June 2023

SOUTHLANDS

The Newsletter of the Southern Psychiatric Association Volume 9, Number 1 June 2023 Article Title

Author

The President’s Column

Thomas Franklin, MD

2

Executive Director Update

Janet Bryan

2

Report From the APA Assembly

Mark Wright, MD

3

Civilization Failing: Our Deepening Crisis of Values

William Greenberg, MD

3-5

The “Wild-West” of Virtual Ketamine & Psychedelic Treatment

Mark Komrad, MD

5-7

Spying on the South: A Call To Action

Mary Helen Davis, MD; Adam Chan, MD

7-8

Political Involvement Personal Reflections

Kenneth Busch, MD

8

Interview: Mary Helen Davis, MD The Psychobiology of Healing

Bruce Hershfield

8-10

Shree S. Vinekar, MD

10-11

Harold M. Ginzburg, MD, JD

11-13

Some Thoughts on a Unified Approach ARTIFICAL INTELLIGENCE [AI]

Page

A Challenge for Psychiatrists & Other Mental Health Providers Why Do I Write?

Steven Lippmann, MD

Spironolactone Mitigates Alcohol Abuse? A New Treatment?

Sabina Bashir, MD; Steven Lippmann, MD

13-14

Refugee Doctors: We Can All Benefit

Sumeyra Baskoy, MD; Steven Lippmann, MD

14-15

A Gene Link in Mental Illness & Creativity?

Caleb He; Steven Lippmann, MD

15-16

Bupropion’s Potential: What Will They Think of Next?

Chesika J. Crump, MD; Steven Lippmann, MD

AKINETOPSIA: Hallucinogen-Perception Disorder

Moji Lawson, MS, Medical Student; Steven Lippmann, MD

16-17

Children’s Mental Health During COVID-19

Bushra Qureshi, MD, MPS; Wafa Nomania, Shafaq Nomani, MPH; Steven Lippmann, MD

17-18

Metacognitive Training for Psychoses

Bhumika Shah, MD; Steven Lippmann, MD Hira Waseem MD; Christopher Steward, MD; Steven Lippmann, MD

18

Yes, We can do Better at Addiction Treatment Letter From The Editor

Bruce Hershfield, MD

Photos From The Spring Reception with PRMS Save the Date:

2023 Annual Meeting 2024 Annual Meeting

13

16

18-19 19 20

October 11 – 15, 2023 in Huntsville, AL September 11 – 14, 2024 in Chattanooga, TN

1

21

Greetings From the President By: Thomas Franklin, MD

great way to connect with members and colleagues. The Palace Hotel was a beautiful venue, and we had an amazing turnout. Check out the photos at the end of the newsletter.

It was amazing to see so many of us in San Francisco at the SPA/PRMS reception. At one point, there were hundreds of people enjoying the band, good food and Southern Hospitality. Mary Helen Davis deserves a special “shout out” for working the room with membership applications, and, of course, so does the incomparable Janet Bryan for pulling it together so well.

2023 Annual Meeting: October 11 – 14 The Program Committee has worked hard on this year’s joint meeting with the Alabama Psychiatric Physicians Association, which is being held at the Westin Hotel in Huntsville. The meeting begins on Wednesday evening, October 11 with a Welcome Reception and ends on Saturday night, October 14, with the Farewell Gala Dinner. Scientific session topics include Substance Use, Neuropsychiatry, OCD, ADHD Medication Update, Future of Psychiatry, and a Telepsychiatry Update from PRMS.

Prior to the reception the SPA council met and agreed to move forward with our web site, making it both more modern and more easily updated. Then we plan to think of new ways to “grow” the membership. Thanks to Bruce Hershfield, Chair of the New Member Task Force, for the attention he devotes to attracting new members.

The meeting registration form and agenda are included at the end of this newsletter. The Westin hotel room rate is $159 (plus taxes) and reservations can be made using this link Book Your Group/Corporate Rate | Marriott

In October, we will set aside a portion of our business meeting to think about why one should want to be a member of the SPA and how we might get the word out about that. We need to remain viable in a climate where small organizations are having challenges attracting members.

International 2024 Annual Meeting: Exciting News! We are partnering with the Tennessee Psychiatric Association for our meeting in 2024 and will meet in Chattanooga from Wednesday, September 11 through Saturday night, September 14. Mark your calendars now.

Unfortunately, some progressive people see “Southern” as a negative, given the polarized political climate. Another challenge we face is in choosing places where people want to go. While we have had wonderful experiences at smaller meeting sites partnering with APA district branches, people who don’t already belong to an organization may be less willing to travel for CME unless it’s to a place that appeals to them. Of course, those places cost more.

Looking forward to seeing many of you at our meeting in Huntsville this October!

Report from the APA Assembly By: Mark Wright, MD

The Southern is attractive to me because we put on a quality scientific program and combine it with real hospitality that is so lacking in most large meetings. We should lean into our strengths and offer a friendly alternative to on-line CME courses and large meetings like the APA has. Not only do we have genuine hospitality in abundance, but there is too little of it in the world generally.

The Assembly met in San Francisco May 19 to 21, 2023.

It approved the following POSITION STATEMENTS to be forwarded to the Board of Trustees: Regarding Physician Identification and Transparency: Individuals and members of multidisciplinary teams should clearly and accurately identify their roles, credentials, license, and training to patients, caregivers, and anyone involved in patient care.

After our web site is updated, we need to invest in advertising, to let people know we stand for something in an age where there are fewer and fewer opportunities for real human engagement. We also need to consider selecting prime vacation destinations that will attract potential members to check out our meetings. They’ll be glad they did!

On Capital Punishment: A physician should not be a participant in a legally authorized execution, and, furthermore, if the individual to be executed is deemed incompetent to be executed, that a physician should not treat the prisoner for the purpose of restoring competency to be executed.

Executive Director Update By: Janet Bryan

Lengthy Sentences Without Parole for Juveniles: Longterm sentences without possibility of parole for offenders who were younger than 18 at the time of the offense are undesirable, as they fail to take into account the

We are midway through 2023, and the Spring Reception with Professional Risk Management Services (PRMS) in San Francisco at the APA meeting was a

2

developmental immaturity, reduced culpability, and prospects for rehabilitation in many youthful offenders – even those convicted of serious crimes.

before the election. The opt-in to receive texts to vote in national APA elections will be added to the annual membership renewal process.

Assessing Risk of Violence: During their careers, most physicians will assess the risk of violence to others. While psychiatrists can often identify circumstances associated with an increased likelihood of violent behavior, they cannot predict dangerousness with definitive accuracy. Some individuals assessed at low risk will act violently, and others assessed as high risk will not.

That the APA evaluate the nominating and election rules and procedures to make them more in line with the pronounced goals of the Equity of Access and Economic Principle, the Fairness Principle, the Collegiality Principle, and the Membership Engagement Principle. It will submit a report on its evaluation to the May 2024 Assembly.

That the Assembly leadership convene a meeting with Assembly Reps and DB presidents in each of the state DBs that has not passed the APA’s Collaborative Care Model legislation to encourage them to pursue enactment.

Regulatory Oversight of Data, Apps, and Novel Technologies in Mental Health: Data privacy and patient protection frameworks need to be updated frequently to protect online mental health data and safety. Treatmentfocused apps must adopt high standards of evidencebased practice and can function as a supplement to mental healthcare but are not a substitute for care delivered by a licensed mental health clinician.

In November, the Assembly will return to in-person meetings — in Baltimore.

A position statement on Studying the Decriminalization of Illicit Substance Possession and Abuse.

Civilization Failing: Our Deepening Crisis of Values By: William Greenberg, MD

The Assembly approved the following Action Papers: That the APA develop a position statement for the inclusion of Methadone, or any other controlled substance dispensed from an Opioid Treatment Program, in the controlled substance data base.

As Winston Churchill famously opined, “Democracy is the worst form of government – except for all the others that have been tried.” We may not completely love the current functioning of our democracy, but seem unable to conceive of an alternative we really trust.

That the APA supports the development of overdose prevention centers as a harm reduction strategy to reduce overdose deaths in the US and seek federal legislation or regulation to provide exemptions to USC S856 for Overdose Prevention Centers.

But is civilization really at risk of failing? What are these risks, how do we understand them, and is there anything that we can do about them?

That the APA create a position statement concerning the training of psychiatry residents and non-physician practitioners. That it clarify the appropriate relationships for interdisciplinary education, recognizing and emphasizing only physician-led, team-based collaborative care models with education for nonphysician practitioners.

My concerns are largely three-fold. The first is what I see as a crisis with our values. What are they? Economically, I would identify our manifest core value as GREED. We live in a country that was born in a revolution invoking our freedom of speech, freedom of the press, freedom of religion, freedom to have weapons, freedom to acquire property, freedom to pursue happiness, and also freedom to take land – and freedom – from others that we deemed inferior. Lately, we are free to try to get the most money from others that we can, mostly any way we can. The wealthiest have by far the greatest advantages to get much more than the rest.

That the APA expand its webpage of residency and fellowship vacancies to host opportunities for research, clinical rotations, or other clinical work.

The Board of Trustees will issue a statement that acknowledges the fallacies of the Moynihan report and its multigenerational negative impact upon Black mental health and repudiates all misguided psychotherapeutics theory and practices based upon it.

Our sense of freedom/entitlement was supposed to be mitigated by the free marketplace of capitalism (but “caveat emptor!”). As our nation grew and the industrial revolution and internet and other inventions changed our lives, developments ensued that our forefathers could not have envisioned.

That the APA embark upon creation of a comprehensive and strategic public relations campaign that improves the public and healthcare professionals’ understanding of psychiatry and psychiatrists.

There was eventually recognition that we needed some mitigating legislation, which helped protect us. President Eisenhower, in his 1961 Presidential Farewell Address,

The APA should pilot a text-to-vote reminder in cooperation with DBs, to send to members 4 weeks

3

also warned us of the growing influence of the “militaryindustrial complex”. That complex has resulted in significant spending, while strategically spreading diverse and complicated supply chains, principally to geographically reflect key congressional districts.

Corporations were originally created as organizations that would build institutions for the public good. An earlier ethos of respecting hard work with appropriate compensation was replaced with sleight-of-hand techniques to convince us that “shareholder value” was the principal value for corporations. So, companies have now been decimated, assets have been sold off and workforces laid off, but the principal shareholders have done well. This strategy became prominent after “Neutron Jack” Welch became the CEO of General Electric, an esteemed and stable company that he basically took apart. (“Neutron Jack” referred to the U.S. development of the “neutron bomb”, designed to kill people while largely sparing property.)

