2019–2020 Annual Report
Dear Friends, I am delighted to present you with our UM Department of Psychiatry and Behavioral Sciences 2019-2020 Annual Report! Since assuming the role of Chair of the Department, I have had the pleasure of working more closely with our faculty to learn the details of the many innovative projects and programs they are leading. From initiatives addressing ongoing challenges such as cyberbullying, suicide, stress and trauma, to developing and implementing advanced, evidence-based technology that provides access to personalized assessment and functional skills training for our aging population, their work is sure to transform the field of mental and behavioral health as we know it. Having amassed millions of dollars across 14 grants last year, our researchers continue to break through scientific barriers, uncovering novel information that can be applied to new treatments and therapies for a myriad of disorders. One of the most exciting parts of working in academic medicine is witnessing these discoveries and seeing how our findings help shape the methodologies we use in identifying, diagnosing, and treating mental and behavioral health disorders. For several years now, physicians in other fields have embraced personalized or precision medicine, which tailors treatment to the patient’s individual genetic profile. Particularly in evaluation of complex or comorbid mental and behavioral health disorders—where
there is no “one-size-fits-all” solution for a problem—the idea of personalized psychiatry has gained traction and shown promise in predicting a patient’s response to certain therapies. To align with this idea and with goals set forth by the UHealth enterprise and Miller School of Medicine, and executive leadership to create a destination site for outstanding medical care, the Department is currently exploring a sub-specialty model that would create disorder-specific programs for mood disorders, psychotic disorders and substance use disorders. This model would ultimately facilitate continuation of our main goals of provision of highquality care in a teaching environment where faculty experts are always available and cutting-edge investigation is underway. As science and medicine continue to evolve, so too must the curriculum we employ to teach and train our future leaders in mental and behavioral health treatment. To align with the inevitable expansion of precision medicine, and in response to the country’s changing healthcare needs, medical education is adapting accordingly. The overarching curriculum for the medical school will be changing soon as we move toward the NextGenMD approach in 2022. At UM we have already implemented a technique called self-directed learning. Held to a rigid and regimented schedule throughout medical school, this method of teaching gives students more flexibility in managing their time, and more control over how they learn. We have already seen significantly better performance among students, particularly our MD, MPH candidates in taking this approach.
This past year brought on a myriad of unexpected and substantial challenges; a worldwide pandemic broke out, its magnitude unlike anything most of us have ever seen, and racial and social injustice ascended to the center of our collective awareness. Our financial, economic, social and health sectors were shaken to their cores. We will almost certainly witness the consequences of the events of 2020, not to mention the mental and emotional tolls it took on people, for years to come. Fortunately, thanks to the nature of psychiatric and psychological treatment, we have been able to maintain contact with our patients—a crucial piece of their wellness plans. I would be remiss if I did not acknowledge the extraordinary members of our Department for rapidly adapting to the new practice model of telehealth, helping to establish a new sense of stability; our patients for their flexibility and understanding during the transition from in-person visits to online sessions; and our supporters and donors for continuing to believe in us and our abilities. Our immensely talented, multidisciplinary, multifaceted team truly embodies our Departmental mission of transforming lives through teaching, research and service. I am exceedingly grateful for the opportunity and privilege to lead this Department, and tremendously proud of their work and achievements this past year. I hope you enjoy reading about them in this publication. Most Sincerely,
Barbara J. Coffey, MDMS
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A revolutionary new curriculum called NextGenMD is being created at the Miller School of Medicine to prepare and inspire future doctors to more effectively treat individual patients—and to begin to transform the entire health care system. Nearly 200 faculty, residents and students have spent many months working on eight planning teams. In the first phase of the new curriculum, launching with the Class of 2024, the emphasis will be on case-based learning, rather than the traditional lecture. Clerkships will begin much earlier, too. Dr. Mousa Botros, Assistant Professor of Clinical Psychiatry and Psychiatry Clerkship Director said, “The new curriculum allows our medical students to have an early exposure to the clinical setting, empowering their ability to integrate basic science and clinical skills. The clerkships will run in integrated clinical settings to address patients from an encompassing approach. Psychiatry will be integrated with both neurology and family medicine in a combined—Mind, Matter, and Medicine—clerkship.” By reinventing the curriculum through the NextGenMD initiative, the school is building a stronger commitment to understanding the impact of social determinants of health on patient care, and instilling in students an ability and a responsibility to make the changes that will lead to improved outcomes. Faculty members are designing Miami-specific cases to be used in sessions. Symptom-based learning will lead students to consider a fuller range of possible explanations for every patient case and prepare them for their early clinical experiences.
