Transactions THE NEWSLETTER OF THE PHILADELPHIA PSYCHIATRIC SOCIETY / FALL 2020
President’s Message / Ilia Nikhinson, MD As we enter Autumn, we look for a transition from challenges to calm, and a hope for a return to a new version of a normal we used to know. We have faced some challenges this year - COVID-19 pandemic, civil protests, legislative issues, and more, all while continuing to care for our patients. COVID-19 has affected more than how we treat our patients. It has caused the chapter to cancel several of our CME events—Colloquium of Scholars, the Women’s Brunch, and this year’s Benjamin Rush Gala all due to social distancing guidelines. While these events have been canceled this year, work has continued. I am pleased to announce that both the Colloquium of Scholars and Women’s Brunch will be held in the Spring (format to be decided), and our plan is to bring the Benjamin Rush Gala back in Fall 2021. More information on these events will be shared by email and on the website after the New Year. We are fortunate that our Addictions Symposium Committee, with the help of our staff, will host the 6th Annual Addictions Symposium. This will be a virtual event, and will be held on Saturday,
On the legislative front, we received unexpected news. We learned that the Minors Consent Act (Act 147 of 2004) was amended in late June of this year, and on July 23, Act 65 of 2020 became law. Deborah Ann Shoemaker, PaPS Lobbyist completed a comprehensive analysis of Act 65, which has been posted on the PaPS website. Please take time to review the analysis. It can be found here. If you have any questions after reviewing the analysis, please free to email Deb at: dshoemaker@pamedsoc.org. We also had a huge legislative success. With the help of over 3,000 letters from APA members, and strong lobbying efforts in Washington, DC by many APA staff members, we received word on September 21 that the proposal to establish a pilot program within the Veteran Administration allowing psychologists to prescribe had been removed from consideration by the House Veteran’s Affairs Committee (House VA Committee) for this congressional session. I am honored to follow in the footsteps of so many others and serve the chapter as President for this year. Thank you for your confidence in me and the PPS Council. Please feel free to reach out with any questions or concerns at philapsych@papsych.org.
October 31, from 7:30 am to 3:00 pm. The program will feature talks by Frank Leone, MD; Sosunmolu Shoyinka, MD; William Santoro, MD; Kyle Kampman, MD; and a panel discussion by Fred Baurer, MD, Lara Weinstein, MD, and Margaret Jarvis, MD. For more information and to register for the event, click here.
IN THIS
ISSUE
6TH Annual Addictions Symposium
Society Committee Interest Form
WHAT DO YOU THINK OF OUR NEW LOOK? COVID-19 and Anxiety Disorders
Meet Your 2020 Executive Committee
TRANSACTIONS
Join us for the 6th Annual Addictions Symposium on Saturday, October 31, 2020! Due to COVID-19 restrictions, the Addictions Symposium will be a virtual event. Although, unlike previous years, our event this year will be a one-track event, we have a full agenda filled with timely topics being presented by Philadelphia experts. We are excited to welcome back Frank Leone, MD, MS as our Keynote speaker. Dr. Leone directs Penn’s Comprehensive Smoking Treatment Program, a clinical program of the Penn Lung Center. He will be speaking on the topic Tobacco Addiction. Sosunmolu Shoyinka, MD, the Chief Medical Officer for the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) will be joining us to present a talk on Disparities in Addiction. In his role as Chief Medical Officer, he works to ensure policy and programs throughout DBHIDS are aligned with current evidence and best practices. William Santoro, MD, FSAM, DABAM is making a return appearance this year. Dr. Santoro is the Chief, Section of Substance Use Disorder in the Department of Psychiatry at Reading Hospital & Medical Center. He is also a member of the MDAIR Board (Methadone Death and Incident Review Board) since 2017. Dr. Santoro will be speaking on Opioid Use Disorder. The Treatment of Alcohol, Cocaine, and Methamphetamine Use Disorders will be presented by Kyle Kampman, MD. Dr. Kampman served as a medical officer in the United States Navy from 1985 to 1990. He is currently a professor at the University of Pennsylvania. Dr. Kampman has extensive experience in the treatment of alcohol, cocaine, and opiate dependence, and has chaired the committee that wrote the ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.
