BrainStorms 2021 Summer Edition

Summer 2021 The publication of the University of Miami Department of Psychiatry and Behavioral Sciences

In This Issue

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Center for Cognitive Neuroscience and Aging: The First 1,000 Days David Loewenstein, Ph.D. ABPP/CN, Professor of Psychiatry and Behavioral Sciences, Director, CNSA, reflects on the early years of the luminary program.

It’s All About the Children Fred Seligman, M.D., C.M., M.P.H., Voluntary Professor, shares his memories of UM from his time on faculty and discusses his current role mentoring residents and fellows.

Predicting Preterm Birth: Quick Questionnaire Screens for Risk Factors and Protective Features A study by Firdaus Dhabhar, Ph.D., Professor at Sylvester Comprehensive Cancer Center and Departments of Psychiatry and Behavioral Sciences and Microbiology and Immunology

Advice for Women Juggling Work and Caregiving Elizabeth Crocco, M.D., Medical Director of the UM Memory Disorders Clinic, offers advice for women caring for elderly people experiencing cognitive decline.

Clinical Trials Learn about research studies currently recruiting participants and how you can help advance science and medicine.

Published Research Our faculty has published more than 100 articles in scientific journals over the past year. Here are some highlights from 2021.

A Message from the Chair Dear Friends, We hope you're enjoying summer thus far! It’s been a year of ups and downs and although the pandemic isn't behind us just yet, I am encouraged by the diligence and caution exhibited by our healthcare professionals. Both here at UM and nationwide, we continue to see meaningful progress with the use and availability of vaccines and it is our hope this trend continues.

This summer, our Center for Cognitive Neuroscience and Aging (CNSA) is celebrating its third anniversary! When I arrived at UM in 2017, the CNSA was just coming into existence. It has been remarkable to watch them grow and thrive. I hope you enjoy reading about their tremendous accomplishments in a piece by, David Loewenstein, Ph.D., Director of the Center, in CNSA: The First 1,000 Days (p.2).

I’m delighted to include a piece in this issue about Fred Seligman, M.D., a dear friend and colleague. Formerly on the faculty in the UM Department of Psychiatry and Behavioral Sciences and Division Chief for Child and Adolescent Psychiatry, Fred now generously devotes his time to mentoring residents and fellows. Read more about his storied career and many contributions to the field of psychiatry throughout the years in It’s All About the Children (p.4).

In June, we held a lovely virtual ceremony for our Class of 2021

Psychiatry Residents and Fellows.

We are so proud of this talented group and wish them well in their professional journeys onward. I have no doubt they will each flourish in the next chapter of their careers.

Finally, we must acknowledge the recent events in our neighboring town of Surfside. An unimaginable tragedy, my heart goes out to everyone affected. We have been in contact with local officials, organizations, and other mental health professionals, and are here for those who may need counseling or help coping after such sudden, devastating loss. On behalf of the Department, please be sure that we are keeping the residents of Surfside in our thoughts.

Wishing you a happy, healthy, and restful summer,

Barbara 1 BRAINSTORMS | SUMMER 2021

Center for Cognitive Neuroscience and Aging: The First 1,000 Days

By David Loewenstein, Ph.D. ABPP/CN, Professor of Psychiatry and Behavioral Sciences, Director, CNSA

When we launched CNSA in the summer of 2018, we set forth a number of ambitious goals including: furthering innovative and state-ofthe-art research into brain disorders, aging, and cognitive neuroscience, being leaders in developing treatments and effective interventions for Alzheimer’s disease (AD) and related disorders, as well as expanding our role as a primary site for the 1Florida Alzheimer’s Disease Research Center of Excellence. A further goal was the development and implemention of methods to best reach the underrepresented minority groups affected by AD. I knew we had the best possible faculty and staff in place to work together to reach these goals; a group of some of the brightest minds in geriatric psychiatry, neuropsychology, neurocognitive disorders, aging, and AD. I am immensely proud to be able to say that one pandemic and 1,000 days later, we have indeed achieved many of our goals, and are continuing to make significant strides toward others. It is extraordinary what our Center has accomplished in this time, a tribute to our extremely cohesive and hardworking team.

Our mission was always to become a national and international leader in cognitive neuroscience by developing cutting-edge strategies and new paradigms for studying the aging brain and identifying biomarkers of early disease processes. With a first-class, state-funded Memory Disorders Clinic directed by Elizabeth Crocco, M.D., several large federal R01 grants resulting from collaborative efforts between myself Rosie Curiel Cid, Psy.D., and a stateof-the-art functional skills assessment and cognitive training program developed by renowned psychologist Philip Harvey, Ph.D., we are well on our way to fulfilling our mission.

Perhaps our crowning achievement, in 2020 we were awarded a five-year, $15 million grant to collaborate with other universities in Florida on Alzheimer’s disease research. The 1Florida Alzheimer’s Disease Research Center (ADRC) brings together top Florida researchers to

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focus on better understanding how to diagnose, treat, prevent, and potentially cure Alzheimer’s in diverse populations. One of 31 Centers of Excellence designated by the National Institute on Aging, the 1Florida ADRC is the only one funded in the state of Florida.

