authorization; Uniform Request Forms

HB 2622 Nonretaliation Policies; Health Care Institutions

SB 1059 Mental Disorders; Considerations; Involuntary Treatment

SB 1089 Behavior Health Professionals; Unauthorized Practice

SB 1090 Outpatient Treatment Centers; Behavioral Health

SB 1250 Overdoes; Disease Prevention: Programs

SB 1270 Insurance; Prescription Drugs; Step Therapy

SB 1377 Civil Liability; Public Health Pandemic

SB 1716 Arizona State Hospital

The priority bills that the Society opposed, but were passed include:

SB 1269 (Strike Everything) Licensure; Regulation Health Care Professionals

SB 1457 Abortion; Unborn Child; Genetic Abnormality

Look for more information on the impacts and benefits to physicians and patients included in the Arizona telehealth legislation in a shared white paper resource from the Arizona Medical Association. Made available by ArMA to Society members for free, this resource will be distributed in a separate communication to our members.

For the final 2021 APS Lobbyist Legislative Report to the Society, CLICK HERE. The Legislative Report provides a summary of the legislation that has been voted to support, oppose, or monitor by the Society in this 2021 Legislative Session. CLICK HERE for a chart summarizing those Bill positions. For a comprehensive report of all health care legislation compiled by the Arizona Healthcare Advisory Coalition, of which the Society is a member, CLICK HERE.

If you would like to become a member of the Government Affairs Committee, chaired by Dr. Don Fowls, please contact Teri.

I’m happy to give another brief update regarding our advocacy work on the Arizona MD Licensure Application and Renewal. You may recall that in March ’21 we penned a letter to the Arizona Medical Board, joined by the Arizona Medical Association and twenty-two other physician associations and organizations, which asked the AMB to consider updating their “Confidential Questions” section toward less discriminatory and stigmatizing language. To briefly summarize, the form currently asks (in obtuse language) if applicants have received substance use or mental health treatment in the past five years, and if so, to provide details of the disorder and contact info of the treating providers.

Our letter, which outlined new language, gained broad traction among physician associations and thus far has been well-received among the Board Members. The AMB has been very receptive to the conversations around promoting physicians to seek care and destigmatizing mental health. In response to language changes proposed for the July 8th meeting of the AMB, the Arizona Psychiatric Society and Arizona Medical Association jointly submitted a letter in support of the proposed changes. At that July 8 meeting of the AMB, Dr. Chhatwal, Teri and I joined our third Arizona Medical Board meeting to speak on this issue and politely remind the Board of its importance, and were successful in obtaining a unanimous vote in moving forward the proposed language! The Arizona Medical Board is moving forward with the administrative steps necessary to enact a rule change to support this change in language, and we will be reporting back on how you can help support the process. With thanks to the AMB for making physician mental health and the discussions around destigmatizing the same a priority, we are optimistic the process has gained the necessary momentum and will now require time and patience.

In the coming months we will continue our work toward to promote the updated language, “Do you currently have a medical condition that impairs your judgment or adversely affects your ability to practice medicine in a competent, ethical and professional manner?”, in an effort to reduce the stigma of physicians receiving mental health treatment.

The APA 2021 Annual Assembly was held virtually in the weekend prior to the virtual educational sessions of the APA Annual Meeting. Arizona was well represented at the Assembly, with all three Arizona Assembly Representatives (Drs. Gretchen Alexander, Jason Curry, and Gurjot Marwah) present and contributing to key votes by strength. From Arizona, Dr. Jasleen Chhatwal was also in attendance as APA Assembly ECP Chair. In 2022, Arizona will return to two Assembly Representatives based upon membership numbers at the end of 2020.

Dr. Mary Jo Fitz-Gerald served as Acting Speaker for Dr. Joseph C. Napoli, who passed away just two weeks prior to the meeting while still serving as Assembly Speaker. Drs. William Greenberg, Leslie Gise, Eugene Lee, and Nazanin Silver led a tribute in Memorium for Dr. Napoli at the beginning of the Assembly, and many remained online after the meeting to offer respects. Key topics of Assembly business referenced in the officer updates, position statements, and action papers included the COVID-19 pandemic, structural racism, mental health equity, legislation, APA finances, MOC, and APA governance. In the address of President-Elect Dr. Vivian D. Bender, she shared that she will focus her Presidency on addressing challenges of social, economic, environmental, and political factors that have the greatest adverse impact on mental health through the creation of a Presidential Task Force on the Social Determinants of Mental Health.