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Uniquely, future classes will be pursuing a more targeted, specialized approach to learning by choosing a Pathway of Emphasis if they are not enrolled in one of the school’s distinctive dual-degree programs. More than 20 pathways will be offered in topics including ethics, health policy, population medicine and many others. Pathway directors will serve as mentors to the students and be involved in their research projects. Dr. Firdaus Dhabhar, Professor of Psychiatry and Behavioral Sciences, will be directing the Mind-Body Medicine and Health pathway of emphasis. “This pathway will expose our medical students to ideas, information, and research, with the aim of enabling them to maximally harness endogenous, biological, mind-body healing mechanisms that exist within their patients, while implementing everything else they learn in medical school to help their patients from the outside,” he explained. Though the curriculum is still a work in progress, students so far have been receptive and enthusiastic about the evolution of NextGenMD. The landscape of medicine is changing, and psychiatry is no exception. Over the last ten years, the number of students choosing to pursue careers in psychiatry at UM has increased nearly six-fold. Given that one in five American adults (about 46 million people) live with a mental illness—and less than
half receive treatment—it’s critical this trend continue upward. Dr. Dhabhar’s pathway will use a combination of didactic sessions, discussions, student presentations, and clinical/research-based experiences. It is designed to enable students to understand, analyze and evaluate such concepts as differing cultures and their approach to mind-body medicine and health; psychological and biological mechanisms through which the brain can affect health, healing and recovery; health consequences of the physicianpatient relationship and stress management; and the mechanisms of resilience and recovery. The surprises and struggles of 2020 have certainly emphasized the themes of resilience and recovery and highlighted the importance of finding the patience and perseverance to overcome. The NextGenMD motto— empower to transform, inspire to serve—will undoubtedly guide our students on their journey to becoming leaders in the field, prepared not just to handle lasting challenges from covid-19 but generally improve the overall health of humanity. This article includes original content written by Chris Morris, Sr. Editor, UMMG Communications, that previously appeared in UM’s Spring 2020 edition of Medicine magazine.
Over the last ten years, the number of students choosing to pursue careers in psychiatry at UM has increased nearly six-fold.
Dr. Hilit Mechaber, Senior Associate Dean for Student Affairs, with some members of the Class of 2024.
The new curriculum consists of three phases: Phase 1 is grounded in the foundational and translational sciences that are taught and learned during the first year through symptom-based virtual clinics that incorporate health systems science, social determinants of health, core clinical skills, and professionalism.
Phase 2 consists of integrated clinical clerkships during the second year, where continued themes of foundational, translational, and health systems sciences are embedded within clerkships; this provides students ample experience to plan their future areas of concentration.
Phase 3 allows all students in their final years of school to develop a personalized pathway of excellence in a specialized area of interest, including scholarly or dual-degree pursuits, or an early transition to residency.
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Our Department boasts one of the largest residency programs in the country. We are particularly proud of the fact that each year, between 50-75% of our residents choose to remain at UM for a designated fellowship training program in any of the following specialty areas: Addiction Psychiatry, Child and Adolescent Psychiatry, Forensic Psychiatry, Geriatric Psychiatry or Consultation-Liaison Psychiatry. Residents are prepared to become recognized leaders in the field through training in which they lead and direct multidisciplinary treatment teams while working with a broad and diverse group of patients. Jackson Memorial Hospital, an accredited, non-profit, tertiary care hospital and the major teaching facility for the University of Miami Miller School of Medicine is located on the same campus. The primary training facility for the Department of Psychiatry is Jackson Behavioral Health Hospital (JBHH), a three-story, 180,000-square-foot facility that provides a full continuum of care for the entire family through evaluation, clinical treatment, and teaching and research. Residents also rotate through the Bruce W. Carter Veterans Affairs Medical Center (VAMC). The VAMC Department of Psychiatry and Behavioral Sciences provides rich
Radu V. Saveanu, M.D. Director, Psychiatry Residency Training Program
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Daniella David, M.D. Associate Director, Psychiatry Residency Training Program
training opportunities for Psychiatry residents and fellows in diverse settings. Trainees rotate in inpatient and outpatient services, as well as specialized residential rehabilitation units for Post-Traumatic Stress Disorder (PTSD) and Substance Use Disorders (SUD), both issues deeply affecting our veteran population. Our residents are regularly recognized for their exemplary work. Each year, no fewer than a dozen residents attend the American Psychiatry Association’s Annual Meeting to present posters featuring their research on topics ranging from global mental health concerns like the impact of climate change, stigma, physician burnout and more. The APA Annual Meeting is the largest and most comprehensive meeting in psychiatry, drawing more than 15,000 attendees from 50 countries, and offering more
Edmi Y. Cortes Torres, M.D. Associate Director, Psychiatry Residency Training Program
Elizabeth Crocco, M.D. Fellowship Director, Geriatric Psychiatry
than 500 educational sessions over the four-day event. In 2019, 17 residents, fellows and medical students presented 16 posters at the annual meeting. Frequently, residents return home with awards in tow, and last year was no exception.