With momentum from these successes, we recruited a phenomenal new faculty member, Marcela Kitaigorodsky, Psy.D., and an excellent biostatistician, Diane Zheng, Ph.D. Dr. Kitaigorodsky has led efforts to develop novel telehealth platforms to assess older adult participants in our many National Institutes of Health (NIH) studies and Florida Department of Health (FLDOH) projects and has published in this area.

These platforms have allowed us to improve access and convenience for patients and will enhance our patients’ experience well beyond the pandemic.

In the last three years, we have established a robust post-doctoral fellowship program in neuropsychology and cognitive neurosciences, training three fellows per year and eight doctoral level graduate students annually. Importantly, we have established robust programs in amyloid and tau PET imaging— of which we are the only university in the state funded

by NIH to conduct—advanced tau imaging, are working on large proposals to expand our work with newest generation blood-based biomarkers and have continued to develop and refine Cognitive Stress Tests (CSTs) and semantic interference paradigms for the earliest detection of Alzheimer’s disease and related disorders (ADRD). Our current CST, the LASSI-L, has been translated into several languages and is used nationally and internationally in clinical and research studies.

Our successes are the result of a team effort, thanks to the wonderful Department of Psychiatry and Behavioral Sciences and our many university partners on the Medical and Coral Gables campus. We have over 20 affiliated faculty across the university working with the CNSA. They have supported our mission to become a leader in cognitive neuroscience and enhanced our understanding of normal aging and neurodegenerative diseases in the brain.

With regards to recent news: l Dr. Rosie Curiel Cid, Chief of Cross-Cultural Neuropsychology and 1Florida ADRC Outreach, Retention, and as Engagement Core Leader for the entire 1Florida ADRC has made great strides in outreach of underrepresented diverse ethnic and cultural groups in aging and Alzheimer’s research. She is, to our knowledge, the youngest Hispanic female at UM to have received an R01 grant.

l Dr. Elizabeth Crocco, Chief of Geriatric Psychiatry and Medical Director of the UM Memory Disorders Clinic— the only state-funded clinic at UM—continues to expand research into Alzheimer’s disease and neurocognitive/ neuropsychiatric conditions and recently received a $250,000 Florida Department of Health research grant to develop an advanced registry of African American older adults at risk for Alzheimer's disease.. l Dr. Marcela Kitaigorodsky, Assistant Professor and Director of Cognitive Research Operations, has developed a virtual neuropsychological battery for use in our studies and ensures our post-doctoral fellows and residents receive exceptional training.

Wonderful clinicians and educators such as Dr. Dolores Perdomo, Assistant Professor of Psychiatry and Behavioral Sciences and our research managers, coordinators, recruiters, research assistants, students and biostatistician all contribute to the synergy and productivity of the CNSA and its mission to serve our increasingly older and culturally diverse adult population. These outstanding individuals, our extraordinary faculty, and our committed staff make it possible for us to provide innovative programs for care providers. Together, we’re building an environment ripe for training of the next generation of leaders in the field.

As I look toward the future, I am honored to serve as the director of our rapidly growing Center, and ineffably proud of all we’ve achieved in our first 1,000 days. Our team is passionate about the continued pursuit of novel opportunities to transform the landscape of cognitive neuroscience and aging – and the breakthroughs yet to be discovered by our future clinician-scientists.

Dr. Rosie Curiel Cid, Dr. David Loewenstein, Dr. Liz Crocco 3 BRAINSTORMS | SUMMER 2021

It’s All About the Children Fred Seligman, M.D., C.M., M.P.H., has long observed human interactions.

The interactions that interest him most are those between children and parents and their effects on our youth. His desire to help children drew him to medicine—first to pediatrics, then to child and adolescent psychiatry.

“The world of children was where I wanted to be,” Dr. Seligman said.

After more than 52 years at the University of Miami Miller School of Medicine and mentoring nearly 100 child and adolescent psychiatry trainees to date, Dr. Seligman remains committed to helping the next generation of physicians understand what he has witnessed and learned about children. “My goal has been for them to understand the uniqueness of children, the wonderment of growth and development, the importance of preventive and public health approaches, the importance of relationships to pediatrics, and especially the techniques and usefulness of psychotherapy to normalize the lifelong parent-child (child-parent) relationship from birth to death,” he said.

Navigating the world of children’s health care Dr. Seligman started his academic career in medical school at McGill University in Montreal, Canada. He pursued a career in pediatrics, undergoing pediatric residency training at Montreal Children's Hospital, and then the University of Washington School of Medicine, Seattle, from 1964 to 1967.

Even then, he wanted to know more about children’s development and the mother-child bond. While in training in 1966, Dr. Seligman received a master’s degree in public health in maternal and child health from the University of California, Berkeley. He completed a fellowship in childhood development with a focus on intellectual disabilities at the University of Washington in 1968.

With a desire to go into academics and having already earned praise for his work in health care delivery, Dr. Seligman accepted a faculty appointment in the Department of Pediatrics at the University of Miami Miller School of Medicine in 1968 to join a brand-new health care delivery program for mothers and children (CHCP).