CLICK HERE to view the full APA Assembly Notes, with details of the specific position statements and action papers, awards, and APA reports that were part of the APA Assembly.

Dr. Nicholas Ahrendt is the current Disaster-Response Chair of the Arizona Psychiatric Society. In his role as Chair, he co-led a mental health response to COVID-19 work group, identifying physician wellness and destigmatizing the seeking of care by physicians as a priority for that work group. Dr. Ahrendt’s passion and commitment to that outreach was material to uniting over 23 physician organizations to present comment to the Arizona Medical Board on the need to destigmatize the questions around licensure in Arizona. For these and other contributions to leadership, a Presidential Award for Leadership was presented to Nicholas Ahrendt, MD at the 2021 Annual Meeting.

The 2021 Resident Recognition Awards were presented by Dr. Chhatwal, on behalf of the Society, to the following Resident-Fellow Members of APS:

This award recognizes a Resident-Fellow member who best exemplifies one or more of the APS values of providing compassionate patient care and support of peers, leadership, community service, advocacy, and clinical excellence.  Each of the award recipients took a moment to share a quote with the Society on what membership means to them. Their answers are clear reflections on why each was chosen to receive this recognition.

CONGRATULATIONS to the 2021 Psychiatric Residency graduates and 2021 Fellowship program graduates! Thank you for the important difference you make for psychiatry and our community, and we are always rooting for you to find joy in practice in Arizona, but wish you every success wherever your career path takes you. We also thank the faculty, program support, and mentors who have made such a difference in the path of these residents and fellows in psychiatry. It takes a caring community!

Thanks to each of the poster presenters contributing to the Yukari Kawamoto, MD Memorial Poster Session for 2021, and Drs. Ole Thienhaus, Joanna Kowalik, and Srinivas Dannaram, Poster Judges. The virtual poster presentations continue to be available for viewing. After opportunity for live Q&A with the presenters on May 20, 2021, the Society presented the following poster awards (each of these presentations is available to be viewed by clicking on the Title):

First Author: Mark Anderson, DO, PGY-3, University of Arizona College of Medicine, Tucson

Secondary Authors: Rose Sivilli MD, Ross Francis MD, Nina Vadiei PharmD, BCCP

Title of Poster: True Allergy to Antipsychotic Medications Within an Inpatient Psychiatric hospital: A Retrospective Chart Review

First Author: John White, DO, PGY-3, University of Arizona College of Medicine, Tucson

Secondary Authors: Jennifer Bao, M.D., Michael Duerden, M.D.

Title of Poster: Forging Resilience in Residency

First Author: Brant Thayer, MD, PGY-3, Creighton University School of Medicine Valleywise Health Center (Phoenix) Psychiatry Residency Program

Secondary Authors: Gwen Levitt, DO, DFAPA; Terence Meyerhoefer, MS-3

Title of Poster: Response to the Atherosclerotic Cardiovascular Disease (ASCVD) Score in an Inpatient Psychiatric Setting

First Author: Brett Alan Dinner MS, University of Arizona College of Medicine, Tucson

Secondary Authors: Adiel Carlo, MD, Marisa Fernandez MD, Andy Trang MD

Title of Poster: Pick up! Telehealth No-Show Rates in Psychiatry during the COVID-19 Pandemic

First Author: Tyler R. Shiflett, DO and Ramsha S. Rao, MD, PGY-3s, University of Arizona College of Medicine, Tucson

Title of Poster: Developing Resident On-Call Guidelines For Contacting Off-Site Attendings in a Hospital System

First Author: Carrie Lin, MD, PGY-1, University of Arizona College of Medicine, Phoenix

Secondary Authors: Alena Petty, DO

Title of Poster: Psychosis and Catatonia in a Postpartum Patient: A Case Report

First Author: Gwen Levitt, DO, DFAPA, Psychiatric Physician Peer, Valleywise Behavioral Health

Secondary Authors: Jennifer Weller, PhD

Title of Poster: Outcomes of COVID-19 in an Inpatient Setting

We invite RFMs, Medical Students, and our Physician members to plan ahead to submit to present at the 2022 Annual Meeting. If you have any questions regarding the same, please contact Teri.