Residency Program Mission Our mission is to train excellent psychiatrists for the increasing demand in the community and foster the growth of future leaders in research and clinical psychiatry.
Vanessa L. Padilla, M.D. Fellowship Director, Consultation-Liaison Psychiatry
Spencer Eth, M.D. Fellowship Director, Forensic Psychiatry & Interim Fellowship Director, Addiction Psychiatry
Nicole Mavrides, M.D. Director, Child and Adolescent Psychiatry Training Program
“Our residents have a variety of options and experiences that allow them to use their knowledge and talents to discover their own niche within a large, supportive community. I am proud to lead this growing and evolving program and continue fulfilling our mission to train the future leaders in psychiatry.” Dr. Radu Saveanu
The Psychiatry Resident Retreat is a twice-yearly event planned by the residents for the residents. The retreats are organized to foster a collaborative work environment among the growing and diverse group of Psychiatry residents. The first retreat is typically held every August as the Department welcomes its new group of first-year residents in July. The second retreat usually takes place in March as we begin the process of graduating and transferring residents. As hospital schedules vary amongst the residents, they look forward to days where they can get together as a group and build a relationship as a team.
Class of 2019 | Of our 12 fantastic residents who graduated in 2019, nine chose to pursue further training as fellows at UM/Jackson in specialties including Child and Adolescent Psychiatry, Forensic Psychiatry, Consultation-Liaison Psychiatry and Addiction Psychiatry. One accepted an attending position at the Miami VA and two joined Jackson Behavioral Health Hospital in the psychiatric ER.
Class of 2020 | Of our 16 talented residents who graduated in 2020, five have chosen to pursue further training as fellows at UM/Jackson in specialties including Child and Adolescent Psychiatry, Forensic Psychiatry and Consultation-Liaison Psychiatry. Two graduates have accepted positions at the Miami VA.
UM Department of Psychiatry and Behavioral Sciences Fellowship Breakdown
2
fellows in addiction psychiatry
3
in consultationliaison psychiatry
1
in geriatric psychiatry
10
in child and adolescent psychiatry
5
2
in forensic psychiatry
In 2019, UM faculty launched a small-scale, functional research training track for interested and eligible psychiatry residents, fellows and MD/MPH students. A primary goal of the Psychiatry Residency Research Track is to further the development of residents interested in pursuing careers as scientists. The size of our residency program has grown consistently over the past several years, as has our trainees’ interest in becoming more academically inclined in the field of psychiatry. This new track will offer dedicated research training for a select group of promising research-focused residents. Upon completion of the Research Track, they will be highly qualified to compete for early career grant awards. The faculty mentors leading this new program include Dr. Barbara Coffey, Chair of the Department; Dr. Phil Harvey, Chief, Division of Psychology; and Dr. David Loewenstein, Director, Center for Cognitive Neuroscience and Aging. Collectively, they have received more than $100 million in grant funding throughout their careers in a myriad of topics spanning genomics, tics and Tourette’s, schizophrenia, bipolar disorder, Alzheimer’s disease and related dementias, mild cognitive impairment, suicide, cognitive and functional skills training, and more. They are among the most well-known and well-respected scientists in their respective areas of expertise. Dr. Coffey states, “Despite the many advances in neuroscience, genomics, and
neuroimaging in recent years, we are not developing enough well-trained clinical scientists to advance the field. We thought by starting this track at UM we could start to make an important contribution to the scientific workforce.” Regardless of the residents’ previous level of experience, the track will provide them with skills that are critical for research, including but not limited to: research design, statistical analysis, writing scientific papers and broader conceptual issues associated with research such as how to plan studies that are realistic and successful. “The bottom line is there is no formal exam or test to become a scientist; admission to the track is by interest. We’re offering anyone who has the interest
and is willing to develop the skills the opportunity to pursue a career in academic research,” Dr. Harvey explains. Residents who enroll in the Research Track will work closely with their designated mentor as they progress through the curriculum. Ultimately, the resident will aim to submit their studies to conferences, present an abstract at a national psychiatry meeting, present a study at our Departmental Grand Rounds, and write and submit a manuscript to a peer-reviewed medical journal. Dr. Loewenstein states, “Both individual and group mentoring experiences are essential for training the next generation of clinician scientists and critical in advancing knowledge and clinical applications in psychiatry and related neurosciences.” Dr. Phil Harvey, Chief, Division of Psychology Dr. David Loewenstein, Director, Center for Cognitive Neuroscience and Aging Dr. Barbara Coffey, Chair, Department of Psychiatry & Behavioral Sciences Drs. Harvey, Loewenstein and Coffey have amassed more than $100 million in grant funding throughout their careers.