The Miller School of Medicine was not the renowned medical school in the late 1960s that it is today, according to Dr. Seligman. But he believed UM would give him opportunities to pursue his interests in promoting comprehensive and accessible children’s health care. “I felt that a non-established place still had a lot of things to do. There was room for change and room for growth,” he said.

Dr. Seligman went on to establish the Division of Comprehensive Health Care in 1969 at the Miller School. It

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was one of the first divisions of comprehensive health care at a U.S. medical school at the time, providing multidisciplinary health care to low-income children within a 10-mile radius of the University and Jackson Memorial Hospital. Dr. Seligman coordinated a team of clinicians, including experts in mental health, pediatrics, dentistry, nutrition, speech, hearing and others including some as unique as anthropology. The division also had components in research and teaching.

“That was years before these aspects of care were considered standards of care,” he said.

Dr. Seligman anticipated issues in medicine decades before they became mainstream thinking. Yet another example: While in medical school at McGill, Dr. Seligman noted a gap in human sexuality training. It was not just at McGill, but throughout North America, that medical schools provided no education and training about how to speak with patients about sexual orientation or problems in sexuality. So in 1970, he co-founded the University of Miami of Medicine Human Sexuality Program, a week-long course in human sexuality in the medical school curriculum. It was the second such course at a U.S. medical school in the country.

The bridge from pediatrics to child psychiatry Dr. Seligman’s interest in child and adolescent psychiatry and its role in the delivery of comprehensive children’s health care in the CHCP program surprised even the Chair of UM’s Psychiatry Department at the time.

“Dr. James Sussex, chairman of the Psychiatry Department, was surprised that we would be so intensely interested in psychiatry’s support,” Dr. Seligman said.

“After that we became friends.”

Dr. Sussex offered Dr. Seligman an appointment in the Department, leading to his dual appointment at UM in Psychiatry and Pediatrics. Dr. Sussex also suggested Dr. Seligman become a child psychiatrist.

“I decided that was not a bad idea,” Dr. Seligman said.

Dr. Seligman went on to complete his residency in Psychiatry in 1977 and fellowship in Child and Adolescent Psychiatry in 1978 at UM.

Mentoring, the noun Dr. Seligman says that mentoring stands out as one of his biggest professional pleasures in child and adolescent psychiatry. It is not simply that he has mentored trainees in the Department, but rather how he has mentored them.

One could think of mentoring as a noun or a verb. The verb is to advise or train another. A teacher is likely that kind of a mentor, according to Dr. Seligman.

“But that is not quite what I see as a mentoring process.

I see mentoring more as a noun. A mentor is a long-term trusted advisor. It is not only teaching somebody facts, but it is helping somebody with things like providing them guidance and role modeling,” he said.

Psychiatry provides Dr. Seligman the ideal platform to deliver his mentoring style. The model in psychiatry, he said, is to give trainees one or two supervisors who they meet with weekly.

“No other specialty that I know of has this kind of dedicated hour that is given by a more senior physician,” he said. “We have an opportunity to dialogue. It is from this that I grew into the broader idea of a mentorship.”

He describes his approach as an interaction between a couple of people. “To me it is much more of a personal relationship of guiding somebody, not only in the technique of being a psychiatrist, but also looking at your role, what you want to do, who you are and how you practice,” he said.

Dr. Seligman tells his mentees that they can talk with him about anything.

“I think in most of their experiences it is much more didactic, teacher to student approach,” he said.

In the end, Dr. Seligman strikes an interaction between he and his mentee much like what he envisions the doctor-patient relationship should be.

document for the field of child and adolescent psychiatry,” according to Dr. Seligman.

Unfinished business and growth in the specialty Dr. Seligman said he feels strongly that the practice of child psychiatry should be where children are, which is in schools.

“That is not the case,” he said.

When he directed the Division of Child and Adolescent Psychiatry, he incorporated on-site training rotations for child and adolescent psychiatry fellows in elementary schools and special needs schools. But that did not result in the change for which Dr. Seligman hoped. Schoolcentered psychiatric and pediatric training and care is still not considered a standard, he said.

Child psychiatry has, however, evolved in an important and positive way in recent years, he said.

While the subspecialty used to be isolated from psychiatry, today mental health and mental illness are considered on a continuum. And child psychiatry is considered integral to the continuum of care for mental health and illness.

“Even with diseases like manic depression, schizophrenia, you can pick up early signs of it in children,” Dr. Seligman said. “These diseases start in children. What we have also learned is the adverse role of bad environments and trauma to children. Adverse environments can change a child’s genetic makeup. Children experiencing trauma tend not to live as long. Now we know that mental health is a life-long affair.”

continued on page 7

Maintaining the connection with patients Psychiatry used to be more Freudian; more psychodynamic, according to Dr. Seligman.

“It was more psychotherapy or a verbal exchange between a patient and a doctor,” he said.

Now there are time constraints, an expectation of the use of medication by both patients and other professionals so that the exchange between the child and adolescent psychiatrist and patient has become extremely focused, not always in a good way.

“I try to encourage mentees to expand their roles to get to know people--to find out how things are going not only in reference to their illness. I try to get them to consider a very important dimension, which most doctors never consider.

How are things at home?” Dr. Seligman said.