2
FALL/2020
Our day will conclude with a panel discussion on Practicing Addiction Medicine in the Pandemic. Our panelists are Fred Baurer, MD; Lara Weinstein, MD, MPH, DrPH; and Margaret Jarvis, MD. Dr. Baurer maintains a private practice in addiction psychiatry and psychotherapy, utilizing a recovery-oriented approach to psychotherapy. He co-teaches seminars and workshops in this approach for the Philadelphia Center for Psychoanalysis. Dr. Baurer currently serves as President of the Pennsylvania Society of Addiction Medicine (PSAM). Dr. Weinstein is a family medicine specialist in Philadelphia, PA. She currently practices in the Department of Family and Community Medicine at Jefferson Family Medicine Associates. Dr. Jarvis is the Medical Director at Marworth, a residential addiction treatment center for the Geisinger Health System, located in Waverly, PA. She is also a Clinical Assistant Professor of Psychiatry at the Penn State University College of Medicine in Hershey, PA. Join us virtually on Saturday, October 31, 2020 for another exciting and informative educational event! To learn more about our speakers and to register for the event, visit our website or our registration portal.
3
TRANSACTIONS
FALL/2020
Philadelphia Psychiatric Society Committee Interest Form One of the most valuable ways a member can contribute to the growth of the Chapter is to participate on a committee. We invite all members to become involved. If you have an area of expertise, an area of interest or just want to get involved, we want to hear from you.
Benjamin Rush Gala Awards
Reviews all submitted nominations for the annual Benjamin Rush Gala Awards and determines the awardees. This committee performs most of its work via email with occasional conference calls/Zoom.
Education
Develops and conducts the Chapter’s Colloquium of Scholars CME program annually. This committee performs most of its work via email with occasional conference calls/Zoom.
Hospital Psychiatry
Comments on issues related to inpatient psychiatry in the Philadelphia area, including interaction with CBH and CCBH. Most of this committees’ work is done via email with an occasional conference call/Zoom.
Membership
Develops and implements membership recruitment and retention programs. The committee performs most of its work via email with an occasional conference call/Zoom.
Nomination
Reviews all submitted nominations and letters of interest for open Council positions determines and presents a final slate of officers to Council. This committee performs most of its work via email with occasional conference calls/Zoom.
Women’s Interest Committee
Develops and conducts the Chapter’s Women’s Brunch CME program, and the Women’s Networking Social annually. This committee performs most of its work via email with occasional conference calls/Zoom. Please check off the committee(s) you are interested in and fax the completed form to: PPS Attention: Dawn Losiewicz at 855-918-3611; you can also send an email to Dawn with your selections: philapsych@papsych.org Name:
MD or DO:
(Please print)
Telephone Number: Email Address:
I am interested in participating in the following committee(s):
Benjamin Rush Gala Awards
Membership
Education
Nomination
Hospital Psychiatry
Women’s Interest Committee
FAX BACK completed form to: Dawn Losiewicz, PaPS at 855-918-3611.
TRANSACTIONS
4
FALL/2020
COVID-19 and its Implications for Anxiety Disorders Authors: Alice Liu*1;
Andrea N. Weir*2; Vishesh Agarwal*3.