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“The opportunity to learn from world-class researchers within the Department is invaluable. Their immense support and mentorship has been crucial, and I am happy to say we already have a few posters and an article in the works. I cannot speak highly enough of this new track!” David Martinez Garza, MD, PGY-3, Class of 2022
Valentina Metsavaht Cara, MD, recipient of the Area V Resident Award at the 2019 American Psychiatric Association Annual Conference, with Florida APA assembly members. David Martinez Garza, MD, presenting his poster at the 2019 APA Annual Meeting.
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There are a growing number of healthy aging adults, individuals with mental illness, stroke, traumatic brain injury or aging-related conditions such as mild cognitive impairment who lack the functional skills needed to perform everyday tasks in a broad range of areas. These activities often require interactions with different elements of technology, such as banking (using an ATM or online banking), online shopping, wayfinding, navigating the complex health care universe including scheduling appointments, ordering and refilling medications, or using common and essential technologies such as smartphones or the internet. These challenges are currently multiplied by the COVID-19 crisis, which has led many older people to socially distance and now rely on technology such as videoconferencing for doctor’s visits or even ordering food. Many of these technology-based challenges arise from changes in cognition, either normal and expected aging-related changes or impairments acquired from these other illnesses. A great deal of research has been directed towards understanding the implications of these cognitive changes for independent living as well as to the development of interventions to remediate cognitive and functional declines. However, data has shown that current practice targeting the improvement of basic cognitive abilities alone via various types of brain exercises or games does not restore the ability to perform everyday living activities. No one would expect someone who had never played the piano before to able to play one after successful cognitive training. Technology related functional skills also need to be learned and this is something that previous training programs did not target. These realizations are what led to the concept for iFunction in 2016.
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The idea was developed by Dr. Sara J. Czaja, Director of the Center on Aging and Behavioral Research at Weill Cornell Medicine and Professor Emeritus at the University of Miami, and Dr. Philip D. Harvey, Leonard M. Miller Professor of Psychiatry and Director of the Division of Psychology and the Brain Fitness Pavilion, renowned researchers whose focus is on functional skills assessment and training within the areas of aging, MCI, dementia, serious mental illness, and traumatic brain injury. “Ensuring technological proficiency and user confidence among older adults is of paramount importance,” explained Dr. Harvey. “To do so, it is critical that equal access is available. This is a driving principle behind iFunction.” The program bridges the “real world functioning skills” gap between daily life,
functional skills and technology and can help people regain their prior functional skills or assist them with the acquisition of new functional skills such as those needed to manage emerging and existing technologies. This takes place through a proprietary, unique and evidence-based functional skills assessment and training software platform that can be delivered on both PC and Mac, platforms with a tablet web-based version ready by the end of the year. The solution allows for restored independence, improved ability to learn new skills and higher quality of life for people and increased productivity/reach as well as a reduction of costs for clinicians and caregivers. “Our goal is to help ensure that older adults are able to successfully negotiate our increasingly digitized world,” said Dr. Czaja. iFunction Mission To restore or improve the capacity of individuals to do everyday tasks and enhance the quality of life for older adults as well as for people suffering from Mild Cognitive Impairment (MCI), Serious Mental Illness (SMI) and Traumatic Brain Injury (TBI).
“Ensuring technological proficiency and user confidence among older adults is of paramount importance. To do so, it is critical that equal access is available. This is a driving principle behind iFunction.” Dr. Phil Harvey
Founding Team: Professor Sara J. Czaja, PhD (CSO); Professor Philip D. Harvey, PhD (CSO) and Peter Kallestrup, MS (CEO). Dr. Czaja and Dr. Harvey are leading US researchers within cognition and functioning in aging and technology and neuropsychiatric conditions respectively. Peter Kallestrup comes with 20+ years of top leadership experience and results within the US and international healthcare markets.