Dr. Seligman also has focused on maintaining connections with colleagues, often through the lens of a camera. He has been the official photographer of the American Academy of Child and Adolescent Psychiatry for about the last 13 years, covering annual AACAP meetings and memorializing attendees’ faces. His photos are available at www.fredseligman.com.

“My hope is that others will add the names of the people to the photos that the Academy has in its library, so that, going forward, these photos will be an important historical

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Predicting Preterm Birth: Quick Questionnaire Screens for Risk Factors and Protective Features Screening women before pregnancy or shortly after conception for factors that place them at increased risk for preterm or premature birth may help avoid adverse outcomes months and even years later. Anxiety, pain, fatigue, and poor self-rated health, for example, can increase the risk of a woman delivering a baby before gestational age 37 weeks, or preterm, a new study published May 20 in the American Journal of Perinatology reveals.

The study also found that protective factors such as happiness and social support predict lower risk. Preterm birth can have significant and long-lasting adverse developmental, health, and financial consequences.

“Identifying factors and potential mediators that predict, contribute to, or prevent preterm birth—and using this information to reduce risk—would be highly beneficial,” said senior author Firdaus S. Dhabhar, Ph.D., professor at Sylvester Comprehensive Cancer Center and in the Departments of Psychiatry and Behavioral Sciences, and Microbiology and Immunology at the University of Miami Miller School of Medicine.

The prospective cohort study builds on previous research showing that pregnancy-related anxiety, perceived stress, depression, and low support from a baby’s father can increase preterm birth risk.

Novel findings include firsts The researchers also take things a step further with several novel findings.

“To our knowledge, our study is the first to also show that greater tiredness or fatigue, high frequency of pain experience, low self-rated health, low happiness, and low social support from parents and siblings are associated with increased risk of preterm birth,” Dr. Dhabhar said.

Importantly, the study used a practical rapid questionnaire, the DQAQ, developed by Dr. Dhabhar, that quantifies stress and psychosocial factors.

“The DQAQ could be a useful alternative for studies and investigators who do not have the time and resources

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to use traditional methods to quantify these factors, and/or don’t want to burden study participants with numerous questionnaires,” Dr. Dhabhar said.

The DQAQ is new, requires further validation and has the potential to streamline the study of stress and psychosocial factors in research and clinical conditions other than preterm birth.

Measuring relative risks Along with co-first authors Martin Becker, Ph.D., and Jonathan Mayo, Ph.D., at the Stanford University School of Medicine, Dr. Dhabhar and a team of colleagues assessed the relative risk of preterm birth for each risk or protective factor, and supported their results using machine learning approaches.

They found, for example, that generalized anxiety increased the risk of preterm birth almost nine times, pain by nearly six-fold, and tiredness or fatigue by almost four times. A perceived risk of birth complications raised the risk by four-fold, and divorce increased risk by three times.

How women rated their past and current health also played a role. For example, women with a poor self-rating of their health over the previous three years had an almost three times greater risk. A poor current health rating was associated with two and a half times greater risk.

Timely research “Stress and anxiety associated with the pandemic makes this research particularly timely, because the impacts of the pandemic have not only been physical morbidities and mortality, but also social and psychological stressors, such as personal isolation, loss of a loved one, loss of a job, etc. Such stressors may contribute to preterm birth and other pathological outcomes in pregnancy, as well as affect the outcomes of newborn infants, including their life course trajectories,” said co-author David K. Stevenson, M.D., Harold K. Faber Professor of Pediatrics, senior associate dean for maternal and child health, and co-director of the Maternal and Child Health Research Institute at the Stanford University School of Medicine.

The study also found that women who reported low happiness had a nine times greater relative risk of preterm birth, low levels of support from parents or siblings increased the risk by three and a half times, and low support from the baby’s father increased risk three-fold.

“The protective effect of factors such as happiness and social support is an exciting aspect of these findings, one that also gives hope,” Dr. Dhabhar said.

“The results suggest that positive and nurturing aspects of humanity may be able to counter the harmful effects chronic stress, anxiety, and other negative factors.

We’d like to expand our investigation of positive and protective factors in future studies. Our ultimate goal is to ameliorate or eliminate the effects of harmful factors and harness the effects of beneficial factors on health and healing.”

The study, “Deleterious and Protective Psychosocial and Chronic Stress Related Factors Predict Risk of Spontaneous Preterm Birth,” was supported by the March of Dimes Prematurity Research Center at Stanford University. Nisha K. Phogat, M.S., a research associate at the Miller School, is among the study’s authors.

continued from page 5 Enjoying life and grown children Dr. Seligman’s four grown children are thriving, and he is embracing his current role as voluntary professor at the Miller School, in which he continues to mentor child and adolescent psychiatry trainees. Personally, he is enjoying family and life. He spends extended summers at his lakeside home in Maine.

“My daughter, who is an internist, hopefully has learned some role modeling from me,” he said.

A recent story about an encounter between his daughter Susan (M.D., UM ’00) and one of her patients suggests his guidance has impacted the doctor she is today.

Much of Dr. Seligman’s training was in working with intellectually disabled patients. Susan has gained a reputation as being sympathetic and knowledgable about caring for adults with developmental issues and has many patients from local group homes.

