PsychPearls by Psychiatric Times

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Last month we taught you how evening light can worsen mood. Today, we teach you how to fix that.

Psychiatrists are not strangers to difficult and even potentially dangerous patients, but James L. Knoll IV, MD, has made these populations one of his specialties. With decades of experience in forensic psychiatry, Knoll takes listeners deep into the US criminal justice system, where he treats both inmates suffering from detention-related psychiatric disorders and an especially challenging group that he has dubbed morally objectionable patients. In this conversation, Psychiatric Times and Knoll cover:1. What he means by the term morally objectionable patients. 2. How prisons’ strict social hierarchies can contribute to psychiatric illnesses. 3. The high prevalence of bipolar disorder and schizophrenia in corrections—and their potential causes. 4. The different challenges of treating patients in prisons vs jails. 5. Why inmates with psychiatric illnesses end up in the correctional system for longer than those without psychiatric illnesses.6. The role of mental health courts in improving psychiatric care in the correctional system.7. The challenges of treating patients who are high in psychopathy or have anti-social personality disorders. This is the first half of the Psych Pearls podcast with Dr Knoll. Stay tuned for the second half later in the week. Dr Knoll is professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor-in-Chief of the Psychiatric Times and President-elect of the American Academy of Psychiatry and the Law (2022-23).

Lamotrigine was launched for bipolar disorder in 2003, but it was a quiet launch, and since then a few myths have gathered around it as if to fill that vacuum. Today, we will address 4 of them.

PSYCHPEARLS PODCASTAlzheimer disease (AD) remains one of the most dreaded diagnoses a patient can get. The US Food and Drug Administration (FDA) raised hopes when it approved aducanumab, which promised to be the first disease-modifying drug for AD. But the approval immediately proved controversial. Three FDA board members resigned, the FDA then narrowed its patient label, and in mid-July, major hospitals announced that they would not administer the drug. In this edition of Psych Pearls, Helen Lavretsky, MD, MS clarifies the issues in the aducanumab debate and offers guidance for clinicians whose patients may ask about it. Going beyond pharmacology, she points out that other treatment options, including mind-body interventions and diet changes, have been shown to slow AD’s progression. In this conversation, Psychiatric Times and Lavretsky cover:1. The aducanumab controversy2. Advice for talking to patients and caregivers about aducanumab and other novel pharmacological options3. Mind-body and lifestyle interventions for AD4. AD prevention programs, including nutrition, exercise, and stress reduction5. Taking care of caregivers, including psychiatrists and other medical professionals6. How to prescribe joy Dr Lavretsky is a professor in-residence in the Department of Psychiatry at the University of California, Los Angeles. Her work on geriatric depression and integrative mental health using mind-body interventions has received national attention, and she has won numerous grants supporting that work. A distinguished fellow of the American Psychiatric Association and a fellow of the American College of Neuropsychopharmacology, she is also on the board of Psychiatric Times.

PSYCHPEARLS PODCASTThe initial wave of COVID-19 cases flooded New York City hospitals with patients who urgently needed medical attention. Despite the potential dangers, psychiatrists and other physicians rushed to their aid. There were examples of inspiring teamwork and mutual support everywhere. At the same time, many physicians found themselves in new and unfamiliar roles, sometimes without the necessary mental health resources to cope with what they were seeing and doing. In this edition of Psych Pearls, hots Angela Coombs, MD, and Jennifer Sotsky, MD, talk to Kasey Grewe, MD, and Niesha Voigt, MD, about their experiences in the early days of the pandemic. Many physicians have undergone traumatic experiences during the COVID-19 pandemic. If you or anyone you know needs mental health resources, consider contacting the Substance Abuse and Mental Health Services Administration’s national hotline (800-662-HELP) or the Physician Support Line (888-409-0141). Dr Grewe is an anesthesiology Critical Care Medicine Fellow at University of California, Los Angeles Health. Dr Voigt is a PGY 3 resident and co-chair of the Psychiatry Residents Diversity Alliance at Columbia University Medical Center. About the hosts: Dr Coombs is a board-certified psychiatrist and assistant professor in Clinical Psychiatry at Columbia University Medical Center and the New York State Psychiatric Institute. She serves as the medical director and team psychiatrist at ONTrackNY Washington Heights Community Service clinic. She completed her public psychiatry fellowship and adult psychiatry residency at Columbia University where she was a chief resident and co-organized the curriculum on racial/ethnic mental health disparities. In addition to her clinical work in the public sector, she also works in Columbia's psychiatric emergency room and has a private practice in Upper Manhattan. Dr Sotsky is a fellow in consultation-liaison psychiatry at Columbia University Irving Medical Center with a part time private practice. She was formerly a chief resident at Columbia’s psychiatry residency program. Before medical training, she received an MS in Narrative Medicine, an interdisciplinary field that studies illness through a humanities lens. She is co-author of Conquering Lyme Disease: Science Bridges the Great Divide and has interests in medical education, psychotherapy, and medical humanities. Acknowledgement: Thanks to Columbia University Department of Psychiatry for allowing us to present the Breakthrough Session podcast with experts in the field of psychiatry.