Author Affiliations: 1 MS4, Sidney Kimmel Medical College, Philadelphia, PA; 2 MS4, Philadelphia College of Osteopathic Medicine, Philadelphia, PA; 3 Vice Chair, Psychiatry, ChristianaCare, Wilmingtron, DE. Author Contact: Vishesh Agarwal, MD; Vishesh. Agarwal@christianacare.org; Office: 302-320-2633; Fax; 302-320-4934
Introduction
COVID-19 (Coronavirus disease 2019) is reshaping our lives—from the start of virtual (or hybrid) learning across the nation, to how rituals like Halloween and the Super Bowl will be celebrated, to how long we might need to continue social distancing and to some extent social isolation. The economic and social setbacks from the pandemic are resulting in remarkable psychological distress as individuals and communities adjust to unfamiliar school and work schedules. This unprecedented global event will have significant downstream effects, potentially provoking a consecutive mental health epidemic. It is self-evident that factors such as isolation and loss of social supports may exacerbate mood disorders, but how may these changes impact anxiety disorders? Let’s take a closer look at the unique challenges that the pandemic presents to a specific subset of disorders on the anxiety spectrum: Post-traumatic stress disorder (PTSD), Agoraphobia, and Obsessive–compulsive disorder (OCD).
an astonishing 96.2% prevalence of PTSS. The development of these symptoms seems to be most highly linked to loneliness, COVID-19 related worries, and an overall decrease in distress tolerance. While data is still limited on the long-term effects of these findings, we can draw on history to map out the road ahead: about one quarter of survivors of the 2003 SARS epidemic met clinical diagnosis for PTSD by the 30 month mark. With the more widespread nature of the COVID-19 pandemic, as well as increased news coverage in the age of technology, we may expect to see significant increase in chronic PTSD prevalence after the pandemic subsides. While these traumatic events may lead to longlasting morbidity in some, such adversity also has the potential to create the response of resilience. If research on responses to natural disasters can provide insight, up to two-thirds of impacted individuals will portray resilience to such stressors.
PTSD
COVID-19 related stressors have the potential to contribute to the development of PTSD. As the outbreak rages on, many will personally suffer from or know others affected by the novel coronavirus, or even witness the loss of a loved one. Numerous early studies from around the globe have demonstrated that the initial COVID-19 outbreak led to an increase in Post-Traumatic Stress Symptoms (PTSS) in members of the general population. These include intrusive memories, nightmares, flashbacks, avoidance, and negative mood surrounding traumatic experiences related to the pandemic. A study on hospitalized patients who recovered from COVID-19 during China’s initial outbreak revealed
Continued on page 5
TRANSACTIONS
5
FALL/2020
COVID-19 and its Implications for Anxiety Disorders Continued from page 4
Agoraphobia
It is also yet to be determined whether acute social withdrawal due to COVID-19, which may superficially resemble agoraphobia, is likely to increase in prevalence, as well as the consequences of such increase to society and the long-term impact of chronic isolation on individuals. The evolution of technology has made the ability of individuals to work-from-home increasingly feasible. Additionally, services that allow for the online delivery of groceries and food with no-contact services can facilitate such reclusive behaviors. Even online video streaming services continue to offer cinematic releases to be viewable from home. It is likely in the coming months we will continue to see trends of isolation and solitude.
OCD
Another implication to consider is the effect of COVID-19 on OCD. We have already seen from small early studies that patients who already have OCD are experiencing increased symptoms of both obsessions and compulsions during the pandemic. But could the unique impact of COVID-19 on the daily lives of individuals with regards to these cleaning rituals and infection prevention trigger new onset OCD in certain individuals?
The strict guidelines laid out by national and international agencies on infection prevention may mimic some of the most publicly perceived symptoms of OCD, such as repeated handwashing/hand sanitizer use, avoidance of potential contaminants, wearing personal protection such as gloves and masks, and social isolation. Initial research suggests that some people may develop a COVID-19 related stress syndrome that can be characterized by behaviors that reflect the fear of infection, including the fear of unclean surfaces, xenophobia related to the fear of infected individuals, and intrusive thoughts concerning the virus. It has yet to be revealed whether these symptoms will resolve as the pandemic subsides, or whether this COVID-19 related adjustment disorder will evolve to become chronic diagnoses in some individuals. A special consideration is whether these new contamination-related obsessions and compulsions may be more prevalent in healthcare workers at the forefront of the pandemic. Particular characteristics of medical work during a pandemic may predispose individuals to developing these symptoms, including high level of exposure to COVID-19, concerns over work safety, and implementation of infection control measures such as handwashing, sanitizing, and using personal protective equipment.