One day, while examining a 21-year-old intellectually disabled patient, she felt something concerning on his neck and ordered an x-ray to be taken right away in a nearby office in the same building. But when she looked out of her office window, Susan saw the young man get into a car without going for his x-ray.

“She ran out of the building, went up to the car and said, ‘Listen, I want you to go right now for that x-ray because I’m worried that you might have something that will affect

your life,’” Dr. Seligman said. “The patient went and got the x-ray, which revealed a thyroid tumor. It was treated and he is fine. I was very proud of her. Sometimes, caring for somebody doesn’t end when they leave your office.”

Present and Future “Dr. Seligman has continued to generously give time and support to our Department in so many ways. One of the most important contributions to the Department has been his generous, ongoing support, along with his wife Cathy, of our Grand Rounds series. He has continued to supervise and mentor our child and adolescent psychiatry fellows,” said Barbara J. Coffey, M.D., M.S., Professor and Chair of the Department of Psychiatry and Behavioral Sciences at the Miller School.

Dr. Coffey remembers Dr. Seligman providing her with guidance, orientation, and support when she first joined the faculty in 2017.

“Dr. Seligman is a Department treasure, and we are very grateful for his steadfast engagement and support,” Dr. Coffey said. “Dr. Seligman started at ‘a non-established place that still had a lot of things to do,’” where ‘there was room for change and room for growth,’ and has been instrumental in nurturing our Department’s growth and development on our journey to regional and national recognition. Now, that is mentoring!”

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Advice for Women Juggling Work and Caregiving

If anyone understands the challenges of caring for the elderly, it’s Elizabeth A. Crocco, M.D., medical director of the University of Miami Health System Memory Disorders Clinic. She sees the toll that aging and illness takes on patients and caregivers. And as Chief of the Division of Geriatric Psychiatry at the Miller School of Medicine, she knows that cognitive decline makes taking care of an older person even harder.

Most of this burden falls on women. The Alzheimer’s Foundation’s 2021 Alzheimer’s disease Facts and Figures Report says that approximately two-thirds of dementia caregivers are women. According to the 2015-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys, 63% of people caring for someone with dementia for more than five years were also women.

“The data shows it’s mostly middle-aged women caring for their kids and elderly parents while working full-time.

There is significant data showing that caregivers are stressed out. Add a pandemic to that, and you get exponential levels of stress.” The report confirms her point. It stated that female caregivers might experience slightly higher burden levels, impaired mood, depression, and impaired health than male caregivers. It’s thought these differences arise because female caregivers spend more time caregiving, assume more caregiving tasks, and care for someone with more cognitive, functional, or behavioral problems.

These issues hit close to home for Dr. Crocco. When it was time for her mother to stop driving, “She told all of her friends I was the one who took away her driving, but my family had to be objective. Caregivers must evaluate what’s dangerous and what’s not when looking at a parent’s situation.” Those decisions are more complex when stress and exhaustion take hold. However, Dr. Crocco believes that anyone managing or providing care must value their well-being.

The importance of me time “It sounds like a pat answer, but carving out time for self-care is essential. Women need to take time for quiet and relaxation – maybe a half-hour in the morning or a walk with a friend in the evening,” Dr. Crocco says. Need a more extended respite to refill your reserves of patience and compassion? Ask a family member to stay with your

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elderly relative for a few days while you take a vacation.

How do you practice self-care when you’re pulled in multiple directions by work, home, and family?

Delegate. “You must ask for help. You have to be able to say, ‘I’m burned out. I need help.’” Think about where you can find help inside and outside your family. It’s essential, Dr. Crocco says, to recognize that some family members are better at certain tasks than others. “Not everyone has the availability or proximity to help with daily care. They can do other things, from handling paperwork, bills, and taxes to scheduling doctor’s appointments and ordering grocery deliveries.”

Ask your neighbor Thinking outside the family box, ask your relative’s doctor for resources or consult a physician, like Dr. Crocco. Other possibilities include your church, synagogue, mosque, neighbors, friends, or community organizations such as the Alliance for Aging, Meals on Wheels, assisted living, or adult daycare facilities. The Memory Disorders Clinic refers families to resources if their relatives are patients. “We also refer caregivers to therapists who understand dementia and Alzheimer’s disease,” Dr. Crocco says. A therapist who understands cognitive decline can discuss your challenges and help you develop solutions.

Depending on your workplace, you might be eligible for unpaid leave from your job to handle caregiving responsibilities under the federal Family and Medical Leave Act. If that’s not an option, ask your supervisor if you can work remotely when necessary.

You might also use an app, such as Lotsa Helping Hands, to manage responsibilities and delegate tasks to family or friends or CareZone to keep track of health information and medications.

Practicing tough love Dr. Crocco understands elderly patients who want to age in place, but she says it’s not always practical.

“People should remain independent in their own homes as long as possible. But it’s often challenging for a physically or cognitively elderly parent to understand that it takes an army of people to achieve that. And it places a tremendous burden on their adult children and families.”

She hopes most people will make arrangements while their judgment is still good. “I tell my two sons, ‘When I become infirm, put me in an assisted living facility and visit me once a week.’” Every adult should have their affairs in order.

It’s especially important for older adults to have a trust or will, a healthcare surrogate, power of attorney, a co-signer on bank accounts, and similar forms.