CLICK HERE or the image above for a downloadable resource developed by Janssen Neuroscience: Summary of the Journey of Adult Patients with Schizophrenia, including the clinical and economic consequences of the burden of schizophrenia and newer treatment guidelines that support long-acting injectable (LAI) antipsychotic medications in certain adult patients with schizophrenia.

2021-2022 Corporate Sponsor

The Arizona Medical Assocoation 2021 House of Delegates was held entirely via Zoom, with the hopes of returning to Wild Horse Pass next year. Approximately 75 members were in attendance. My co-Delegate was Allan Anderson, MD, Director, Banner Alzheimer's Institute, Tucson.

Wednesday evening breakout caucuses were held to host initial discussions regarding the various resolutions proposed. Spirited dialogues were held regarding the proposals to downsize the Board and a resolution to support banning Conversion Therapy.

Friday started out with a Virtual Wine Tasting with 35 Attendees. Aridus Wine Company of Wilcox, AZ, sent attendees tasting kits with 3 different red varietals, and we were walked through the tasting of each by the vineyard owners. And, we were given a virtual tour of SE Arizona Wine Country.

This was followed by a variety of breakout sessions with HOD sponsors.

The evening progressed with the welcoming of the new President, Miriam Anand, MD, and award presentations. The evening closed with a webinar discussion on COVID-19 vaccines with Dr. Cara Christ and representatives from Pfizer and Moderna as presenters.

Saturday was down to business with multiple resolutions reviewed via parliamentary procedure. Some highlights were:

1) a resolution to downsize the ArMA Board of Directors passed after spirited discussion and opposition,

2) a proposal to form a Private Practice committee did not pass,

3) a resolution to recognize the unscientific basis for conversion therapy and call upon the

Arizona Legislature to pass legislation making conversion therapy illegal for minors under the

age of 18 (Resolution 16-21), authored by Dr. Stephen Herman, ArMA and APS member, was passed (Psychiatry provided input to support this resolution),

4) Medical Student’s efforts to establish a Mental Health Awareness Week for their brethren was referred back to Committee for further processing,

5) a position on Police Interventions on calls involving the Mentally Ill was referred to the Public Health Committee for revision, and

6) a “Pandemic Response” resolution was referred to the Government & Legislative Affairs Committee for further working.

The day wound down with raffle prizes and a goodbye to the outgoing President, Ross Goldberg, MD. Dr. Goldberg expressed relief about leaving after this “year from he—“ (i.e. COVID-19). It was clear from the resolutions discussed that Mental Health and Psychiatry are in the mix of issues facing ArMA and its members.

Let us all look forward to meeting in person next year!

Early 2020 as the pandemic was unfolding, the International Society of ECT & Neurostimulation (ISEN) cancelled it’s 29th Annual Meeting normally held on the weekend of the American Psychiatric Association Convention. From there out it appeared that all of the major conferences I normally attend were going virtual…MGH Psychopharmacology 2020, NPA Psychopharmacology 2021 and ISEN 2021. I contacted our Teri Harnisch at that time and let her know of the situation, and inquired whether write-ups would be of any continued interest as these meetings would be available on-line, and later on-demand. Ms. Harnisch replied with the following; “what I think would be very interesting is to have your perspective on what you felt worked well with the virtual education and what you missed from attending live, together with your notes on the education”. So here goes:

The attendance was doubled compared to last year’s in-person meeting; 1,360 attendees; 1,150 in the U.S, so more of an “international presence”. The unanticipated jump in attendees made it difficult to have all of the attendees questions answered (I was 0 for 5). Missing was the availability to curbside some of the speakers during breaks (some MGH conferences had tables set up for sit down sessions). The steep part of the learning curve was the time zone difference. I was all set for an 8 AM start time as listed on the syllabus as part of in-person conditioning. The night before while preparing it finally dawned on me that it was 8 AM EST. So, the weekend had a bit of non-jet lag with me eating lunch while everyone in Phoenix was having breakfast.