Tailored for usage by individuals, researchers, and clinicians, iFunction is designed to help meet the unique challenges each of these groups faces. iFunction software currently can be used to learn several critical functional skills, including ATM and internet banking, ticket purchase, prescription refill with both the telephone and the internet, daily medication management, and internet shopping. These training programs have already helped both healthy older people and those with MCI make substantial gains with treatment. Pairing iFunction skills training with computerized cognitive training leads to even more rapid gains, as the researchers have confirmed in a peer reviewed paper published in the Journal of Visualized Experiments. These astonishing statistics translate to tremendous costs: an estimated $130 billion in direct mental health expenditures and over $100 billion for
traumatic brain injury and stroke—not to mention around 10 million family members providing unpaid care to a loved one with a cognitive impairment. Older adults spent $1.9 billion of their own money last year to treat themselves, with many of these treatments not having any proof that they are beneficial. In 2018, Sandra Wisham, 76, of Coral Gables, FL, began attending the brain-fitness course at her retirement center, offered by Dr. Harvey’s Brain Fitness Pavilion. She spent an hour or two a week working through the iFunction computer exercises, watching her performance improve every time. Wisham says her two months of brain training “made her feel great.” Ticking off the tasks in her cognitive-training program gave her a boost in confidence and made her feel more capable. It also got her out of her apartment and helped her to meet new people. “I’d definitely do it again,” she says.
In the US there are an est.
46,000,000 people 65 and older Roughly
6,000,000 have mild cognitive impairment
25,000,000 have serious mental illness
10,000,000 have persistent traumatic brain injury or lasting effects from a stroke
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In 2019, the University of Miami officially launched CHARM—its new Center for HIV and Research in Mental Health—at a reception held at the Miller School of Medicine. Co-directors Deborah Jones Weiss, PhD, M.Ed., Professor of Psychiatry and Behavioral Sciences, Daniel Feaster, PhD, Professor of Public Health Sciences, and Principal Investigator Steven Safren, PhD, Professor of Psychology, were joined by Adam Carrico, PhD, Professor of Public Health Sciences and Psychology, in explaining the Center’s mission to halt Miami’s HIV/AIDS epidemic to the dozens of researchers in attendance. “We are hoping to learn about the consequences of the combination of mental health and HIV infection in men and women that result in disparities in health outcomes. Understanding HIV in the context of mental health can enable UM scientists to inform guidelines for health interventions,” said Dr. Deborah Jones Weiss. “The Miami metropolitan region has become ground zero for new HIV infections; this may be due in part to challenges in gaining access to testing and HIV prevention services for those most at risk of infection.”
CHARM is funded by a four-year $3.32 million grant from the National Institute of Mental Health. Support for researchers includes consultation, mentoring, centralized peer review and other forms of assistance. The Mental Health Disparities Core of CHARM, led by Dr. Jones Weiss, provides workshops on research methods, community research, and COVID-19 research for UM scientists and community collaborators. Since April 2020, Drs. Jones Weiss and Safren have led widely attended local, national, and international Zoom seminars for families, patients, clinicians, scientists, and frontline health care providers on coping with COVID-19 related stress and anxiety, addressing topics ranging from work-related fear and burnout to interpersonal stress and sleep to children and bad dreams. Listeners are able to ask questions and share concerns in real time. CHARM and the Center for AIDS Research are also collaborating on COVID-19 mental health research among patients living with HIV, led by Dr. Jones Weiss and Dr. Maria Alcaide.
CHARM’s Mission The Center for HIV and Research in Mental Health (CHARM) at the University of Miami aims to bridge the boundaries that have traditionally divided behavioral and biomedical research to catalyze mental health HIV science in one of the regions of the United States hardest hit by HIV/AIDS, with the over-arching theme of “Reducing the Impact of Mental Health and Minority Health Disparities across the HIV Prevention and Care Continua.” The Center offers the expertise, infrastructure and resources necessary to address and strengthen mental healthrelated HIV prevention and care research at the University of Miami and reduce the impact of mental health disparities as barriers to behavioral and bio-behavioral approaches in HIV prevention and care.
The work at CHARM is supported by four cores: Administrative Core The Administrative Core provides scientific and programmatic leadership, management, strategic/ fiscal management for the center. This Core also leads the CHARM Community Advisory Board and all community engagement activities, which are central to the Center’s work.
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Developmental Core The Developmental Core provides the mechanisms for funding pilot projects consistent with the center aims to maximize the chances for later NIH-supported high-impact HIV/AIDS mental health science. This Core takes the lead in ensuring dynamic and supportive mentorship, and capacity-building for early stage investigators, working also with the University of Miami Center for AIDS Research (CFAR) to include perspectives at the interface of behavioral and biomedical sciences.
Mental Health Disparities Core The Mental Health Disparities Core promotes research on HIV-related mental health disparities by providing expert consultation on intervention development with diverse populations, qualitative and mixed-method research, culturally competent assessment measures and equitable human participant’s research with disenfranchised populations.