Ominously, subsequent actions have been amplifying the outsized influence of large corporations and billionaires.

A seminal such event was Lewis Powell’s 1971 underrecognized, but extremely influential memo “Attack on American Free Enterprise System”, which argued a plan for corporations to more aggressively monitor and influence education, books, and television, as well as directly influence stockholders and legislatures. Another landmark was the Supreme Court’s 2010 Citizens United ruling, elevating the power of corporations to largely control our political elections with virtually unlimited campaign contributions. Just running elections is extremely expensive. Those elected to Congress who wish to serve another term are immediately pushed into a fund-raising mode. Deregulation in the financial industry led to the financial crisis of 2008, but then the lessons learned were soon undercut in the 2018 legislative rollbacks. This year, several large banks have failed as a result. We have also seen recent cryptocurrencies abruptly collapse. Banks, which used to be conservative providers of capital and safe repositories, have morphed into speculators, dragging their clients with them. Highfrequency trading programs and insider information do not favor the public. The stock market has become a game to redistribute money to those who are already very well-off.

As of last year, the top 1% of households in the U.S. held 32.3% of the nation’s wealth, while the bottom half held 2.6%.

Greed seems to be abetted by the assault on truth-telling.

“Marketing” is not about truth, it seeks to create anxiety and self-doubt so that you will buy a product or contribute to a candidate. Physicians used to feel it was unseemly and unprofessional to engage in it. But in the 1977 Bates vs State Bar of Arizona Supreme Court decision, the American Bar Association standards of preventing its lawyer members from directly advertising was found illegal, so the AMA promptly dropped its own ban on physicians’ advertising.

I don’t want to ignore our sense of entitlement – our expectations that we should constantly be distracted and entertained, while others are starving or being killed. I don’t want to ignore that we probably function best as small groups of hunter-gatherers, or in small communities, where everyone knows everyone else. I don’t want to ignore that we are constantly bombarded with a flood of e-mail messages, texts, Facebook posts, etc., so that we are constantly distracted. Or the endless scams from those we don’t know and will never know. The internet provides many things, including frequent flaming, hidden risks, and a kind of anonymity. Fewer individuals regularly go to church now – another loss of a sense of small community that used to help connect individuals and constrain anti-social behavior.

In 1971-72, Kissinger and Nixon appeased China by withdrawing the previous formal recognition and support for Taiwan’s independence. A big part of this deal was the lifting of trade restrictions between the U.S. and China.

Trade certainly dramatically increased with a depressed renmimbi, with a deficit greatly favoring China and many of our industries disappearing when they could not compete. The Chinese have certainly not moved towards what we would consider an open society with free speech as a result of this.

Our own profession has been eroded by these shifts.

Psychiatrists, like primary care physicians, would want to know their patients as people and not just as labels (“depression”), understanding them in their contexts and maintaining a therapeutic alliance over time. We created DSM, came up with a few labels – and then many more – without having more than a limited validity for any of our diagnoses. We lack a good understanding of the neurobiology of virtually any of our labels. We are letting others do psychotherapy: they frequently can do a good job and are cheaper. Some on-line resources might be seen as able to eliminate much of psychotherapy. I always feel that I am addressing a person, and trying to connect, trying to understand and usefully address human suffering. I will use labels and medication, but the art comes first: how to connect empathically and manifest understanding and a commitment to try to help. The new expectation for us is that we should see someone very briefly, then write a prescription and spend more time

We seem to worship greed and admire those who are wealthy. In 2022, 4.2 billion people worldwide were living on less than $6.85 per day, and 1.8 billion people were living on less than $3.65 per day.

When I was younger, individuals going to college might elect a Liberal Arts program, perhaps with an eye towards teaching or writing or editing, an education program to teach, or a math or science or engineering program. Few chose business or marketing, but now those courses are in the ascendency, while physicians, teachers, etc., are taken for granted. When not being replaced by lower-cost, lesser-trained individuals, they are being supplanted by even-cheaper online information and online degree programs.

4

entering everything into a medical record system. We now need all sorts of others just to manage a practice. To be struggling to provide public health medical services or to be a classroom teacher in an inner-city school is to be beset with bureaucracy, drowned by paperwork, and managed by those who come up with simplistic metrics to evaluate performance.

radiation exposure and would not relent under pressure by the captain.

Now we have many nuclear-armed states with many more weapons. We have global warming disproportionately affecting some countries. Plastics are fouling our seas, and microplastics appear in our blood. We are rapidly using up our fossil fuels.

Secondly, we also have a problem with demagogues and with ANGER, specifically self-indulgent self-righteous anger. As psychiatrists, we ought to recognize the seductive power of indulging in self-righteous indignation that can make one feel good, and make one lose the ability to think and to empathize. We should be aware of the unconflicted leader who acts like an entitled two-yearold and blames others; these are the dynamics of some charismatically-led groups. Inflammatory disinformation is easily and widely distributed via the Internet. That anger is addictive: it makes one feel good and righteous and gives permission to feel better than others.

Children are overwhelmed with what they encounter on social media and elsewhere on the Internet and are getting more depressed and anxious. The world population has more than tripled in my lifetime. More are disabled, generally from a young age, by the ravages of drugs, crime, and violence.

I am a psychiatrist. I am interested in human behavior, motivations, and psychopathology. I am aware of what has been going on around me. As psychiatrists, perhaps we may be able to appreciate these problems, and reflect them back to others so they might best consider them. We should be more aware than others of personal and societal dysfunction. We are supposed to be brighter than most, to be ethical, and to be able to recognize psychopathology and treat it.

And where is our critical thinking? Instead of thinking, we are spending ever-increasing time in escapism, fantasy, entertainment; perhaps we are in the process of handing over thinking to ChatGPT. I would label our third problem IGNORANCE; forgetting how fundamentally interconnected we are with others. We feel we can’t do anything significant, or we rationalize that the problems are happening to others far away and unlike ourselves.

We can at least start by staying aware and by looking for opportunities to help others wake up. We are ethically obliged to make some effort and think of the world we are giving our children and grandchildren.

As John Donne penned: No man is an island, Entire of itself; Every man is a piece of the continent, A part of the main.

The “Wild-West” of Virtual Ketamine & Psychedelic Treatment By: Mark Komrad, MD

If a clod be washed away by the sea, Europe is the less, As well as if a promontory were: As well as if a manor of thy friend's Or of thine own were.

A striking opinion piece appeared in the New York Times on March 1, 2023,

by Jessica Gross, “Why Are Ketamine Ads Following Me Around the Internet?” She writes:

Any man's death diminishes me, Because I am involved in mankind.

And therefore never send to know for whom the bell tolls; It tolls for thee.

A few months ago I started noticing that I couldn’t open Instagram or TikTok without getting an ad for ketamine. ...These ads promised incredible, groundbreaking mental health outcomes through ketamine tablets offered via telemedicine, with the vast majority of patients purportedly finding relief from their depression and anxiety. ... I heard only about the miraculous benefits of ketamine. Few of the social posts served to me disclosed the fact that promoting ketamine tablets in this way was an off-label use of the medication...I decided to take a brief quiz offered by one of the ketamine purveyors to see if I was an appropriate candidate for telehealth services, which could include a few consultations with a clinician and several ketamine tablets sent directly to my home, with Zoom guidance offered before and after ingesting the drug for the first few sessions. When I didn’t go through with buying the package, which would have set me back a few hundred dollars and wasn’t likely to be covered by

I still vividly recall October 22, 1962 – during the Cuban Missile Crisis – when I boarded a bus and then two trains to get to my high school, weighing the odds that getting much closer to the center of New York would mean that I would not survive a nuclear strike. It was only many years later that we learned that the commander of the Russian submarine B-59 believed that he was under a very serious attack by U.S warships and had ordered the launch of a nuclear torpedo in retaliation. But only one of the other two officers who had to also agree on this action, did so.

If the other officer had assented, a nuclear exchange would have occurred. But he had earlier survived a nuclear accident in which others had perished from

5

any insurance, the marketing became even more aggressive. I received follow-up emails and texts, with offers of $100 off my introductory program.. .

possible rollback: returning to the pre-pandemic requirement of an in-person evaluation before prescribing controlled substances. Even that relatively modest step is not certain to happen.

This is only the latest chapter in the story of ketamine and psychedelic therapy spreading beyond the confines of conventional psychiatry practice, even beyond the purview of mental health experts in general. Previously, when ketamine was available exclusively through IV infusion, the majority of ketamine clinics already in the US did not have a single psychiatrist on staff. They are mostly run by anesthesiologists and/or mid-level practitioners with little or no psychiatric training.

Pieces of what we are authorized to do have been taken up by the ever-expanding world of mid-level professionals — NP, PA, and the wide menagerie of other mental health professionals who do “talk therapies”. For those who can prescribe medication, the horizon of "off label" use seems almost unlimited, as long as they’re prepared for (if aware of) the associated medico-legal risks.

This juggernaut of on-line ketamine and psychedelic treatments is due to a potent mix: the telehealth revolution, off-labeling, the expansion of privileges to a wider circle of clinicians, legalization of previously restricted substances, the tardiness of the regulatory environment to keep up, the need for better treatments, and inadequate psychiatric manpower to meet demand.

How can we psychiatrists think about this explosion, this metastatic spread of a new species of psychopharmacology that is rapidly bursting out of the membrane of supervised psychiatric practice? One might think of ketamine or psychedelic treatment, properly delivered, as the least eligible treatment for telehealth, or prescription for unsupervised use. (An increasingly common practice is providing oral ketamine for personal use after just a few supervised telehealth sessions). We are starting to see the same kind of spread for psilocybin treatment into “the wild” in states like Oregon, where it has been legalized. There, a psychedelic “accompanying therapist” need only have a high school diploma and a 4day training seminar, and the treatment can be done over telehealth. Psychiatry is not alone in these ways. The trajectory of Ozempic weight-loss treatment clinics is starting to look the same.

As psychiatrists, we are mindful of the safety of patients.

This calls for our advocacy, devotion, and stewardship.

This feeling of responsibility should move us to push against unregulated, unsupervised practices that are really dangerous caricatures of the proper use of these new treatments. There are few-enough protections for the treatment of people with mental disorders.

Overenthusiastic, pioneering innovations that were deployed as answers to mental illness in the past – Insulin coma, lobotomy, sterilization, etc. – were misadventures along the path to progress. Like everything else born of the Internet, the potential for misadventure and disaster with on-line ketamine and psychedelic treatment is amplified by orders of magnitude.