Concluding Thoughts
Drawing from emerging research and past epidemics it is evident that COVID-19 will leave a lasting psychological toll, specifically on anxiety disorders. We speculate that the traumatic stress of quarantine, social shunning, and falling ill with a novel contagious disease may leave lasting symptoms of PTSD in some patients. Furthermore, mandated social distancing and emerging tools to allow for prolonged physical isolation can contribute or exacerbate agoraphobic tendencies. Lastly, widespread encouragement and specific guidelines for decontamination rituals for infection prevention may lead to exacerbation of symptoms in OCD patients and may precipitate OCD symptoms in previously healthy individuals. In conclusion, we anticipate that the COVID-19 pandemic will lead to a significant morbidity in disorders on the anxiety spectrum for many years to come.
VIRTUAL
6
TRANSACTIONS
PaPS 2020 V irtual EDUCATION
M E E T I N G
VIRTUAL
Join us for the 14th Annual Patient Safety & Risk Management Virtual Program The 14th Annual Patient Safety and Risk Management Program will be held via Zoom Webinar on Saturday, November 14 from 8:15 AM to 5 PM. Program Chair Dr. Rajnish Mago, and the state education committee, have put together yet another program that will provide relevant, up-to-date information that can be immediately used in your daily practice. This year’s focus is on how to adjust to our “new normal” during this time of uncertainty. Speakers and presentations include: Clinician Wellbeing, Burnout and Depression, will be presented by Richard F. Summers, MD, from Perelman School of Medicine, University of Pennsylvania.
Mental Health Consequences of the COVID-19 Pandemic. presented by Maria A. Oquendo, MD, PhD, from Perelman School of Medicine, University of Pennsylvania.
FALL/2020
Patient Safety & Risk Management
SATURDAY NOVEMBER 14
2020
An Update on Psychotropic Medicals and Pregnancy, will be provided by Marlene P. Freeman, MD. Dr. Freeman is from Massachusetts General Hospital and Harvard Medical School. Risk Management: Practicing Telepsychiatry in the Age of COVID-19, will be presented by Donna Vanderpool, MBA, JD, Director of Risk Management at PRMS. We hope you will join us virtually on Saturday, November 14! The full agenda and registration information can be found on our website. The APA designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credit TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. As determined by the program committee, 6.5 AMA PRA Category 1 Credits of this program may qualify for patient safety/risk management licensure requirements.
STAY CONNECTED with PaPS and follow us @PA_PsychSociety on Twitter!
BE HEARD!
TRANSACTIONS
7
FALL/2020
Meet your 2020–2021 Executive Committee Meet your 2020 - 2021 ExecutiveSociety Committee New officers of the Philadelphia Psychiatric (PPS) were formally installed at the Annual Business Meeting on June 22, 2020. New officers of the Philadelphia Psychiatric Society (PPS) were formally installed at the Annual Business Meeting on June 22, 2020. Ilia Nikhinson, MD serves as president. Dr. Nikhinson has been serving in the field of medicine for over 25 years. Upon graduating from Omsk Medical School in Russia in 1983, he began his career as a pediatrician. In 2002, he completed the residency training program in psychiatry at the Medical College of Pennsylvania/Hahnemann University in Philadelphia. Shortly thereafter, he began working at The Behavioral Wellness Center at Girard (formerly Girard Medical Center) as the Medical Director of Extended Acute Care Unit. He was later promoted to Chairman of the Department of Behavioral Medicine in 2010. Holly J. Valerio, MD serves as president-elect of PPS. Dr. Valerio is a Clinical Assistant Professor of Psychiatry in the Associated Faculty of the University of Pennsylvania Perelman School of Medicine and a board-certified psychiatrist in Pennsylvania. Dr. Valerio specializes in treatment of anxiety disorders including OCD, PTSD, social anxiety, panic disorder, specific phobias, and generalized anxiety. She also has expertise in treating a variety of other psychiatric illnesses including depressive disorders, bipolar disorders, and psychotic disorders. Wei Du, MD serves as vice president. Dr. Du is professor and academic chair of the Department of Psychiatry at Drexel University College of Medicine. He is the former director of the General Adult Psychiatry Residency program at Drexel University College of Medicine. He has won the Teacher of the Year Award in the department in 2007, 2009, 2010, 2011 and 2012. He provides lectures on psychopharmacology of depression and anxiety and serves on the graduate student thesis committee. Dr. Du is also involved in medical student education, providing lectures on schizophrenia, and neurobiology of depression and anxiety. Christopher W. Tjoa, MD serves as treasurer. Dr. Tjoa is the Interim Chief Medical Officer of Community Behavioral Health and maintains a small co-located psychiatry clinic within the Department of Gastroenterology at the University of Pennsylvania.