PSYCHPEARLS PODCASTDuring the first wave of COVID-19 cases in New York City, physicians of all kinds took on unfamiliar roles and, in many cases, potentially risked their lives to help their patients. In this edition of Psych Pearls, a quartet of doctors remember the early, uncertain days the pandemic. Hosts Angela Coombs, MD, and Jennifer Sotsky, MD, talk to Sara Nash, MD, MS, and David Chong, MD, about their personal experiences, how the challenges of the pandemic have evolved over time, what has kept them going throughout the year, and why preexisting social inequalities made the pandemic even deadlier in some communities. Dr Nash is assistant professor of psychiatry at Columbia University Medical Center and program director of its fellowship in Psychosomatic Medicine. Dr Chong is associate professor of medicine and program director of the Internal Medicine Training Program at Columbia University Medical Center. About the hosts: Dr Coombs is a board-certified psychiatrist and assistant professor in Clinical Psychiatry at Columbia University Medical Center and the New York State Psychiatric Institute. She serves as the medical director and team psychiatrist at ONTrackNY Washington Heights Community Service clinic. She completed her public psychiatry fellowship and adult psychiatry residency at Columbia University where she was a chief resident and co-organized the curriculum on racial/ethnic mental health disparities. In addition to her clinical work in the public sector, she also works in Columbia's psychiatric emergency room and has a private practice in Upper Manhattan. Dr Sotsky is a fellow in consultation-liaison psychiatry at Columbia University Irving Medical Center with a part time private practice. She was formerly a chief resident at Columbia’s psychiatry residency program. Before medical training, she received an MS in Narrative Medicine, an interdisciplinary field that studies illness through a humanities lens. She is co-author of Conquering Lyme Disease: Science Bridges the Great Divide and has interests in medical education, psychotherapy, and medical humanities. Acknowledgement: Thanks to Columbia University Department of Psychiatry for allowing us to present the Breakthrough Session podcast with experts in the field of psychiatry.

Even before the COVID-19 pandemic hit, many patients were already waiting months to see a psychiatrist. In this edition of Psych Pearls, we speak to James Phelps, MD, about the roots of the crisis and what psychiatrists can do to meet the nation’s mental health needs, especially through new models of collaborate care. Phelps also reviews his long career treating bipolar and other mood disorders. He discusses some of the most exciting recent discoveries, including research on inflammation and circadian rhythm disturbance, and mood bias. He also reviews recent research on digital therapeutics, which may offer powerful new options for treatment. Dr Phelps is research editor at the Psychopharmacology Institute, medical director at PsychEducation.org, and adjunct faculty at Samaritan Mental Health in Corvallis, Oregon. He is the bipolar disorder section editor for Psychiatric TimesTM and the author of A Spectrum Approach to Mood Disorders for clinicians and Bipolar, Not So Much for patients and their families.