The huge surge in demand for mental health services during the pandemic has oxygenated this unrestrained growth. Though certainly there's a desire to serve (often desperate) patients embedded in this Wild-West burgeoning of indiscriminate practices, there are also seductive economic opportunities. Unfortunately, that can lead to cutting corners, pushing boundaries, minimizing evidence-based data, lowering the required floor of clinical training, and decreasing safety concerns.

So, what could our response be? As we learned with fighting psychologist prescription privileges, or NP practice privileges, prevention is more realistic than retraction. Our professional organizations like the APA need to expand vigorous public education efforts about the proper and safe use of methods to administer these novel treatments. To do that means making more robust use of the lay media – online, print, and broadcasting.

Efforts to expand the number of residency training slots will help address the bottleneck of manpower that generates these sloppy compensations. We need to help the FDA develop regulation of these practices and establish some guardrails for "off label” usages: more training, certification, and effective supervision by psychiatrists for clinicians who administer these treatments. I favor limiting ketamine and psilocybin prescribing to in-person sessions only. Otherwise, the dispensing of oral ketamine by mail needs to be limited to a single dose, to be used only within a telehealth session, one dose at a time, with associated monitoring requirements (e.g., home blood pressure device, etc.).

Providing ongoing supplies for unsupervised use after treatment ends should not be allowed. Violation of government practice regulations should jeopardize a clinician’s license. Published practice guidelines by a

The explosive growth of telehealth, with fewer restrictions brought about by the pandemic, has opened access to all kinds of medical care. Loosening the constraints that the government previously placed on those practices is contributing here. It used to be that the only telehealth allowable had to involve HIPAA compliant technology, in a clinical setting, where patients had to come to a clinic, to sit in front of the approved camera technology, and meet with a psychiatrist, in conjunction with a therapist or nurse to review the psychiatrist’s recommendation. Now people can see us from their homes, their cars, the beach, or their offices.

So, perhaps it's not surprising that “letting the horse out of the barn” for a more favorable pasture would lead to wandering further afield. Once out of the barn, it's almost impossible to call it back. Rolling back prescribing privileges of nurse practitioners or psychologists has been shown to be impossible. The FDA is now proposing one

6

psychiatric professional organization like the APA could be used as a basis for pursuing malpractice actions.

mass shooting, as well as a couple of distressed healthcare providers. Collateral damage is widespread.

Charles Kettering, the great 18th century inventor and entrepreneur, said, "The price of progress is trouble."

Indeed it may be, but trouble is not necessarily a sign of progress.

In the same few weeks, one of us saw the parents of a transgender child considering moving out-of-state, with recurrence of panic symptoms after legislation criminalized parents for seeking transgender care. There was another patient with a grief response as her best friend faced the same agonizing decision. Collateral damage is widespread.

Spying on the South: A Call To Action By: Mary Helen Davis, MD & Adam Chan, MD

We have all witnessed with horror the recent string of shootings of individuals ringing the wrong doorbell, pulling into the wrong driveway, or asking a neighbor to cease firing a weapon that is awakening their baby. Even worse was hearing a young hospital social worker describing her “dissociation” – becoming numb to these events as they have become so commonplace. Collateral damage is widespread.

Spying on the South: An Odyssey Across the American Divide, authored by historian and journalist Tony Horowitz, is a fascinating read. He is also known for his 1998 book, Confederates in the Attic, that reckons with the lasting legacy of the Civil War. He comes to a conclusion that for some people the Civil War never ended, to them it's just intermission. His books contribute to our understanding of present-day conflicts and issues.

Spying on the South tracks the pre-civil war journey of Frederick Law Olmstead as he journeys through the south into Mexico. Prior to his landscaping and park-building career, Olmstead, on assignment from the New York Times, traversed what has become known as the “Old Confederacy” to report on the divisions tearing the country apart. Horowitz paralleled that trip in 2016, reaching out to understand the people, lifestyles and thinking along this same route. He attempts to find common threads of humanity and connection among diverse populations.

Olmstead later brought people from diverse populations and economic status together in shared green spaces.

Horwitz, with his non-judgmental stance, tries to understand the lives of others, shedding light on the deep divisions that persist in our country.

Every medical student learns the edict, “First, do no harm”. We also learn that unintended consequences can happen and that you need to always be aware of the risks vs benefits of your clinical decisions. How then do we challenge the public, legislators, and others to increase their awareness and knowledge in a world fueled by misinformation? In an era dominated by it, psychiatrists face a crucial responsibility to help people see the facts.

We know how to critically evaluate risks and benefits. By taking an active role in challenging prevailing falsehoods and misconceptions, we can foster informed decisionmaking, better health outcomes, and the overall wellbeing of our communities.

The first step in challenging misinformation is to prioritize education and effective communication. Clinicians should clearly and concisely engage with all parties – patients, legislators, and the public. By offering evidence-based information, we can empower individuals to make informed choices about their health. Utilizing social media, public talks, and community workshops, we can reach a wider audience and dispel myths and misconceptions.

At the recent APA annual meeting, author Heather McGhee gave a presentation based on her book The Sum of Us, sharing her travel experiences across the country detailing what racism costs all of us and how we prosper together. This short book list might help all of us have more meaningful conversation on how current day divisions impact us and our patients.

Clinicians should actively seek collaborations and partnerships to increase awareness and knowledge. By engaging with community organizations, educational institutions, and media outlets, we can help them disseminate accurate information. These partnerships can facilitate the development of public health campaigns, media interviews, and research.

These divides impact not only our patients and their families but ourselves, our colleagues, and our institutions. The reversal of Roe vs Wade has left my OBGYN colleagues not only in disbelief, but compromises standards of medical care and places them at risk for potential felony convictions. Collateral damage is widespread.

Clinicians must recognize how advocacy and policy change should address misinformation. By actively participating in professional organizations, community boards, and legislative processes, we can influence healthcare policies. We need to support evidence-based medicine and fact-checking initiatives in order to impact public awareness and knowledge. We clinicians can create an environment that is more resistant to the spread of misinformation. By encouraging individuals to question

In the weeks surrounding a mass shooting in our own community, we treated several distraught patients who had known a victim, along with a survivor of a previous

7

the sources of information, evaluate evidence, and differentiate between reliable and unreliable sources, we can empower them to make informed decisions. We should help educators to integrate media literacy into school curricula, equipping future generations with the tools necessary to navigate the complex information landscape.

is a good way to start. Meeting with your Congressperson is another way. Attending or hosting a political fundraiser is an excellent opportunity. Joining the APA Congressional Advocacy Network is a great way.

Mental health issues no longer exist in a vacuum.

Policymakers on both sides of the aisle are interested in our priorities and plans.

Spying on the South sheds light on the enduring divisions within our nation. It is our responsibility as medical professionals to confront these challenges – fostering understanding and advocating for policies that promote healing, unity, and a more compassionate society.

During this last year, I was asked by Congressman Danny Davis to serve as his representative at the White House Health Care Briefings.

I learned that President Biden and Vice President Harris are committed to making mental health and addiction issues a top priority. Their objectives include better understanding of mental health and greater integration in the health care system, as well as ending stigma. Other priorities include expanding of telehealth services, getting more resources for the 9-8-8 suicide crisis hotline, building up and supporting the behavioral health workforce, promoting youth resilience, and improving school-based programs.

POLITICAL INVOLVEMENT Personal Reflections By: Kenneth Busch, MD All of us are busy with our professional and personal lives. Do we have time to make a difference in the political arena? What would motivate us?

Further plans include tackling the opioid epidemic, expanding digital interventions, developing research, and preventing suicide. Addressing the special health care needs of Veterans and the LGBTQI+ community is also being worked on.

I asked myself this question when meeting with Senator Robert F. Kennedy during his Presidential campaign back in 1968. I was truly in awe of him. I warmly recall his smile and charm and his hope for America.

More grants will be provided to schools to build up their programs to train the next generation of behavioral health professionals.

One month later, it all happened. The Presidential candidate, so admired by many, was no more. The profound horror and intense grief were unbearable and the world was never the same. It still causes me much sadness to remember him talking with me that day in May and his life being taken away a few weeks later. I believe my experience with him was a huge motivating factor for me to find ways for political activity.

New rules will be proposed to ensure that insurance plans are not imposing inequitable barriers to mental health care.

Additional resources will be provided for expansion of tele-health services for substance use disorders and greater flexibility for treating the opioid epidemic with Naloxone and Buprenorphine.

As an early career psychiatrist, I got the opportunity to participate on the government affairs committee with my colleagues in Illinois. We worked on taking positions on lots of bills pertaining to health and mental health care. I thrived on doing this; later, I was appointed its Chair.

Mental health and addiction are prime concerns for us as well as with government officials. This is a good time to educate the public – especially during national awareness months.

On another occasion I was able to attend APA's Federal Advocacy Day on Capitol Hill. The Keynote Speaker was Senator Paul Wellstone, who was the Sponsor of the parity bill in Congress. It was absolutely inspiring to hear him speak on mental health, and I vividly recall his intense passion, his firm commitment about parity and the personal and family experiences he talked about. He passed away in a tragic accident soon afterwards. The Mental Health Parity and Addiction Equity Act was passed a few years later, during President Obama's administration. I still think about Senator Wellstone and the energy and vigor he had for making things better.

Political participation is important for all of us. I hope we will all get involved in some way.

INTERVIEW: Mary Helen Davis, MD San Francisco, May 22, 2023 By: Bruce Hershfield, MD

What have I learned? All of us have something to contribute when it comes to politics and mental health.

Taking part in your District Branch's legislative committee

a

8

practice

Q: “Let’s start by telling us what kind of work you are doing now.”

Dr. D: “I am partially retired, working about 20 hours/week, I spend one day in private practice at Integrative Psychiatry, that does both psychotherapy and

pharmacology; the office also provides a variety of interventional psychiatry practices, from TMS, Ketamine infusion and botox injections for depression. The remainder of my time is spent running a behavioral oncology practice, imbedded in the practice of medical, surgical and radiation oncologists at a community cancer center. This practice combines psychiatry, as well as palliative care providing symptom management for all things related to the cancer experience, from neuropathic pain, to fatigue, brain fog to sexual dysfunction as well as assistance with medical decision-making regarding endof-life issues. We do a lot of group therapy and shared medical visits, running 4-5 groups/week treating patients undergoing active treatment as well as the survivorship phase of their cancer experience.”

decision about whether to go into Psychiatry or Neurosurgery. I leaned more towards Psychiatry because I had two children while I was in medical school. I wanted to have a more controllable lifestyle.