Methods Core The Methods Core provides expertise in research design, statistical analysis and data management. This core is creating a data repository and unified data architecture to optimize users’ ability to access formative data as well as engage in resource sharing.
“Understanding HIV in the context of mental health can enable UM scientists to inform guidelines for health interventions.� Dr. Deborah Jones Weiss
From left, Raymond Balise, PhD, Victoria Mitrani, PhD, Adam Carrico, PhD, Steven Safren, PhD, Daniel Feaster, PhD, Deborah Jones Weiss, PhD, M.Ed., Allan E. Rodriguez, MD, and Maria Alcaide, MD.
In 2017, Florida reported the highest number of HIV diagnoses at
1.1 million people in the U.S. are living with HIV today
4,800
Approximately
26,632
people are living with HIV in Miami
1 in 7
30-50%
people with HIV in the United States do not know that they are infected
of people with HIV are also living with psychiatric disorders
Breakdown of people living with HIV
42.5% Black
45.4%
74.4% male
Hispanic/Latinx
25.6%
10.7% White
female
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Commonly, when people think of tics and Tourette Syndrome (TS), they envision an individual blurting out words or rapidly and involuntarily moving a part of their body. While these may be indeed features of tic disorders, diagnosis and treatment are much more complex. Eighty-six percent of children diagnosed with TS also have a co-occurring emotional, behavioral or developmental condition such as Attention Deficit/Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), anxiety, depression, or Autism Spectrum Disorder. Finding a balanced regimen of therapies or treatments requires diligence, care, and sometimes input from experts in different fields. The Clinical Program Our clinical program draws on the expertise of this multidisciplinary team to integrate patient care at every stage of illness—from those showing the first signs of a problem to those suffering from a treatment-resistant disorder. Our wide range of treatments include neuropsychological testing, pharmacotherapy, and psychosocial interventions and work to tailor these treatments into a personalized plan of care. The Research Program It is unclear what causes TS; it’s been discovered that genetics plays a role, but no singular event has been identified The Tourette Association of America (TAA) Center of Excellence designation is significant because it recognizes medical institutions that offer the highest level of care, undertake groundbreaking research, lead training of future generations of health care clinicians and/or provide
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as the cause. Boys are three to five times more likely to have TS than girls, and those ages 12-17 are twice as likely to be diagnosed than children ages 6-11. Focuses on the clinical and neurological course of symptoms, the genetic factors that contribute to this course, the development of novel treatments, and the relationship between tics and associated disorders provide us with the opportunity to learn more about this disorder. The D1AMOND Study Currently, we are conducting a study in which we are evaluating an investigational drug to determine its efficacy in children and adolescents
exceptional community outreach and advocacy for Tourette Syndrome and other tic disorders. There are currently 16 TAA Centers of Excellence in the US that regularly communicate, comprising a large-scale collaborative approach focused
ages 6-17 with Tourette Syndrome. As tics are often difficult to diagnose and manage, and there are very few established treatments, this study is important because it may provide a new option which may reduce or eliminate the unpredictability and disruptiveness of physical and verbal tics in children. Overactive dopamine systems in the brain have been found to underlie the neurobiology of TS, making this investigational drug ecopipam, particularly interesting. Ecopipam blocks dopamine D1 receptors, which has shown promising results in preliminary studies, including fewer side effects than the current commercially available dopamine D2 receptor blockers such as haloperidol.
on improvement and advocacy for patient care. As part of this collaboration, the TAA hosted training for practitioners— Comprehensive Behavioral Intervention for Tics (CBIT)—the first-line recommended treatment for tics, at our own University of Miami medical campus. CBIT
is a therapy that teaches people to recognize feelings that occur prior to their tics, and learn competing responses to the tics, which can reduce them over time. The session was part of a series of trainings designed to improve treatment availability around the country.
“ Obtaining the Center of Excellence designation was a collaborative effort between the Department of Psychiatry and my colleagues in the Departments of Psychology, Pediatrics and Neurology. Our team is looking forward to serving our community’s youth, families and adults who have been impacted by tic disorders and Tourette Syndrome.” Dr. Barbara Coffey and Dr. Jill Ehrenreich-May, Co-Directors, UHealth Tourette Center of Excellence
A powerful partnership: Tanya Sokol (TAA), Dr. Barbara Coffey, and Amanda Talty (TAA) at the 2019 Mental Health America 2019 Annual Conference, Washington, DC.
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The UM Department of Psychiatry and Behavioral Sciences prides itself on being a collaborative, multidisciplinary team. We are proud of our partnerships and joint training programs with the Jackson Health System and the Miami VA. In 2019–2020, we welcomed 16 outstanding new clinicians and scientists, enhancing our areas of expertise.