Ellen D. Conroy, DO serves as secretary. Dr. Conroy recently retired from The Corporal Michael J. Crescenz VA Medical Center where she was an addiction psychiatrist. She currently serves on the Women’s Interest Committee, which she previously co-chaired. Dr. Conroy also serves on the board of the Pennsylvania Society of Addiction Medicine, is a member of WAAM (Women Advancing Addiction Medicine) and Pennsylvania/Philadelphia Medical Societies. She is double boarded in family medicine and Psychiatry/Neurology and has a master’s degree in Nutrition. Additionally, she serves on the COVID Task Force for her church. She has been married to Tom for 42 years, has two children, two grandchildren and a dog.
TRANSACTIONS
9
FALL/2020
Nostalgia: Illness or Cure? / By Kenneth J. Weiss, MD, DLFAPA For hundreds of years before modern terminology, “nostalgia” was regarded as a disease. Separation from home causes distress among migrants, exiles, and soldiers. The term’s Greek origin is an amalgam of nostos, for returning home, and algos, for pain. Think of it as homesickness with a splash of black bile (melancholia). It was noted by Philadelphia’s Dr. Weir Mitchell during the Civil War, when nostalgia, the illness, was associated with malingering. The condition could be fatal, leading Dr. Mitchell to declare the cure as sending the soldier home (1). But when we talk about nostalgia today, it sounds like a good thing—a return “home” to familiar surroundings, people, landmarks, sensory experiences, and “the good ol’ days.” We indulge ourselves by bringing back our personal past, listening to oldies and wearing retro clothing. It is fun, right? Simply eating a cookie can bring back a flood of memories, as Proust observed in Swann’s Way. Whether temps perdu was better is debatable, but in hard times, selective recollections function as a security blanket. At the same time, one can feel nostalgia’s bite. Apparently, it does not take prolonged separation from familiarity to bring on yearning for a time before. If you are like me, you feel mixed emotions thinking about how things were as recently as 2019: you could touch and hug others, go to restaurants, cultural activities, and sporting events, and travel at will.