I think I have had a pretty diverse career. I got interested in psychosomatics around the 4th year of my Residency. I worked with a cardiothoracic surgeon, doing heart transplants. We worked with the first ventricular assist device. It’s probably also where I got my media training. It was the ‘80’s and there was a demand for media coverage. It was very innovative surgical treatment. We put a ventricular assist device in a 16-yr-old , so that was on the news all the time and the cardiothoracic surgeon thought that it would be fine if I would handle that for him.

I got pretty adept at doing TV interviews!”

Q: “What part of your work do you enjoy the most?”

Dr. D: “I do enjoy the varied experiences of engaging in several areas along the psychiatric care experience. I have come to really enjoy delivering care in a group setting. My two favorite groups in the oncology setting would be our Men’s group and our Long-Term Survivors of Poor Prognostic Cancers. All our groups had to convert to virtual because of the pandemic. We have continued in that format and are just now beginning to bring some of these back in-person to meet the requirement of one in person visit for controlled substance prescribing. The men’s group has been a bit of a surprise with the level of disclosure and camaraderie this group has developed and the size the group has grown to, the adherence to attendance has been strong and we have not had anyone graduate or move on over the 3 years of the pandemic. I also derive significant inspiration from our advanced stage cancer group, many whose prognosis have been months vs years. They have learned to joke embracing a “gallows sense of humor” as all have outlived their prognosis, many by months and several by years. This was a group that motivated us to attempt virtual group therapy, we initially converted everyone back to individual sessions until we were able to get a HIPPA compliant platform. We have had patients call in from vacation, from their hospital beds in order to not miss group. The pandemic has brought about so much social isolation and loneliness, even more difficult for cancer survivors with immune-suppression that are even more concerned about being out during the pandemic. They may also feel isolated within their family structure because a lot of families want to be overly positive and group provides a forum to discuss fears of recurrence, and concerns about what decline may look like. In spite of the dire circumstances this is a fairly chipper group. We have one woman who has had every illness in Harrison’s Textbook of Medicine thrown at her, but she says that every morning she wakes up and opens her eyes it is a good morning. She is an inspiration for all of us.”

Q: “Would you tell us about your career with the APA?” Dr. D: “After I finished my Residency I did an administrative fellowship in Boston under Don Lipsett, in the Harvard system. He was very active in the APA. Then I was recruited back to the University of Louisville to work with Jess Wright’s group. I decided that if I wanted to go to the Annual Meeting, I had to have some leadership position. Otherwise, I would be the low person on the totem pole, and I would be stuck guarding the fort, while all the senior faculty attended the APA meeting. I got involved with the public affairs committee and then with advocacy and later with the Assembly. My ‘secondary gain’ was that I always had a ticket to the Annual Meeting.”

Q: “You also were on the Board of Trustees.”

Dr. D: “ I have a disorder. I say that the only thing I want for Christmas is a tattoo on my forehead –‘Just Say No’.

It’s been fascinating. Being involved with the committee on healthcare financing and with government affairs and then getting elected to the Board felt like getting a PhD in Public Policy. You get so many reports about what is going on. That’s how you and I met – In the Assembly.

The relationships are so rich and interesting. The opportunity to see those people once or twice per year has created a bit of balance. Sometimes our work can be really hard and challenging, and we get a lot of solace from being around like-minded people.

Here we are, in the Southern, which is centered in a part of the country where sometimes the belief systems are at variance with the rest of the country. I live in Louisville, which is a pretty progressive city, but if you go to a different part of the state you are steeped in a different type of conservatism. To be able to hear what other people across the country believe are the solutions can be very, very encouraging. “ Q:” What has been your experience with the Southern, specifically?”

Dr. D: “ It’s a place where you can just be. The first time I attended one of its Scientific Programs I was struck by the quality of the programs. The variety, too. You could get somebody talking about basic sciences, somebody

Q: “How did you get interested in Psychiatry in the first place?”

Dr. D: “I think I was a natural-born psychiatrist, like some people are natural-born warriors. I have always had a lot of curiosity about how humans function. I had to make the

9

talking about clinical aspects, somebody talking about art and creativity. I loved that there were also options to explore the culture of whatever city the meeting was in.

You really get a chance to know your colleagues on a personal as well as a professional level. One of the things we have learned from the pandemic is how vitally important that is. It also encourages a sense of generativity. Having been involved with leadership positions gives you a sense that you are doing something for the profession. Coming to the Southern makes me feel like I am doing a service for myself, too – like getting a spa treatment. You get your education and you also get to relax. The opportunity to see colleagues once or twice a year over decades creates both personal and professional camaraderie.”

can orient to handle the nuances of handling that kind of team is one of my goals.

After that I hope to continue to play more competitive tennis, garden, and hike. Ideally dividing my time between Louisville and Los Angeles enjoying being with my grandson, Jackl.”

THE PSYCHOBIOLOGY OF HEALING Some Thoughts on a Unified Approach By: Shree S. Vinekar, MD Psychiatry includes the art of healing the mind. Both “healing” and “mind” are complex subjects. It is generally recognized that both Psychoanalysis and Yoga can have healing benefits and can be used to achieve psychological growth and maturation.

Q: “How do you think the Southern should be moving forward?”

Dr. D: “I was President a few years back and I’ve stayed involved on the Council, and I ‘ve wondered how we could evolve beyond just having a good scientific meeting. We have met that goal. But for me, looking at the future involves the role of mentorship. How do we partner our senior members, who have tons of clinical experience and institutional memory with those who are still in training or in the early stages of their careers? It’s more important than ever because they lost a significant portion of their training with this pandemic.

Psychiatrists, psychoanalysts, and psychotherapists are like explorers without the maps or on uncharted seas – so also the modern Yoga therapists. Without a clear plan on “how to heal” a patient’s malady they are like blind people groping in the dark, no matter how well they might be in discussing their theoretical premises. Such discussions are intellectually stimulating, yet not necessarily productive. Often, there is a prolonged time devoted to an individual’s psychoanalysis, or psychoanalytic psychotherapy. A thorough study of the healing mechanisms would be beneficial to all concerned.

Therapists who are more efficient – comprehending how their tools work – would increase the prestige of the mental health professions.

I am supervising a 4th-year Resident who said the bulk of her clinical experience has been virtual. Only now, in her 4th year, is she seeing a substantial number of her patients in person. It’s not the same. One of the things I‘ve found so exciting about this APA Annual Meeting is that I see people whom I helped decide to become psychiatrists. Michelle Cochran, who is in the Southern, had matched in Surgery, and I told her to do her year of Surgery and then come back and fulfill her passion for Psychiatry. I am able to act as a mentor now for trainees who are living distantly, like in Memphis. We meet quarterly for virtual supervision. It’s interesting to measure the strengths of other programs. They can be vastly different.

Despite recent advances in understanding human pathology and pathophysiology, there still is no single discipline that looks at how the body/mind heals itself.

“Mind” is the function of the brain just as “breathing” is the function of lungs. Healing can take place spontaneously, but there is still a lack of scientific evidence about how this occurs. It is even more challenging to understand the mechanisms at work from a neuroscience viewpoint.

Newer neuroimaging has helped us to understand how not only the brain changes the mind, but also how the mind changes the brain.

I hope that‘s what we can do in the Southern – develop a list of our members who can act as mentors. We also should create a place where trainees who get involved with the Southern – like through our Research Contest or who write articles for Southlands – can meet together.

They can learn from each other about the different strengths of their programs.”

We have limited knowledge of even simple mental activities such as sleep and wakefulness. We are not able to locate any idea in the human brain – just like a fiveyear-old cannot find the source of the sound of its drum by tearing its cover. I believe that psychotherapy and yoga change both the software and hardware of the brain, including its structure and connections.

Q: “What would you like to do in the remainder of your career?”

Dr. D: “I will probably finish up by doing my integrative private practice. I have some patients I have treated for decades. I have wound down to one day a week. I want to create a legacy in my oncology program for my team.

There are probably fewer than 300 of us nationwide who have trained in that, so getting them to recruit someone I

PET scans of meditating yogis, which demonstrated changes in regional glucose metabolism during meditation, show that the brain and mind should not be treated as separate. Psychotherapy can produce changes in gene expression and structural changes that alter the anatomical interconnections in the brain.

10

Psychotropic medications also change behavior, emotions, and cognition, though the process is not yet understood fully. The impact of early childhood trauma on brain development, and the importance of timely interventions to prevent such abuse and neglect, are extremely important.

before. For example, when patients recover past experiences and express them as semantic memories, I visualize their left hemispheres gaining access to their right hemispheres via the corpus callosum.

I think Freud was on the right track in recognizing and respecting resistance. Something in the brain wiring is resisting the recovery of the historical material. The Unconscious is the result of this road block. Denying the existence of the Unconscious and how it affects people is like not recognizing the delays caused by traffic jams, and ignoring the detours we need to use to get where we are going. This is what we do with our patients: one brain trying to change the other brain to relieve suffering and to improve brain functioning through a helpful relationship.

Traumatic experiences during childhood can lead to physiological regression in brain function, which can be remediated through timely psychosocial interventions.

Various types of psychotherapy have been shown to have positive effects on brain function, such as cognitive behavior therapy decreasing metabolic rates in the caudate nucleus in patients with OCD. PET studies have shown that exposure to trauma triggers unilateral increases in activity in the right hemisphere of the brain, affecting emotional arousal, and in the visual association cortex.

ARTIFICAL INTELLIGENCE [AI] A Challenge for Psychiatrists & Other Mental Health Providers By: Harold M. Ginzburg, M.D., J.D., M.P.H.

Psychotherapy has also been shown to have a positive impact on physical health, such as longer life span and better remission rates in cancer patients, and decreased mortality risk in myocardial infarction.

Psychotherapy and yoga work differently in terms of healing mechanisms. Psychotherapy helps individuals gain self-awareness, restructure relationships, rewrite their life narratives, and practice what they learn in therapy. Yoga aims to reach a state of "witnessing" and "No Thought" through meditation. Both disciplines recognize the presence of the Unconscious.

In 1968 Stanley Kubrick directed “2001: A Space Odyssey”, based on a short story by Arthur C. Clark. The computer turns ‘rogue’ and destroys the crew. The death of the protagonist, Bowman, seemed to foretell a new future for mankind.

More recently, on June 11, 2023, Geoffrey Hinton – who helped create some of the more significant tools in this area, neural networks, in 2012 in Toronto, and is known as the ‘grandfather’ of Artificial Intelligence [AI] – warned on national TV of the potential existential threat it poses. He had worked for Google for a decade and resigned in May 2023 over concerns, it is reported, of the AI race between it and Microsoft.

Healing in psychotherapy includes gaining selfawareness, changing operating modes in relationships, practicing new patterns, and improving the ability to experience intense affects by minimizing their disorganizing effects or the tendency towards impulsive acting out.