Mousa Botros, MD Assistant Professor
Shaily Desai, MD VA Staff Psychiatrist
Zelde Espinel, MD Assistant Professor
Amalia Martinez, MD VA Affiliate Assistant Professor
Lisa Oliveri, MD VA Affiliate Assistant Professor
Christine Pao, MD VA Staff Psychiatrist
Elizabeth Perkins, MD VA Staff Psychiatrist
Daema Pina, PsyD Assistant Professor
Michelle Rodriguez-Diaz, PhD Assistant Professor
Claudia Rodriguez-Miranda, MD Assistant Professor
Not pictured Ali-Reza Force, MD VA Staff Psychiatrist Maria Rivas-Torres, MD Assistant Professor Edward Suarez, MD Assistant Professor
Mitchell Rovner, MD Assistant Professor
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Emelin Sanchez-Fonseca, MD VA Staff Psychiatrist
Luis Tuesta, PhD Assistant Professor
In the Department of Psychiatry and Behavioral Sciences, we are surrounded by a caring community of alumni, donors, faculty, staff, grateful patients, and friends who have built and nourished a vibrant culture of philanthropy across our Department. Most importantly, that generosity translated into support for key clinical programs and groundbreaking research into innovative discoveries. Through the generosity of our donors, we have been able to: Provide excellence in medical education Our Department is dedicated to training the next generation of excellent psychiatrists and to fostering leaders in research of clinical psychiatry who are well-prepared for the full range of psychotherapeutic and psychopharmacologic modalities in neuroscience. One way to achieve this is through attendance at Grand Rounds. Ongoing private support from the Lasdon Foundation has enabled us to host the Cathy and Fred Seligman Grand Rounds, featuring an invited 20 accomplished speakers, Departmental chairpersons of prestigious universities, and eminent scholars and distinguished professors from the most renowned medical and research institutions in this country and abroad.
Launch the UHealth Therapeutic Adult Suicide Prevention Program Suicide is a public health crisis particularly among Americans between the ages of 45-64. Our Department is committed to doing our part to help combat this crisis and we are continually implementing new suicide prevention initiatives. One of those initiatives is the UHealth Therapeutic Adult Suicide Prevention Program. Using a combination of Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), and other evidence-based techniques, our expert clinicians administer a personalized treatment plan to each individual participating in the program.The program is learningbased; our clinicians teach skills that help reduce the risk of suicide and increase enjoyment and satisfaction with life. “Just wanted to drop a quick note to thank you both for accepting my patient into the program. She had a crisis a couple of Fridays ago and I was able to use DBT with her and reinforce that these skills and more would be taught in the program. She really feels validated and supported by the group and by the group and both of you and is learning a lot. Please extend a heartfelt thank you to the donors as this has really been a turning point in my work with her.� An added benefit, both programs transitioned seamlessly online when COVID-19 broke out in 2020. Most of our scheduled Grand Rounds guests opted to lecture via video conference, while our clinicians were able to effectively conduct individual and group therapy sessions for those enrolled in the Suicide Prevention Program.
Dr. Terence M. Keane, Professor of Psychiatry and Clinical Psychology, and Assistant Dean of VA Research, Boston University, giving Grand Rounds at UM.
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CNSA Center for Cognitive Neuroscience and Aging
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With the aging of the population, it has become a global priority to better understand how to detect, monitor and treat neurodegenerative conditions, such as Alzheimer’s disease. These conditions often result in a devastating loss of memory and thinking abilities, and ultimately impacts the independence of our elders and the well-being of their families and our society at large. The mission of the Center for Cognitive Neuroscience and Aging (CNSA) at the University of Miami is to be a national and international leader in understanding the aging brain and a hub to develop and implement the most state-of-the-art techniques for the study of brain disorders. The CNSA is grounded upon three pillars: research, clinical care, and education. Our scientists are leaders in the development of cutting-edge methodologies to
diagnose and treat cognitive disorders. Home to the state-funded and prestigious University of Miami Memory Disorders Clinic, our Center specialists are experts in the provision of clinical care for aging adults and their families. As part of a major academic medical center, the CNSA is committed to training the next generation of leaders in the fields of gerontology, geriatric psychiatry, neuropsychology, and cognitive
neuroscience. Our established training program ensures that we equip future health professionals with the most advanced knowledge to successfully intervene using evidence-based methods to diagnose and treat cognitive disorders. Because our Center focuses on generating patient-centered clinical research with an emphasis on cognitive disorders that affect our aging population, our training program serves as an unmatched platform to prepare future clinician-scientists.