PSYCHPEARLS PODCASTIn this installment of PsychPearls and the Columbia University Breakthrough Session, hosts Angela Coombs, MD, and Jennifer Sotsky, MD, discuss anxiety with Anne Marie Albano, PhD. When does anxiety become a disorder? Anxiety as cultural phenomenon vs individual illness Self-care as a way to conquer anxiety Help-seeking as a sign of strength and self-knowledge Strategies to recognize anxiety The role of technology Dr Albano is professor of medical psychology (in Psychiatry) at Columbia University and director of the Columbia University Clinic for Anxiety and Related Disorders (CUCARD). She is a clinical psychologist and board-certified in clinical child and adolescent psychology. In addition to serving as director of CUCARD, she also conducts research and trains residents, fellows, and psychology postdoctoral fellows and interns. Her research is focused on the development and testing of psychosocial treatments for anxiety and mood disorders, and in understanding the impact of these disorders on the developing youth. Dr Albano devotes her career to the study and treatment of anxiety and mood disorders in children, adolescents, and young adults. She is an expert diagnostician and cognitive-behavioral therapist. Dr. Albano co-developed a cognitive behavioral treatment program for adolescents with social phobia. She has published more than 90 articles and chapters and is the coauthor of several cognitive behavioral treatment manuals, including Anxiety Disorders Interview Schedule (ADIS-IV) Child and Parent Interview Schedules.About the hosts: Dr Coombs is a board-certified psychiatrist and assistant professor in Clinical Psychiatry at Columbia University Medical Center and the New York State Psychiatric Institute. She serves as the medical director and team psychiatrist at ONTrackNY Washington Heights Community Service clinic. She completed her public psychiatry fellowship and adult psychiatry residency at Columbia University where she was a chief resident and co-organized the curriculum on racial/ethnic mental health disparities. In addition to her clinical work in the public sector, she also works in Columbia's psychiatric emergency room and has a private practice in Upper Manhattan. Dr Sotsky is a fellow in consultation-liaison psychiatry at Columbia University Irving Medical Center with a part time private practice. She was formerly a chief resident at Columbia’s psychiatry residency program. Before medical training, she received an MS in Narrative Medicine, an interdisciplinary field that studies illness through a humanities lens. She is co-author of Conquering Lyme Disease: Science Bridges the Great Divide and has interests in medical education, psychotherapy, and medical humanities.Acknowledgement: Thanks to Columbia University Department of Psychiatry for allowing us to present the Breakthrough Session podcast with experts in the field of psychiatry.

PSYCHPEARLSWhat is addiction, and how can psychiatrists best respond to the opioid (and other drug) epidemic? What have we done wrong about it in the medication and other effective treatments for addiction? What does addiction do to the brain? Lloyd I Sederer, MD, a psychiatrist, public health expert, and writer provides key insights on what we can do to save more lives from overdose deaths. Dr Sederer is adjunct professor at the Columbia University School of Public Health; director of Columbia Psychiatry Media; Chief Medical Officer of Bongo Media; and chair of The Advisory Board of Get Help. He has been chief medical officer of McLean Hospital; affiliated with Harvard; Mental Health Commissioner of New York City; and Chief Medical Officer of the New York State Office of Mental Health, the nation’s largest state mental health agency. The mission of Columbia Psychiatry is to find the causes of and cures for mental illness. Dr Sederer’s most recent book is Ink Stained for Life: Coming of Age in the 1950s. A Bronx Tale. His website is at www.askdrlloyd.com.About the hosts: Dr Coombs is a board-certified psychiatrist and assistant professor in Clinical Psychiatry at Columbia University Medical Center and the New York State Psychiatric Institute. She serves as the medical director and team psychiatrist at ONTrackNY Washington Heights Community Service clinic. She completed her public psychiatry fellowship and adult psychiatry residency at Columbia University where she was a chief resident and co-organized the curriculum on racial/ethnic mental health disparities. In addition to her clinical work in the public sector, she also works in Columbia's psychiatric emergency room and has a private practice in Upper Manhattan. Dr Sotsky is a fellow in consultation-liaison psychiatry at Columbia University Irving Medical Center with a part time private practice. She was formerly a chief resident at Columbia’s psychiatry residency program. Before medical training, she received an MS in Narrative Medicine, an interdisciplinary field that studies illness through a humanities lens. She is co-author of Conquering Lyme Disease: Science Bridges the Great Divide and has interests in medical education, psychotherapy, and medical humanities.Acknowledgement: Thanks to Columbia University Department of Psychiatry for allowing us to present the Breakthrough Session podcast with experts in the field of psychiatry.

PSYCHPEARLS PODCAST Learn to Recognize and Treat Traumatic Brain InjuryDavid Arciniengas, MD March is brain injury awareness month. According to a study by the Centers for Disease Control, nearly 3 million individuals a year suffer a traumatic brain injury (TBI), and psychiatric disturbances are the most-common long-term effects of these injuries. In this edition of Psych Pearls, we speak to David Arciniegas, MD, about how to spot TBI and its psychiatric sequalae—and how to give effective treatment. Dr Arciniegas is professor and senior research neuropsychiatrist in the Department of Psychiatry and Behavioral Sciences at the University of New Mexico School of Medicine. He is director of research at the Marcus Institute for Brain health and editor of the Journal of Neuropsychiatry and Clinical Neurosciences.

Psychiatric Times interviews Omar Reda, MD, about international medical graduates (IMG) and his own personal and professional journey. In this podcast he discusses: 1. His childhood and medical training in war-torn Libya2. The challenges facing immigrants who want to become doctors in the United States3. How his colleagues, and the American medical establishment at large, can help IMGs realize their dreams Dr Reda is a practicing psychiatrist, Providence Healthcare System, Portland, OR.See more podcasts at PsychPearls by Psychiatric Times.