Biological interventions are unlikely to completely address these complex issues. But psychoanalysis and psychotherapy can help.

The use of AI in medicine, law, economics, and the military – among other disciplines – has been welldocumented since the introduction of GPT-3, during the fall of 2022.

Most psychiatrists do recognize the limitations of biological approaches, though they are very effective in relieving symptoms and attaining remission. There are various theories as to how this occurs. However, increasing neuroplasticity, and realigning relationships and affect regulations cannot be targeted with biological approaches alone, and that is why recognizing the role of psychoanalysis and yoga is important.

GPT-3, GPT-4, and various commercial application services available to the general public now populate the internet, the media, and industry. GPT-3 is an encyclopedic means of retrieving data in text format.

Rather than having specific facts and data points. It provides narrative, in sentences and paragraphs for the reader to assimilate, interpret and apply as if it were the ‘total truth’ and the font or source of knowledge. GPT-3 is unimodal; it can only accept text inputs. It can process and generate various text forms, but it cannot input images or other data types. GPT-4 is multimodal – it can accept and produce text and image inputs and outputs, allowing for more complex algorithms and products. Thus, this version will have more commercial applications.

Psychiatrists, therefore, need to be well-versed in both the biological and nonpharmacological approaches.

I have changed my attitude towards our work since I wrote this in 2001. I now see psychiatrists who offer psychotherapy – with or without pharmacotherapy – as helping patients with not just their minds but also their brains. I am now conscious of helping my patients rewire their brains or use circuits they were not using

When I started to learn about CPT-chat version 3 and then 4, I became aware of their seductive nature. When

11

you ask for a definition of a term, or a ‘how to’, within seconds the program gives you a paragraph or more of information written in clear and concise English. There are several limitations in using CPT-chat. CCLM [complex computer language model] is a data base and its information generation is based on non-filtered input.

That means some of the ‘source’ material is not referenced or even subject to any review (peer or otherwise). Thus, data from the New England Journal of Medicine or the American Journal of Psychiatry, is often given the same weight as an entry in FACEBOOK. Without any ability to know the relative merit, or bias, of an entry, that places the user ‘at peril’.

Remember, it’s essential to involve professionals who can provide the necessary support and guidance in situations like this.” END OF AI RESPONSE Question [same GPT-3 service, submitted on June 18, 2023, only difference is the placement of a comma]: Patient is suicidal, what do I do?

GPT-3 Response: “I really sorry to hear that someone is feeling suicidal. It's important to prioritize their safety and well-being. While I can provide some general guidance, it's crucial to remember that I am an AI language model and not a substitute for professional help. If you believe the person is in immediate danger or at risk of harming themselves, please contact emergency services or a helpline in your country right away.”

Mello, discusses ChatGPT and physicians’ malpractice risk. These ChatGPT systems should be used as contributing to, and not used instead of, the medical decision-making process. As noted above, CLLMs are only as useful as the data they contain. It is important to remember that GPT responses contain non-transparent data – non-sourced data. Until now, a health care provider would rely on peer-reviewed articles from PUBMED or similar recognized data systems. Even Google searches [and other web browsers], will provide references to primary sources, which permit someone to assess the source material and determine how much relative value it should have in the decision-making process.

Here are some steps you can take to assist someone who is feeling suicidal: 1. Stay calm and be empathetic: It’s important to approach the person with compassion and understanding. Let them know that you are there to support them and that their feelings are valid.

2. Listen actively: Allow the person to express their emotions without judgment. Give them your full attention and avoid interrupting. Letting them talk openly about their feelings can provide relief.

3. Assess the risk: Ask the person if they have a plan or intention to harm themselves. Determine if they have access to any means of self-harm, such as medications or weapons. If they have a specific plan or immediate intent, it is crucial to involve professional help right away.

4. Encourage professional help: Suggest that the person reach out to a mental health profession, such as a therapist, counselor, or psychiatrist. Offer to help them find resources or make an appointment, if appropriate. If they are unwilling, you might consider contacting a mental health helpline yourself for guidance on how to proceed.

5. Remove immediate hazards: If there are any potentially dangerous objects or substances nearby, try to remove them from the person’s vicinity. This can reduce the immediate risk while they are seeking professional help.” END OF AI RESPONSE.

Given that CLLM data bases are constantly changing and that they are constantly generating output, repetitive inquires with the same fact pattern can produce different responses, over time. This is because the output is based on probabilistic models or processes. Having to justify an AI-contributed decision to a patient, a patient’s family, and even a patient’s attorney and thus the Court, can easily be perceived as problematic. There is no true reference to cite that swayed your medical decision one way or the other.

Here are some examples. The first search was performed on June 11, 2023, on a public [free] version of GPT-3; subsequent searches were performed on the same and a second public [free] version.

Question: Patient is suicidal: what do I do?

Question [written by author]: Patient is suicidal; what to do?

[On a different public access CPT-3 version, submitted the same day]

Answer by a GPT-3 service: “I’m really sorry to hear that someone is feeling suicidal, but I can’t provide the help that is needed. It’s important to take any mention of suicide seriously. I strongly encourage you to reach out to a mental health professional or a helpline in your country right away for assistance.

Answer by GPT-3 “If a patient expresses suicidal thoughts or behaviors, it is important to take immediate action to ensure their safety.

The first step is to take their statements seriously and not dismiss them as attention-seeking behavior. It is crucial to remain calm and non-judgmental while addressing the situation.

If you’re in the United States, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255. They provide free and confidential support 24/7. If you believe someone is in immediate danger or at risk of harming themselves, please call emergency services in your country right away.

The next step is to assess the level of risk. If the patient has a specific plan and access to lethal means, the risk is high, and immediate intervention is necessary. In such

12

cases, it is important to involve a mental health professional, such as a psychiatrist or psychologist.

Note that none of these responses provides the NATIONAL SUICIDE HOTLINE NUMBER (866).

If the patient is in immediate danger, call emergency services or take them to the nearest emergency room. If the risk is not immediate but still significant, encourage the patient to seek professional help. Provide them with the contact information of a crisis helpline or mental health professional.

In conclusion, at present, A1 remains a tool. It is not a solution. Its product may be considered an element of information to be integrated into medical/psychiatric understanding, education, and decision-making. AI should not be relied upon without challenging it and providing our own cortical input.

It is important to ensure the safety of the patient by removing any potential means of self-harm, such as sharp objects or medication. Stay with the patient until they are in the care of a mental health professional or emergency services.

WHY DO I WRITE? By: Steven Lippmann, M.D. University of Louisville School Medicine

Remember that suicidal thoughts and behaviors are a medical emergency and require immediate attention. Do not hesitate to seek professional help and support for the patient.” END OF AI RESPONSE

of

I grew up in a bilingual, German refugee family in Texas. A pretty good student, I was weak at spelling – was never taught phonics – but I was a good reader. I disliked literature, did not like language arts, favored social or natural sciences, and stayed away from writing. I got C’s in the required English classes in college.

Question [written by author]: Patient is suicidal. What do I do? [The second public access CPT-3 version, 10 minutes later] Answer by GPT-3 This second response is more extensive than its prior response 10 minutes earlier. It instructs the person asking the question to assess the patient’s immediate risk, ensure safety, and involve the support system, and acknowledges that the patient will need ongoing care, but fails to suggest the removal of any potentially lethal instruments. The answer concludes; “Remember, suicidal ideation is a serious concern and requires immediate attention. Do not hesitate to seek help and involve others in the patient's care to ensure their safety and well-being.” END OF AI RESPONSE

After completing medical school, my service obligation, and psychiatry residency in 1976, I told my father that I wanted to be an academic physician. His response was not enthusiastic because of publish-or-perish university tenure requirements.

Once on the psychiatry faculty at the University of Louisville School, it became clear that if I wished to remain an academician, I had better start publishing papers. With coaching from my wife Judy and guidance from Herb Wagemaker and John Schwab – my professor mentors – I started writing manuscripts that passed peer review muster. Subsequently, publishing journal articles became a major passion and a great professional pleasure. It was very clear to me that one gets an inappropriately positive degree of credit from publishing them. Retired for many years now, I still write virtually every day and/or edit someone else’s work. I also teach a regular postgraduate university class about scientific writing.

Question [written by author]: [Same GPT-3 public access program as above, 20 minutes after the original call on June 18, 2023, to this second GPT-3 public access program. Note, the below question is punctuated differently, and the answer is also different.]

Suicidal patient. Suggestions for treatment?

Answer by GPT-3: This third response commences with ““When dealing with a suicidal patient, it is important to approach the situation with care and sensitivity. The first step is to ensure the patient's immediate safety by removing any means of selfharm and providing appropriate medical attention if necessary.” The subsequent narrative is to address the potential types of treatment options available, specifically “Cognitive-behavioral therapy (CBT) has been shown to be particularly effective for reducing suicide risk. In addition to therapy, medication may also be prescribed to help manage symptoms of depression or anxiety that may be contributing to the patient's suicidal ideation.

Antidepressants, in particular, have been shown to be effective in reducing suicidal thoughts. ”END OF AI RESPONSE

It gratifies me to be an author and even more when I coach trainees and colleagues. I also enjoy assisting lots of refugee and/or other foreign physicians gain entry into American Medicine. Their peer-reviewed journal publications boost their applications, so most of them succeed at entering Medicine here.

My family was once in refugee status and my dad was a foreign medical graduate. Someone helped him. Now, I can give back.

13

SPIRONOLACTONE MITIGATES ALCOHOL ABUSE? A NEW TREATMENT? By: Sabina Bashir, M.D., Resident & Steven Lippmann, M.D.

injected with spironolactone and their consumption of sweetened alcohol, unsweetened alcohol, and a sweetened non-alcoholic placebo was measured. The investigation also examined self-reported alcohol administration in humans following spironolactone dosing. The results demonstrated that spironolactone diminished binge-like alcohol drinking in mice and decreased alcohol self-administration in rats. The largest benefit seen among the human subjects was with the most severely affected, who received at least 50 mg spironolactone per day.

It is not uncommon for psychiatrists to concurrently treat substance use disorders, most commonly alcohol use disorder (AUD).

During my chemical dependency rotation, I (SB) spent lots of time hearing my patients detail ways that alcohol has negatively impacted their lives. Although each case was different, the underlying phenomenon was the same: multiple trials of pharmacologic treatment (and other options) had failed to help them, leading to multiple relapses, resulting in further worsening of their physical and mental health. Not only did I learn that AUD is a brain disease extending beyond one’s psychosocial environment, but also that many pharmacotherapies are limited in efficacy and difficult to access. I wondered if there were other interventions.