Unfortunately, not everyone plans ahead. Older, cognitivelyimpaired individuals may have faulty judgment.

As with Dr. Crocco’s mother, they may balk at significant lifestyle changes. Many fall victim to scams or may refuse to accept the help they need to maintain health.

“You have to make it clear this is a burden on you and may not be realistically feasible. When the parent’s

judgment becomes impaired, the most authoritative member of the family needs to say to them, ‘We need to do this,’ and provide the necessary resources, such as adequate transportation, that are comfortable for both.”

A return to routine The pandemic made a tough job more challenging, as work, school, and eldercare duties overlapped.

With vaccines comes greater freedom and a gradual return to more normalcy. Resources such as adult daycare facilities are reopening, which provides a much-needed respite, especially for caregivers who work from home. “Having a schedule is important. You have to stick to a routine and make time for yourself,” Dr. Crocco says.

It’s not always convenient for caregivers to practice self-care, but by doing so, they bring a better version of themselves to the task. Stepping away, even for a half-hour, might be just what you need to see beyond the burdens to the blessings.

For more information about the Memory Disorders Clinic, call 305.355.9065 or 305.355.7609. To make an appointment, call 305.355.9028, option 1.

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Clinical Trials Clinical trials are the backbone of evidence-based medicine. Broadly speaking, clinical trials evaluate the safety and effectiveness of a medical strategy, treatment, or device.

Moreover, clinical trials provide an opportunity for the general public to participate in the process of developing novel treatments for a variety of conditions.

The results from these clinical trials provide the data necessary to assist in future medical decision-making.

The Department of Psychiatry & Behavioral Sciences is dedicated to generating the scientific knowledge behind the clinical best practices we incorporate in the treatment of difficult and complex

mental health conditions.

The Behavioral Research Assessment Center (BRAC ) is the research hub that fulfills the Department’s mission to develop the next line of treatments.

For more information on participating in available clinical trials, please email brac@miami.edu or call 305.243.5840.

Featured Research Study Health Gatherings— For your health after prostate cancer (Encuentros de Salud) This study evaluates different methods and strategiesto improve quality of life and reduce the symptoms associated with prostate cancer in Hispanic men.

By participating in this study, you will help us better understand the effects of stress in quality of life and health habits in Hispanic males with prostate cancer.

and coping techniques) on quality of life, anxiety, depression, and physical health in Spanishspeaking, Hispanic/Latino men diagnosed with prostate cancer.

To participate you must: l l l l

l l

The program will study emotions, stress, and stress management techniques (such as relaxation

Be 18 years or older Identify as Hispanic/Latino Speak Spanish Be available to participate for 1 year Have a diagnosis of prostate cancer Have received treatment (surgery or radiation therapy) for prostate cancer in the last 8 years

Tics & Tourette’s Syndrome -

Study #: 20180013

Effective Date: 3/13/2019

Frank J. Penedo, Ph.D.

is the Principal Investigator on this study. Professor of Psychology, Dr. Penedo is an expert in cancer survivorship and psychosocial oncology.

He is the associate director for Cancer Survivorship and Translational Behavioral Sciences at UM and the Sylvester Comprehensive Cancer Center.

His work evaluates the role of sociocultural, bio behavioral, and psychosocial mechanisms underlying disease activity and health outcomes, and the efficacy of evidence-based psychosocial interventions in promoting optimal chronic disease management and health outcomes in cancer.

For more information, please call us at 305.243.2100 or email encuentros@miami.edu

Schizophrenia & Bipolar Disorder -

Study #: 20190826

Dr. Barbara Coffey's Tics, OCD, & Related Disorders Clinic at UHealth 305-243-6489 mxc1668@miami.edu

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You may be compensated up to $300 for your time and effort.

Effective Date: 5/21/2020

Cognition & Memory African American Registry

Alzheimer’s Disease Research Center

Help Us Build an Advanced Memory Registry for Older African American Adults At-Risk for Alzheimer's Disease

Help Us Learn More About Memory Changes in Aging

FL Department of Health Researchers throughout the state are working together to study the aging brain and learn more about how to detect and treat brain changes that affect memory during aging. Your participation can help create better tests and treatments.

1Florida ADRC Researchers throughout the state are working together to study the aging brain and learn more about how to detect and treat brain changes that affect memory during aging. Your participation can help create better tests and treatments.

STUDY FACTS

Participation is free Compensation for time Annual Visits No Medication Involved Medical Referrals (if needed)

WHAT’S INVOLVED?

WHO CAN JOIN?

4-5-hour visit Memory Test Brain Imaging Blood Sample Medical History Review

65+ years of age Must have study partner (relative or friend) Fluent in English or Spanish

STUDY FACTS

WHAT’S INVOLVED?

WHO CAN JOIN?