It looks like Mass General is staying virtual this year, without a price reduction compared to in-person. Instead of Boston in October, it will be a laptop in Phoenix.

The attendance scenario was the exact opposite of MGH. After 25 years of being the largest Psy-chopharmacology Conference in the U.S., and having it’s attendance number go up every year, at-tendance fell; 2020 had 1,655 attendees, 2021 had 1,268 (this was not announced; I emailed the NPA after the conference to get this information). It would not be off base to think it was the “no Las Vegas effect”; in in-person attendance, the lecture room slowly empties as the afternoon to-wards Happy Hour progresses. The NPA was holding out to have a live event, but as the pandemic raged on, they went virtual about two months before conference date. It was honorable that they gave a small refund to those that did not cancel, as they knew the Las Vegas experience would be missing. Their was a different method of fielding questions; a queue would pop up with questions posted, and one could ask their own question and get in line, and/or “vote” for a posted question to “move it up the line”. The virtual Happy Hour and Networking Groups had marginal attendance; there were zero in the Bipolar group, and, when I switched over to the Treatment Resistant Depres-sion group, their were 5 in attendance. The traditional raffle prizes took place with prizes applied to next year’s 2022 in-person event. NPA vowed that 2022 was going to be in person (with a parallel virtual option likely), and offered their customary discount of $100 if one registered for next year during the program, as well as advertising discounted hotel rooms.

The attendance fee was $200 less than last year’s in-person fee. ISEN meetings always have inter-national attendees which spend 8 hours on a Sunday in conference. Because of the marked time differences due to virtual meeting, the conference was split up to two days with two 1/2 hour breaks each day, in addition to a lunch break. (A speaker from Singapore was virtually presenting at midnight his time). The international virtual platform had more technical glitches then the MGH and NPA conferences. Getting a chance to catch up with attendees from my Medical School & Residency training days in person was sorely missed. ISEN is planning in-person meeting in New Orleans, along with the APA meeting in May of 2022.

All three of the above institutions were forward that this was their first attempt at virtual meetings, and apologized in advance for the expected technical and logistical glitches. As mentioned, MGH is remaining virtual for 2021, NPA will definitely be in person for 2022 with a virtual option, and ISEN will go back to in person.

To avoid reader fatigue, conference notes will be presented in the Fall Newsletter, in an abbreviated format. Have a great Summer!

Analysis and Commentary: The Ninth Circuit Court of Appeals and Jail-Based Competency and Restoration, Joseph D. Bloom, MD, and Scott E. Kirkorsky, MD, J Am Acad Psychiatry Law 49(3) online, 2021. DOI: 10.29158/JAAPL.200099-20

Primary Disease Prevention for Southwest American Indian Families During the COVID-109 Pandemic: Camp in a Box, Francine C. Gachupin, PhD, et al., including Noshene Ranjbar, MD, DOI: 10.3389/fsoc.2021.611972 (Correction from Spring Newsletter)

Senior Psychiatrists and PRMS have teamed up to create Lessons Learned, a series of virtual Zoom presentations for ECPs and RFMs, featuring nationally noted psychiatrists providing a variety of career topics of interest to younger psychiatrists. Topics over the past year have included Careers in Psychiatry, Hoarding, and Federal and State Mental Health Responses to COVID-19, which recordings are available for viewing on demand (password lessons). Most recently, Dr. Lisa Van Susteren and others presented on "Climate Change and Psychiatry" (this recording will also be made available). Membership in the Senior Psychiatrists, Inc. is open to any member of the American Psychiatric Association who is a Life Member, Life Fellow, or Life Distinguished Fellow. CLICK HERE to complete your one-time registration in order to join.

Resharing the July 1st post to @AzPsychSociety Facebook and Instagram accounts, welcoming new Residents and celebrating the beginning of the residency year. Thanks to Dr. Ramsha Rao for her work coordinating and creating content:

Follow @AzPsychSociety on Facebook, Twitter, Instagram, and Arizona Psychiatric Society on LinkedIn.