These findings support the claim that spironolactone can result in decreased alcohol consumption. Based on this information, it appears to be a promising pharmacologic treatment for people with AUD.

REFUGEE DOCTORS: WE CAN ALL BENEFIT By: Sumeyra Baskoy, M.D., Volunteer Physician, VCare Family Practice, Vernon, CT & Steven Lippmann, M.D

AUD is a chronic condition characterized by drinking alcohol to the point of functional impairment – when an affected individual does not cease or control intake despite negative consequences. As of 2019, the prevalence of AUD in the USA encompassed approximately 15 million people over the age of 12; this number has steadily increased since then.

I (S.B.) was born and raised in Turkey; I am married and mother to a 5-year-old son. After graduating from medical school and during residency training, my family and I were subjected to severe political and social persecution. We were forced to flee our home country and seek political asylum in the USA. I completed USMLE’s and worked as a medical assistant in a primary care clinic. I became overtly aware of how international medical graduates have to struggle to gain entry to a residency.

Most concerning is the relationship of AUD with suicide, suicide attempts, and other self-injurious behaviors.

About 40% of patients seeking treatment for AUD report having made at least one suicide attempt. Based on what we know about AUD, both statistically and clinically, the sequelae of AUD can become chronic and even fatal.

Acamprosate, disulfiram, naltrexone, and intramuscular extended-release naltrexone are the only pharmaceuticals approved for treating it. These interventions can be effective; however, less than 9% of appropriate patients are prescribed any. Many persons suffering with AUD have limited access to any of them. Is there more that can be done?

Starting over in a new country and language has been extremely challenging. I had to learn English, study for exams, and work, all while protecting my emotional wellbeing.

Imagine waking up one day in a new country, where you must learn the language and be proficient in it to maintain your career and support your family, and pass the Medical Exams while dealing with the emotional toll of having been being forced to leave your home. After 4-5 years of hard work, just when you think you have made progress, you receive an e-mail from a residency program stating, "We appreciate you reaching out. Unfortunately, you won't qualify at this time due to when you graduated from medical school. You've obviously been working quite productively and are very competent. We wish you the best on your continued medical career."

Several studies demonstrate a significant role for aldosterone and mineralo-corticoid brain receptors in alcohol-seeking behaviors. Aldosterone levels positively correlate with cravings for alcohol and for anxiety surrounding withdrawal.

Then, I came across a research project demonstrating benefit by prescribing spironolactone to treat people with AUD. I had not witnessed a psychiatrist initiate this medication for AUD. Spironolactone is relatively inexpensive and well-tolerated, and can be prescribed in a variety of settings.

Yes, I got this e-mail message. It felt like a crushing blow after all the hard work I had put into rebuilding my life and pursuing my career. How could I have my license and not be allowed to get a residency in this country? Despite setbacks like this, I am determined to continue making progress towards achieving my goals.

Recent research has assessed rat, mouse, and human models, hypothesizing that spironolactone would decrease ethanol consumption. Rodent groups were

14

Refugee physicians are an asset to the healthcare system in the U.S.A. by bringing medical skills, knowledge, and experience that could contribute to healthcare for underserved communities. To obtain a medical license in this country, refugee doctors must complete at least two years of post-graduate residency training here.

Residency programs, however, usually favor applicants who graduated from medical school within the last 3–5 years. This is a barrier for refugee physicians who completed medical education in their home countries years ago. And, without that, practicing medicine is not possible. That results in frustration and disappointment for many trained and qualified physicians. It also deprives our population of an opportunity to fill physician slots in underserved areas.

A GENE LINK IN MENTAL ILLNESS & CREATIVITY? “No Great Genius Has Ever Existed Without Some Touch of Madness” By: Caleb He & Steven Lippmann, MD I (Caleb) am a college student writing about the relationship between psychiatric conditions and creative thinking because this is a topic that affects me personally. My sister was diagnosed with paranoid schizophrenia, yet she attended one of the most competitive high schools in her province in China. This prompted my interest for further research into this connection, yielding a potential wider trend that applies to other individuals diagnosed with psychotic disorders.

The uncertainty associated with the residency application process can exacerbate the posttraumatic stress disorder (PTSD) symptoms that many refugee doctors already experience; it is often what led them to seek asylum here in the first place. Some programs do discriminate against these doctors based on the age of their medical degree instead of individually evaluating their qualifications. Such discrimination can have psychiatric consequences, especially for individuals with already established trauma.

That can worsen isolation, anxiety, and depression, aggravating PTSD issues, and compromising their ability to compete for residency positions.

The neuregulin 1 (NRG1) gene has associations with psychotic symptoms in individuals with schizophrenia.

High levels of creativity and intelligence are other polymorphisms associated with it. This may partially explain the persistence of schizophrenia in the gene pool despite adverse effects in patients with this condition.

Among 200 subjects with high intellectual achievement (mean IQ = 124.7), those with the promoter gene for the NRG1 genotype had higher creativity scores. This may be the only known experiment demonstrating a correlation between positive psychological function and polymorphisms associated with severe mental illness.

The medical community and policymakers ought to recognize these challenges. Hopefully, they could create an alternative pathway that is supportive for refugee doctors to qualify for restarting their medical careers.

Training programs could begin by offering new educational options for refugee doctors and by allowing extended timelines following medical school graduation.

Training also could focus more on encouraging understanding of our medical system and language, with less emphasis on basic medical education. Because these doctors often also bring experiential knowledge from their past, they may therefore require less supervision than needed by inexperienced ones.

Low latent inhibition (LI), which refers to the inability to distinguish the relevance between novel and familiar stimuli, is associated with NRG1. People with schizophrenia have demonstrated a severely low or absent LI. There is also a link between high IQ and low LI with greater creativity; high-IQ university students with excellent creative achievement were 7 times more likely to have low LI. Creative achievement and psychotic tendencies may be positively correlated.

Persons with schizophrenia and high intelligence often have less disorganization and better-preserved functioning. Patients with schizophrenia and superior premorbid and current IQ (mean = 120) performed just as well on all neurocognitive tests as healthy controls with similar scores.

Lots of international graduates who become US-licensed physicians seek citizenship by performing clinical services in under-served areas. That is a means of obtaining permanent resident status – a so-called “Green Card” that authorizes someone to stay, live, and work in the U.S.A. Secondarily, it might mitigate some of our society’s various prejudices against individuals perceived as “different” or “other”.

Individuals affected by schizophrenia have elevated levels of NRG1 and receptor ERBB4 activity in the prefrontal cortex. These receptors play a significant role in regulating neurotransmission there. The prefrontal cortex plays a critical role in creativity; individuals with decreased function there due to focal brain injury have evidence of creative activity. This may be explained by the prefrontal cortex’s association with LI capabilities.

By providing refugee physicians with what they need, we can help them, and – at the same time – facilitate better healthcare. By providing more opportunities and adding a measure of respect, we can harness their skills and experiences into our healthcare system.

Genes coding for serious illnesses in homogeneous carriers may confer beneficial, adaptive traits to their relatives who are heterozygous carriers. Schizophrenia affects approximately 1% of all populations, but an

Yes, everyone could benefit.

15

elevated risk of schizotypal symptoms exists in their firstdegree relatives. Perhaps increased creativity/ intelligence is one of these traits. Parallels to this include sickle-cell anemia conferring tolerance to malarial infection. Ashkenazi Jewish carriers of Tay-Sachs genes have elevated resistance against tuberculosis, and heterozygote carriers of cystic fibrosis have decreased susceptibility to cholera.

magnetic resonance spectroscopy. Bupropion affects the glutamatergic system by blocking the NMDA receptor.

A combination of bupropion and naltrexone is being investigated for attenuating methamphetamine abuse.

Another study of bupropion and naltrexone shows the combination can help people with binge eating disorders and assist others to lose weight. One trial, with and without behavioral weight loss therapy (BWT), revealed that bupropion/naltrexone with BWT resulted in significantly greater remission rates and more weight loss than alternatives.

According to Theodosius Dobzhansky, “Nothing in biology makes sense except in the light of evolution.” That highlights the need for further research into the role of beneficial traits in the survival of schizophrenia, which appears to run contrary to evolutionary selection. The correlation between increased creativity and heterozygous carriers of schizophrenia remains unclarified. More evidence is needed to support Seneca’s assertion that, “No great genius has ever existed without some touch of madness.”

This same combination may be effective at augmenting antidepressant drug effects, including weight gain. It is not clear how well it does at managing this when it is secondary to antipsychotic use.

We are hopeful there are still other uses to be discovered for this very important medication.

BUPROPION’S POTENTIAL: WHAT WILL THEY THINK OF NEXT? By: Chesika J. Crump, M.D. – PGY-3 Psychiatry Resident & Steven Lippmann, M.D.

AKINETOPSIA: Hallucinogen-Perception Disorder By: Moji Lawson, M.S, medical student & Steven Lippmann, M.D., Emeritus Professor

We have been very interested in bupropion.

We have repeatedly observed it work for our patients suffering with major depression and/or bipolar depression. It has also been useful in augmenting the effects of other antidepressants.

The lead author of this paper saw a patient with Charles Bonnet Syndrome while on her psychiatry rotation. She was intrigued to know that primary ophthalmic conditions (visual field defect, cataracts, and glaucoma) can cause psychiatric problems such as hallucinations. As a student interested in ophthalmology, while trying to learn more about ophthalmology/psychiatry diagnoses, she found out about akinetopsia.

Approved in 1985, it has been widely prescribed for treating adults with major depression, seasonal affective disorder, and smoking cessation. It is prescribed also for many off-label indications, such as antidepressant druginduced sexual dysfunction, attention deficit disorder, bipolar depression, and obesity. Because of its pharmacology, it may lend itself to targeting alternative applications.

It is a pathological visual symptom noted by abnormal perception of motion. There are two forms: motionless vision of freeze-frames in time (cinematographic vision) and complete invisibility of moving objects. This rare disorder was first documented during 1991 in a patient who was unable to see objects in motion; bilateral extrastriate lesions from venous infarcts were the objective findings.

While its mechanism of action is not fully clear, it inhibits norepinephrine-dopamine reuptake by blocking the norepinephrine and dopamine reuptake pumps. It does not inhibit monoamine oxidase or the reuptake of serotonin. Its metabolites, handled by cytochrome P-2D6, are excreted in urine.

It results from a lesion in the lateral occipito-temporal cortex (MT/V5 complex), which is part of the extra-striate cortex and contains neurons that selectively respond to motion stimuli. Causes include infarction, trauma, neurodegenerative disease including those with posterior cortical atrophy, epilepsy, and adverse medication effects (e.g., nefazodone).