Participation is free Compensation for time Annual Visits No Medication Involved Medical Referrals (if needed)

4-5 hour visit Memory Test Brain Imaging Blood Sample Medical History Review

65-90 years of age Must have study partner (relative or friend) Fluent in English or Spanish

Miami Location Aja M. Scott, M.S. | Senior Coordinator | 305.355.9076 | ascott2@miami.edu UM/Jackson Location | 1695 N.W. 9th Avenue | Suite 3202 | Miami, Florida 33136 | www.1floridaadrc.org

Miami Beach Location

Aja M. Scott, M.S. |Senior Coordinator|305.355.9076 | ascott2@miami.edu UM/Jackson Behavioral Health Hospital | Center for Cognitive Neuroscience and Aging 1695 N.W. 9th Avenue, Suite 3202, Miami, Florida 33136 http://cnsa.med.miami.edu/

Raquel Behar, M.S Ed. | ADRC Study Coordinator | 305.674.2101 | Raquel.behar@msmc.com Mt. Sinai Medical Center Location | Wein Center for Alzheimer’s Disease and Memory Disorders 4302 Alton Road | Suite 650 | Miami, Beach, Florida 33144

Health UNIVERSITY OF MIAMI HEALTH SYSTEM

Gainesville Location Amber Miller, M.P.H. | Clinical Research Coordinator | 352.294.8753 | amber.miller@neurology.ufl.edu UF Health Location | Norman Fixel Institute for Neurological Disease | 3009 SW Williston Rd. | Gainesville, Florida 32608

“Drs. Rosie Curiel and David Loewenstein are co-inventors of intellectual property used in the study.”

“This research is not sponsored or endorsed by the U.S. Department of Veterans Affairs administration. “ This research is not sponsored or endorsed by the U.S. Department of Veterans Affairs administration.

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Study #: 20181171

Effective Date: 4/28/2020

Are you 60 or Older?

Be part of research to improve ways to detect changes in memory and thinking

Find out more about these and other studies on UMiamiHealthResearch.org.

Get connected in 4 simple steps:

Join our CST Research Study!

The CST (Cognitive Stress Test) Study is recruiting adults 60-years and older to study the normal aging brain and those with early signs of memory loss.

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We are looking for English and Spanish speakers with:  normal memory  some changes in memory or thinking  no diagnosis of dementia Participants will be compensated for their time.

If you are interested in learning more, please contact our Study Coordinator: Giselle Sesteaga, IMG Phone: 305-355-9081 Email: gas159@med.miami.edu University of Miami, Miller School of Medicine, Center for Cognitive Neuroscience and Aging Study Title: Novel Computerized Cognitive Stress Test Funded by: National Institute on Aging Grant #: R01 AG061106-01 Disclaimer: This research study is being conducted by the Center for Cognitive Neuroscience and Aging of the University of Miami and is not sponsored or endorsed by the Bruce W. Carter VA Medical Center.

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if there is a match

UMiamiHealthResearch.org

N Suchitra Joshi, M.D.

Assistant Professor

FACES Center for Translational Sleep and Circadian Sciences

The UM Department of Psychiatry and Behavioral Sciences extends a warm welcome to new members of the team:

Judite Blanc, Ph.D.

Research Assistant Professor

Crystal Vidal, M.B.A. Director, Research Laboratory

Girard Jean-Louis, Ph.D.

Arlener Turner, Ph.D.

Nakayla Griffin

Professor

Assistant Professor Coordinator

Clinical Research Coordinator

Giselle Sesteaga

Project Manager, Research Support CNSA

11 B R A I N S T O R M S | S U M M E R 2 0 2 1

Published Research | 2021

Shivanshu Shrivastava, M.D., Raul Poulsen, M.D., Nicole Mavrides, M.D., Barbara J. Coffey, M.D.,M.S.

“Catatonia in a 12-Year-Old Child.”Journal of Child and Adolescent Psychopharmacology.

Deborah Jones Weiss, Ph.D., Stephen Weiss, Ph.D.

“Examining potential contributors to disengagement from HIV care among transgender and cisgender individuals in Argentina.”

International Journal of Behavioral Medicine.

Barbara J. Coffey, M.D.,M.S.

“Ticked Off: Anger Outbursts and Aggressive Symptoms in Tourette Disorder.” Child and Adolescent Psychiatric Clinics of North America.

Elizabeth Crocco, M.D., Luminita Luca, Ph.D.

“Low dose lithium treatment of behavioral complications in Alzheimer’s disease: Lit-AD randomized clinical trial,” The American Journal of Geriatric Psychiatry.

“Effects of Vortioxetine Versus Placebo on Cognition and Functional Capacity in Adults with Post-Traumatic Stress Disorder,” Journal of Clinical Psychopharmacology.

Sari Izenwasser, Ph.D.

“N-Substituted-3-alkoxy-derivatives of dextromethorphan are functional NMDA receptor antagonists in vivo: Evidence from an NMDA-induced seizure model in rats.” Pharmacology, Biochemistry and Behavior Vol. 203.

“Adolescent drug addiction.” Pharmacology, Biochemistry and Behavior Vol. 203.

Dante Durand, M.D., Phil Harvey, Ph.D.

“Self-reported social functioning and social cognition in schizophrenia and bipolar disorder: Using ecological momentary assessment to identify the origin of bias.” Schizophrenia Research.

Rosie Curiel Cid, Psy.D., Elizabeth Crocco, M.D., Marcela Kitaigorodsky, Psy.D., David Loewenstein, Ph.D.

“A novel computerized cognitive stress test to detect Mild Cognitive Impairment.”