We do not want our patients to avoid personal growth by retreating into self-indulgent fantasy. Taken to the extreme, it would be a resistance to therapy at minimum and a failure to cope with reality at worst. If, however, dipping into nostalgia helps patients get through hard times, perhaps we should think twice before ripping off the bandage as a matter of principle. Indeed, the tide has turned away from pathologizing nostalgia and toward a normative/adaptive formulation. Evidence of it can be found in scientific and popular literature. In a pre-COVID article entitled, “Fighting the Future with the Past: Nostalgia Buffers Existential Threat,” psychologists concluded that a tendency toward nostalgia may be an adaptive defense against death awareness (2). In a recent article in Forbes entitled “Our Coronavirus Security Blanket: Nostalgia for Old Music, Movies and Much More,” culture writer Matt Klein observes the transition from nostalgia, the disease, to self-treatment (3). The new normal includes, among other things, craving for music from one’s past and even “genres which conjure sentimentality for a time many listeners have never in fact experienced themselves,” Klein learned. Protecting the sense of self amid real fear, imposed change, and great uncertainty has put our patients in a position never experienced within their lifetimes. Everyone must adapt, including healers. While pretending all is well would be a delusion, the better part of valor may be to accept the instrumental use of nostalgia as a culturally sanctioned defense while watching for pathological flights into bygone experiences. Now, where did I put those bell-bottom pants? Ah, right next to the Mallomars! 1. M itchell SW (1914) The medical department in the Civil War. JAMA 62:1445–1450. 2. J uhl J, Routledge C, Arndt J, Sedikides C, Wildschut T (2010) J Res Personality 44:309–314. 3. K lein M (2020) Forbes, April 29, 2020.
10
TRANSACTIONS
FALL/2020
IN MEMORIAM It is with great sadness that we announce the passing of Camille I. Paglia, JD, MD, FAPA. Dr. Paglia was an active member of the Philadelphia Psychiatric Society, having served as an Early Career Psychiatry Representative, Councilor, and all offices of the Executive Committee including President of the Society. For many years, Dr. Paglia worked at Temple University School of Medicine as an instructor in Clinical Psychiatry. And most recently, Dr. Paglia worked with the ACT team in Montgomery County for Horizon House. After spending over a decade as an attorney, Dr. Paglia turned to medicine, specifically psychiatry, after a beloved uncle was institutionalized. In 2015, Dr. Paglia established the Cornelius Randhare Lecture on Serious Mental Illness to memorialize her beloved uncle. The family has requested that donations be made in her memory to the fund. Donations can be made online or checks can be mailed to: Temple University Institutional Advancement PO Box 827651 Philadelphia, PA 19182-7651
Make check payable to Temple University Institutional Advancement In the memo section on the check write: for Cornelius Randhare Endowment Dr. Paglia is survived by her husband, Vernon Francis and sons Anthony and Nicholas. Her obituary can be viewed here
Words of Remembrance
Camille was special in so many ways: her ability to stay calm in highly stressful situations; her consistent and infectious positive attitude, no matter the setting; her dry sense of humor, always accentuated with a twinkle in her eye; and, above all, her passion for her work in our field. When we last spoke, a few days before her passing, she regaled me with her constant mantra: “I love my job! I love my team! I love my patients!” Lawrence (Larry) A. Real, MD Medical Director Horizon House Camille was a beloved member of the Department. She was generous, warm, and would always go the extra mile to help medical students, residents, and other faculty. William R. Dubin, MD Chair, Department of Psychiatry Lewis Katz School of Medicine at Temple University
Ilia Nikhinson, MD President
Rajnish Mago, MD, DFAPA Editor
Pietro Miazzo, MD Immediate Past President
Dawn Losiewicz Deputy Association Executive Administrative Office 777 East Park Drive PO Box 8820 Harrisburg, PA 17105-8820 Toll free: (888) 723-2501 Toll free fax: (855) 918-3611 Email: philapsych@papsych.org Website: www.papsych.org
Holly J. Valerio, MD President Elect Wei Du, MD Vice President Christopher W. Tjoa, MD Treasurer Ellen D. Conroy, DO Secretary
Transactions, the newsletter of the Philadelphia Psychiatric Society is published two times per year, with Spring and Fall issues. Editor: Rajnish Mago, MD, DFAPA Staff Editor: Dawn Losiewicz Articles published in the newsletter may be published in other APA district branch newsletters without permission. Attribution is requested and appreciated. All other rights reserved. transactions welcomes comments and opinions from the membership. Address correspondence to: Newsletter Editor, Philadelphia Psychiatric Society, P.O. Box 8820, Harrisburg, PA 17105-8820. Copyright ©2020. Philadelphia Psychiatric Society.
THANKS FOR READING!