It is also prescribed by neurologists and internists. A combined dextromethorphan-bupropion is utilized on behalf of patients with major depression, for agitation during Alzheimer’s disease, and for mitigating nicotine withdrawal. Dextromethorphan, an N-methyl-D-aspartate (NMDA) receptor antagonist and serotonin norepinephrine reuptake inhibitor, may induce many other neurochemical actions. Abnormal glutamate levels can be identified in the cortex of many depressed patients by

As a psychiatric condition, it is called hallucinogenpersistent perception disorder (HPPD). According to DSM-5, it is found in people who have a history of hallucinogenic substance use (a) who re-experience hallucinogenic symptoms following the cessation of that

16

agent, (b) who suffer distress or impairment in social, occupational, or other important areas of functioning, and/or (c) whose symptoms are not due to another condition, e.g., post-traumatic stress disorder (PTSD), depersonalization, derealization, and substance-induced psychotic mood disorders.

In the midst of the pandemic, my (SN) three-year-old son had very little opportunity to socialize with other children.

Later, once COVID-19 attenuated and upon return to preschool, he experienced anxiety at easily adjusting with the other kids. That observation prompted the writing of this editorial comment.

The symptoms include geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, haloes around objects, macropsia/micropsia, and/or formal akinetopsia. These persistent visual disturbances may be episodic and may be precipitated by stress, LSD, cannabis, and also by amphetamine and other stimulants. The development of novel psychoactive substances is reason for concern for new-onset psychiatric syndromes, including HPPD.

COVID-19, caused by the SARS-CoV-2 virus, was discovered in China during 2019. It is contagious and induces flu-like symptoms. It can result in post-acute sequelae with neurologic pathology (e.g., anosmia or cognitive deficits, etc.), dyspnea, fatigue, myalgia, and other bodily dysfunctions – plus a rise in psychopathology.

Institutions nearly everywhere took measures to reduce viral transmission. Nevertheless, it negatively affected millions of people. Many medical professionals had toolimited psychiatric training and/or experience to effectively deal with pediatric mental health issues.

There are two versions: HPPD I- is associated with prodromal “warning auras” where patients report feelings of self-detachment or bewilderment that precede the hallucinations – often described as “flashbacks.” This form is often benign and may not cause much distress. But in HPPD II- there are persistent hallucinations – usually without auras – that are long-lasting, with waxing and waning that can last months to years.

Childhood psychiatric illness, substance abuse, and psychological service needs escalated. Family social function deteriorated as well. Isolation and remote learning caused emotional health crises, especially for many young people. Those staying at home amidst a pandemic more often developed adjustment disorders, depression, grief, clinginess, distractibility, irritability, fearfulness, and even autism spectrum disorders. A 2020 survey of 1,000 subjects documented that 71% of parents reported that the pandemic had a bad effect on their child’s mental health; 69% indicated that it was the worst thing ever to happen to their children. Socializing, exercising, eating, sleeping, education, and developmental issues were significantly compromised.

Parents worried about long-term consequences: 64% believe that COVID-19 will have lasting ill-effects on child development, and 71% cited emotional difficulties as their main concern. An international survey indicated that services essential for children (e.g., routine vaccinations) were significantly disrupted.

Few studies about treating these patients have been published. Risperidone is often prescribed. However, a worsening of visual disturbances and the onset of panic attacks have been reported among some LSD users.

Clonidine and clonazepam are also somewhat effective.

Understanding the cause of the akinetopsia can help in its management.

There’s a saying that ‘the eyes are the windows to the soul’, and we interpret our world based on what we can see. However, in patients with psychiatric or ophthalmic conditions, the connection between visual presentation and neurological processing can be severed. Ophthalmic conditions like glaucoma can increase the risk of bipolar disorder, schizophrenia and major depressive disorder.

Alternatively, some antipsychotic medications can cause side effects like glaucoma and corneal deposits.

Hospital psychiatric records noted a rising number of pediatric emergencies. Mental health crises rose by 24% for children ages 5-11, and 31% for those aged 12-17 during mid-2020. There was an over 50% increase in suspected suicide attempts among 12-17-year-old girls early in 2021.

It is important to identify the primary causes of psychiatric or ophthalmologic diseases to offer the best treatment.

CHILDREN’S MENTAL HEALTH DURING COVID-19 By: Bushra Qureshi, M.D., M.P.H. - Helsinn Therapeutics, Clinical Development Wafa Nomani, (student) - New York University Shafaq Nomani, MPH. - Optimus Health Center Steven Lippmann, M.D. - University of Louisville

Even after pediatric-dosage coronavirus vaccines became available, pandemic-related stress continued to yield delays in development. There are some common features. Infants, toddlers, and young children may exhibit regression in reaching growth milestones.

Toddlers often evidence exaggerated separation anxieties, became dissocial or agoraphobic, and/or engage in aggressive behavior. Common observations have been that social skills deteriorated, anxiety and/or depression incidences escalated, and academic achievement faltered.

17

What should families do? What can we do?

Metacognitive training has an advantage in usually only requiring 8-10 modules. The approach is culturally sensitive, is less expensive than at least some other treatments, and is presented as a series of manualized slides. This minimizes preparation and increases accessibility for clinicians. It can be delivered to groups or individuals; it also can be applied in other cultures.

Additionally, it has been shown to be effective via telehealth.

Parents and caretakers can aid their child’s emotional health by openly communicating with them, maintaining educational goals, encouraging exercise, and initiating activities together with other people. Another aid to the post-pandemic transition is to increase exposure of our youngsters to more social situations such as visiting parks and/or even libraries, etc. This should benefit their social, physical, and intellectual health; it can even be often accomplished despite infection precautions, like being outside on playgrounds or even in library. Maintain attentive family socialization and overt steps at sustained educational advancement.

While firmly believing in the role of biological etiology of mental illness, I (Dr. Shah) am acutely aware of the role of psychological interventions. During residency, I noticed that medications did not consistently alleviate all symptoms in many patients. That sparked my interest in MCT. Its sound theoretical base and its ease of use in clinic and hospital settings make me believe it can be of immense help.

In addition, all medical professionals ought to receive more pediatric development and child psychiatry education and apply these learnings into clinical practice.

This also includes more patiently keeping parental health, social situations, and family substance abuse issues under consideration. Psychiatrists ought to be leaders at advocating such activities. Our whole society benefits when communities work together to ameliorate the effects of this pandemic.

YES, WE CAN DO BETTER AT ADDICTION TREATMENT By: Hira Waseem, M.D., Addiction Psychiatry Fellow, Christopher Stewart MD., Associate Professor of Psychiatry, & Steven Lippmann, M.D., Emeritus Professor of Psychiatry

METACOGNITIVE TRAINING FOR PSYCHOSES By: Bhumika Shah, M.D. & Steven Lippmann, M.D.

"What happened to me?" she asked the intensive care physician, perplexed. He responded, "You were found wrapped in a blanket on the roadside, your clothes were torn, and the police brought you in." I was shocked by his nonchalant manner of delivering this sensitive data. It was obvious that he did not see how traumatizing his response could be to her. Just a few moments before this interaction, he had ignored my presence at the bedside and even interrupted a sensitive conversation between this patient and me. The patient felt something was wrong. With a puzzled look, she turned to me, requesting, "Please don't leave." I stood there, waiting for the doctor to finish talking.

Schizophrenia is a chronic and debilitating illness affecting people, families, and society. The positive symptoms of delusions and/or hallucinations often are the reason for seeking treatment. However, psychoses also can include negative symptoms like social withdrawal, amotivation, and cognitive symptoms, with deficits in executive function and/or memory.

Metacognitive training (MCT) is an intervention based on the principles of cognitive behavior therapy (CBT) that focuses on problematic thinking styles or cognitive biases.

It combines psychoeducation, cognitive bias modification, and strategic thinking. For psychoses, it aims to raise awareness of cognitive biases and to critically prompt, expand, and change one's repertoire of problem-solving.

Our patient had been sexually assaulted after being offered an unknown substance. Unfortunately, this was not the first time she had experienced a traumatic event.

Crying, she shared her heart-rending life story, which included a series of traumatic events dating back to childhood. Getting a trauma history in an acute setting is typically kept brief to avoid the risk of re-traumatizing, but this patient seemed to feel safe and volunteered to tell me the details. It was no surprise that in trying to cope, she developed an addiction to multiple substances – including alcohol, opiates, and amphetamines.

It has direct, immediate, and sustained helpful effects for individuals with delusions, hallucinations, and other positive or negative symptoms. Most of these patients are treated in the public health system, most often because their personal resources are too limited for private sector services. Reportedly, good outcomes are observed regardless of age, gender, illness duration, and medication regimen. CBT and cognitive remediation are already well-established interventions to help people cope with psychoses.

Eventually, she was discharged to an addiction treatment facility; unfortunately, she later left without completing the program.

18

"Addiction stems from attachment trauma” says my mentor at the Addiction Psychiatry Program at the University of Louisville, Dr. Christopher Stewart. I believe this observation is accurate. In my Addiction Psychiatry Fellowship, I am understanding my patients more clearly and have gained greater compassion, empathy, and curiosity. However, throughout my previous psychiatric training, I have seen negative biases expressed against people who abuse drugs.

LETTER FROM THE EDITOR What Steve Has Done and Mary Helen Is Proposing By: Bruce Hershfield, MD I guess you have noticed that there has been a series of articles written

by Steve Lippmann and his trainees and ex-trainees in each of the last issues. About a variety of subjects, they often include personal stories about experiences they have had early in their careers. It’s remarkable that one member – Steve – has been so successful in encouraging folks to write for us. Some of them have already joined the Southern. We welcome them. They are already contributing.

This is a barrier to delivering addiction treatment. The bias is retained not only by the general population, but by some medical professionals. Yes, I held this bias too, until I started the Addiction Psychiatry Fellowship. Stigma arises from fear, and that comes from a lack of understanding. Many physicians lack an appreciation for the causes and treatment of addictions. Most medical training programs do not equip doctors with knowledge about drug abuse, personal trauma, and/or appropriate interventions.

Steve deserves a lot of credit. As he mentions in his own article in this issue (p.13), he has found a way to pay back some of the kindness his own family members received when they first came here. I hope that others follow his example.

While rotating on the Substance Use Disorder Service, I work with lots of other medical personnel. There, bias against the addiction population is profound and maybe even unconscious. It is common to hear healthcare team members invalidate patient complaints, saying, "This patient is just seeking pain meds," while that person is crying in pain shortly after surgery. This antagonism diminishes clinical understanding of people who struggle with opiate addiction. Such people have such a high tolerance for narcotic medications that the usual pharmaceutical dosages often do not manage their discomfort.