Journal of Prevention of AD. “The Relationship of Semantic Intrusions to Different Etiological Subtypes of MCI and Cognitively Healthy Older Adults.” Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring Journal.

Firdhaus Dhabhar, Ph.D.

“Deleterious and Protective Psychosocial and Chronic Stress Related Factors Predict Risk of Spontaneous Preterm Birth.” American Journal of Perinatology.

Rene Hernandez-Cardenache, Psy.D.

“Viral vector-mediated gene therapy for opioid use disorders.” Experimental Neurology.

“Cognitive and Neuroimaging Correlates of the Insomnia Severity Index in Obstructive Sleep Apnea: A Pilot Study.” Journal of Applied Sciences.

Deborah Jones Weiss, Ph.D.

“Properties of the Vaccine Hesitancy Scale Adapted for COVID-19 Vaccination among People with HIV.” AIDS & Behavior.

“The impact of gender identity stigma and mental health on HIV treatment in transgender women in Argentina.” Annals of LGBT Public and Population Health.

“Examining Factors Associated with Gender Identity Among Individuals Disengaged from HIV Care in Argentina.”

International Journal of Behavioral Medicine.

12 B R A I N S T O R M S | S U M M E R 2 0 2 1

“Poor sleep is associated with small hippocampal subfields in cognitively normal elderly individuals.”

Journal of Sleep Research.

Andrew Wawrzyniak, Ph.D.

American Cohort To Study HIV Acquisition Among Transgender Women (LITE) Study Group.

“Digital epidemiologic research on multilevel risks for HIV acquisition and other health outcomes among transgender women in Eastern and Southern United States: A protocol for an online cohort.” JMIR Research Protocols.

Congratulations to the Psychiatry Residents, Class of 2021!

Left to right: Dr. Cody Bryant, Dr. Michael Sanfilipo, Dr. Kristi Wintermeyer, Dr. Matthew Bojanowski, Dr. Fred Jones-Rosa, Dr. Shumaia Rahman, Dr. Dante Durand, Dr. Jessica Lydiard, Dr. Radu Saveanu, Dr. Natalie Martinez-Sosa, Dr. Nada Alyousha, Dr. Spencer Eth, Dr. Timothy Saeed, Dr. Daniella David, Dr. Rakesh Sharma, Dr. Maria Hadjikyriakou, not pictured: Dr. Joshua Delaney

13 B R A I N S T O R M S | S U M M E R 2 0 2 1

What to Do & Where to Go

Common Purpose Transforming lives through teaching, research and service.

For a Mental Health Emergency, CALL 911 if you believe someone is in danger of hurting themselves or others.

Jackson Behavioral Health Hospital Triage 305.355.7332 Silver Alert If your loved one has gone missing, please CALL 911 immediately.

Silver Alert is a statewide initiative to involve the public in locating a cognitively impaired person who has gotten lost driving or while on foot.

For more information visit florida silveralert.com.

Office Numbers Main Psychiatry Appointment Scheduling 305.243.0214

Chairman’s Office 305.243.6400

Courtelis Center 305.243.4129

University of Miami Hospital (West Building) We offer telehealth appointments for psychiatric and psychological services, please call 305.243.0214

Deerfield Beach 954.571.0117 Center for Cognitive Neuroscience and Aging (CNSA) 305.355.9080

Child & Adolescent 305.355.7148

Brain Fitness Pavilion 305.355.9080 *English, Option 3

Soffer Clinical Research Center 305.243.2301

Memory Disorders Clinic 305.355.9065

COVID-19 Resources

Mental Health Resources

For updates on UM actions and policy changes related to coronavirus please visit umiamihealth.org

In addition to UM, these organizations are offering mental health support and information during the pandemic.

Our Center for Cognitive Neuroscience and Aging’s statement on COVID-19 cnsa.med.miami.edu World Health Organization Follow the WHO’s global response to the coronavirus pandemic www.who.int Centers for Disease Control and Prevention The latest guidance and recommendations for fighting coronavirus in the U.S. www.cdc.gov National Institute of Allergy and Infectious Diseases Emerging research on the novel coronavirus www.niaid.nih.gov

The University of Miami Leonard M. Miller School of Medicine Department of Psychiatry and Behavioral Sciences is committed to: Conducting research that deepens our understanding of the development, pathophysiology, and prevention of psychiatric illness and the nature of human behavior, and apply this knowledge to the development and delivery of more effective, evidence-based treatments.

Offering comprehensive treatment and consultation to our patients, their families, and the community.

Providing outstanding mental health education and multidisciplinary training to the next generation of healthcare providers and investigators.

DIRECCT Core values l Diversity l Integrity l Responsibility l Excellence l Compassion l Creativity l Teamwork

American Foundation for Suicide Prevention www.afsp.org National Suicide Prevention Lifeline 1.800.273.8255 suicidepreventionlifeline.org National Alliance on Mental Illness www.nami.org/Home Mental Health America www.mhanational.org/covid19

The publication of the University of Miami Department of Psychiatry and Behavioral Sciences Executive Editor Samantha Richter Soffer Clinical Research Center 1120 NW 14th Street | Suite 1457 Miami, FL 33136