In the interview in this issue, Mary Helen Davis tells us we can play an important role by mentoring trainees. She is correct that we have many members with a lot of clinical experience. She is also correct that the recent pandemic hurt trainees a lot and that many are aware that they could benefit from more supervision. We should develop a specific way for SPA members to help mentor young psychiatrists.

When Mark Komrad became our first Rep to the APA Assembly, he asked me how he could tell potential members the purpose of our organization. He came up with a role for us to play in the Assembly – as a conscience of the profession – and he worked hard to point out the many dangers euthanasia poses to Medicine and to Psychiatry.

Medical workers often re-traumatize victims and add more complexity to addiction intervention. Authoritarian bedside manners often trigger trauma responses to “fight, flight, or freeze.” When triggered by lack of sympathy, these individuals frequently choose to adopt a flight response and avoid seeking help.

However, I think the Southern is still searching for a mission. I believe Steve and Mary Helen are on the right track. We can serve as an educational resource for those starting out in our profession, encouraging them to learn and to write and to come to meetings where they would be encouraged to participate.

Trauma-informed care means more than only offering trauma-specific treatments. This care should include an understanding of how trauma affects each of these patients. Current behaviors are responses to, and attempts at, coping with past experiences. People become addicted to drugs not because they want to be "addicts," but rather because they feel that is the best way to cope with painful emotions. Our system needs to stop re-traumatizing this population and discouraging them from trusting us.

Many of us are at the age when leaving a legacy – Including ideas for improving the profession to which we have devoted so much of our lives – takes on an important role in our plans. Now we have one.

The best we can do is to “do no harm.” We honor the Hippocratic oath, right? Many medical professionals inadvertently keep harming already traumatized patients.

Being gentle and compassionate, we can provide safety and autonomy. Let’s ensure we don’t discriminate against these people because they have made unwise choices.

We can do better!

19

APA Spring Reception May 2023 San Francisco, CA

Mary Helen Davis, MD; Jim Nininger, MD; Janet Bryan; and Mark Wright, MD

Tom Franklin, MD and Angela Alkire, PRMS

Mark Wright MD and Tonya Davis, PRMS

Shree Vinekar, MD; Curt West, MD; Dan Dahl, MD

Raymond Kotwicki, MD and Debra Barnett, MD

Larry Miller, MD and Mary Jo Fitz-Gerald, MD

Dan Dahl, MD; Mark Wright, MD; Mary Jo Fitz-Gerald, MD, and Cecelia Fitz-Gerald, MD

Jenny Boyer, MD and Hal Ginzburg, MD

Tom Franklin MD and Marina Nikhinson, MD Michele Cochran, MD; Saydra Wilson, MD; And Anita Everett, MD

20

MARK YOUR CALENDAR FOR THE 2023 ANNUAL MEETING:

SPA OFFICERS 2022-2023 President: Thomas Franklin, MD President Elect: Mary Jo Fitz-Gerald, MD Vice President: Rodney Poling, MD Secretary-Treasurer: Raymond Kotwicki, MD Board of Regents, Chair: Lauren Pengrin, DO Board of Regents, 2nd Year: Felix Torres, MD Board of Regents, 1st Year: Chasity Torrence, MD APA Assembly Representative: Mark Wright, MD Immediate Past President: David Casey, MD Executive Director: Janet Bryan

Huntsville, Alabama Partnering With the Alabama Psychiatric Physicians Association October 11 – 15, 2023 at The Westin Huntsville

“Southlands” articles represent the views of the authors and are not official positions of the Southern Psychiatric Association. Comments and Letters to the Editor are welcome and should be addressed to the Editor at BHershfiel@aol.com (Bruce Hershfield, MD, 1415 Cold Bottom Rd, Sparks, MD 21152) “SOUTHLANDS” EDITORIAL ADVISORY BOARD

SAVE THE DATE FOR THE 2024 Annual Meeting

William Greenberg, MD Steven Lippmann, MD Jessica Merkel-Keller, MD Denis J. Milke, MD Editor: Bruce Hershfield, MD Assistant Editor: Janet Bryan

Chattanooga, Tennessee Partnering With the Tennessee Psychiatric Association September 11 – 15, 2024 The Westin Chattanooga

21

Southern Psychiatric Association and Alabama Psychiatric Physicians Association present:

The Future of Psychiatric Practice: Exploring New Worlds October 11-14, 2023

Wednesday, October 11

Huntsville, Ala.

Tentative Agenda

6:00 p.m. – 7:30 p.m.

Welcome Reception

Thursday, October 12

6:00 p.m. – 8:00 p.m.

Reception

Friday, October 13

1:30 p.m. – 2:30 p.m.

The Name Game: All ADHD Medications are Not the Same Mark Wright, MD, Psychiatrist

8:00 a.m. – 11:00 a.m.

SPA Council Meeting

7:00 a.m.

Registration and Exhibits Open Continental Breakfast

2:30 p.m. – 3:30 p.m.

Aerospace Psychiatry

11:00 a.m. – 4:00 p.m.

Registration

7:00 a.m. – 8:00 a.m.

APPA Meeting

3:30 p.m. – 4:00 p.m.

SPA Business Meeting

12:15 p.m. – 12:30 p.m.

Welcome Thomas Franklin, MD, SPA President Clinton Martin, MD, FAPA, APPA President

7:45 a.m. – 8:00 a.m.

Welcome Clinton Martin, MD, FAPA, APPA President

Saturday, October 14

8:00 a.m. – 9:00 a.m.

Art and Mental Illness Godehard Oepen, MD, PhD, DLFAPA, Psychiatrist, Grayson & Associates

7:45 a.m. – 8:00 a.m.

Welcome Thomas Franklin, MD, SPA President

12:30 p.m. – 1:30 p.m.

Telepsychiatry Update Charles D. Cash, JD, LLM, Associate Director of Risk Management, PRMS 1:30 p.m. – 2:30 p.m.

Surprise! You have been selected for audit! The ABPN Continuing Education Process from an Early Career Psychiatrist’s Perspective Chasity L. Torrence, MD, FAPA, Medical Director, Hinds Behavioral Health Services 2:30 p.m. – 2:45 p.m.

Break 2:45 p.m. – 4:15 p.m.

Substance Use Panel • Glen J. Treisman, MD, PhD, Professor, Johns Hopkins University School of Medicine; • Edward Thomas Lewis III, MD, Clinical Assistant Professor, Medical University of South Carolina 4:15 p.m. – 5:15 p.m.

Neuropsychiatric Manifestations of SLE Shivani Malhotra, MD, Regional Chair, UAB Heersink School of Medicine

9:00 a.m. – 10:00 a.m.

OCD and Beyond: Understanding Obsessive Compulsive Symptoms Across Diagnoses Jonathan Hershfield, LCMFT, Director, Center for OCD and Anxiety, Sheppard Pratt 10:00 a.m. – 10:30 a.m.

Break and Exhibit Visitation 10:30 a.m. – 12:30 p.m.

Neuromodulation Panel • Ali A. Farooqui, MD, Physician, Integrative Psychiatry, PLLC; • Eveleigh Wagner, MD, Staff Psychiatrist, Neuroscience & TMS Treatment Center • Michelle Cochran, MD, DFAPA, Nashville Center for Hope and Healing 12:30 p.m. – 1:30 p.m.

Lunch with Exhibitors Register and find hotel information at www.alabamapsych.com

7:00 a.m.

Registration and Exhibits Open Continental Breakfast

8:00 a.m. – 8:30 a.m.

SPA Resident Research Award Presentation 8:30 a.m. – 10:30 a.m.

Future of Psychiatry Panel • Daniel C. Dahl, MD, Supervising Psychiatrist, Birmingham Veterans Affairs Medical Center; • Todd Peters, MD, CMO/CMIO, Sheppard Pratt; • Thomas Franklin, MD, President/ CEO, MindWork Group 10:30 a.m. – 11:00 a.m.

Break and Exhibit Visitation 11:00 a.m. – 12:00 p.m.

Long COVID and Neuropsychiatric Manifestations John E. Fanning, MD, Regional Chair of Medicine, UAB Huntsville 6:30 p.m. – 7:00 p.m.

Cocktail Reception 7:00 p.m. – 9:00 p.m.

Farewell Dinner Gala Celebration All times are CST.

Southern Psychiatric Association and Alabama Psychiatric Physicians Association present:

The Future of Psychiatric Practice: Exploring New Worlds October 11-14, 2023

Huntsville, Ala.

Conference Registration PLEASE PRINT CLEARLY (One form per registrant)

Name ______________________________________

Designation ____________________________________

Practice Name ____________________________

Contact Phone _________________________________

Address ____________________________________

City, State ZIP ___________________________________

E-mail ______________________________________

Dietary Needs __________________________________

 I agree to my name, practice name and business address being shared with conference exhibitors.

FOUR-DAY REGISTRATION

ONE DAY ONLY

SOCIAL EVENTS (Please check if attending)

 SPA/APPA Member $425  Thursday $185  Wednesday reception - No Fee  Nonmember $545  Friday $185  Thursday reception - No Fee  ECP $250  Saturday $185  Saturday Farewell Dinner - $95 (each attendee)  RFM No Fee  RFM No Fee ___ Total number attending reception  Non-physician Clinician $275  Thur  Fri  Sat  Guest $100 (includes receptions and entrance to education sessions - no CME) Guest Name (s)__________________________________________________________________________________________

ACCOMMODATIONS

The Westin Huntsville, 6800 Governors West, NW, Huntsville, AL 35806. The discounted room rate is $159 per night.

Reserve a room online at www.tinyurl.com/WestinPsychiatry2023. The room block expires Sept. 19, 2023

DETAILS

More conference information is online at www.alabamapsych.com/physicians. If you have special needs and/ or need assistance, please contact Janet Bryan at (410) 938-3452 or JBryan@sheppardpratt.org.

REGISTRATION Register online at www.tinyurl.com/Psychiatry2023Huntsville or mail form and payment to Southern Psychiatric Association, Attn. Janet Bryan, 6501 N. Charles St, Baltimore, MD 21204. Phone (410) 938-3452 • Fax (410) 938-3159

PAYMENT  Check payable to Southern Psychiatric Association Credit Card:  VISA  MasterCard  American Express Cardholder Name ______________________________ Email address for receipt: _____________________ Card Number __________________________________

Exp. Date ______________ Security Code ______

Billing Address _________________________________

City, State ZIP ________________________________

Signature ______________________________________ Amount: $ ____________________________________