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More than two years in the making, Dr. David Loewenstein, Director of the CNSA, and his team of expert investigators together with other Florida institutions, have just been awarded a $15 million grant to collaborate on Alzheimer’s disease research. The five-year National Institutes of Health/National Institute on Aging grant brings together top Florida researchers to focus on better understanding how to diagnose, treat, prevent, and potentially cure Alzheimer’s in diverse populations. The 1Florida Alzheimer’s Disease Research Center, or 1Florida ADRC, will be recruiting participants from the University of Miami Miller School of Medicine, the University of Florida, and Mount Sinai Medical Center in Miami Beach. Investigators from these institutions will also be collaborating with other Florida academic institutions including Florida Atlantic University and Florida International University. Dr. Loewenstein, a memory disorders expert and pioneer in the development of novel methods to identify memory disorders during its earliest stages, is the leader of the University of Miami Miller School of Medicine site and Associate Director of the full ADRC. He said, “We are honored that this Alzheimer’s Disease Research Center is one of 31 centers of excellence designated by the National Institute on Aging. Of the 31 centers in the U.S., the 1Florida ADRC is the only funded center in Florida.” The CNSA team is involved in all aspects of the 1Florida ADRC. Dr. Rosie Curiel Cid, Chief of Cross-cultural Neuropsychology, is leading the ADRC Outreach, Recruitment and Engagement Core. This Core will provide critical engagement between the ADRC and people with dementia, their caregivers, and both the professional and local
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lay communities to ensure information is communicated bi-directionally, particularly in diverse populations. Dr. Elizabeth Crocco, Chief of Geriatric Psychiatry and Director of UM’s state-funded Memory Disorders Clinic and Medical Director of the CNSA,will be running the medical aspects of the 1Florida ADRC; and Tatjana Rundek, M.D., Ph.D., professor of neurology and Evelyn F. McKnight Endowed Chair for Learning and Memory in Aging, is co-leading the ADRC’s educational core with Glenn Smith, Ph.D., ABPP/CN, from the University of Florida. Dr. Crocco who has devoted more than 22 years to working with South Florida’s older population affected by Alzheimer’s disease, will also offer her expertise in Alzheimer’s disease and related disorders to the 1Florida ADRC Clinical Core. The team also stands out for being the only university in the state funded by the NIH to conduct tau imaging. Miller School researchers have a number of federally funded grants that are studying abnormal tau protein in the brain. The presence of amyloid alone is not the only indication of future Alzheimer’s disease. Some people also start to show signs of tau deposition years, even decades, before developing symptoms.
“The Miller School is recruiting hundreds of older adults from our local community,” said Dr. Loewenstein. Their focus is on engaging African American and Hispanic older adults to make sure they are well represented, because these groups are historically largely under-represented in aging research, including studies looking at Alzheimer’s disease. “I am the daughter of Cuban exiles; the first to be born in this country. Spanish was my first language. Miami has nurtured this multicultural identity and I am privileged to bring it to the forefront of my work,” Dr. Curiel Cid said. “One of the greatest challenges in aging research is ensuring that the methods we develop to detect and treat diseases of the aging brain are generalizable to all older adults. The CNSA is committed to addressing this by developing tools and methods that are cross-culturally applicable. Now, the 1Florida ADRC will significantly broaden our reach. We assembled a passionate team of scientists from diverse cultural backgrounds to engage, educate, listen to, and partner with our richly diverse communities. We hope to generate new knowledge and contribute to national efforts to accelerate clinically meaningful outcomes for older adults and their families.”
CNSA is proud to partner with these fantastic institutions as part of the 1Florida ADRC to further research in Alzheimer’s disease
To better understand diseases of the aging brain, even decades before they occur, the ADRC scientists have an expertise in studying people who don’t yet have symptoms but might be concerned about their risk for developing Alzheimer’s for another reason, such as family history. They also study older adults who may have thinking or memory problems but haven’t yet been diagnosed, as well as people who have been diagnosed with early mild cognitive impairment. Dr. Loewenstein and colleagues at the Miller School developed a novel cognitive stress test, called the LoewensteinAcevedo Scales for Semantic Interference and Learning (LASSI-L) test, which will be
used in the 1Florida ADRC study. LASSI-L is a scientifically proven measure that is highly sensitive to early Alzheimer’s disease brain pathology and can pick up early changes in memory before traditional cognitive testing detects the disease. “The ADRC brings us to the level of a national center of excellence,” Dr. Crocco said. “We have the funding and the ability now to be able to promote and really develop more and more these wonderful diagnostic strategies, treatment strategies and, hopefully, one day a cure for Alzheimer’s disease and other neurodegenerative disorders.” “Addressing the challenges of AD in our culturally diverse, aging population
is a national and international priority. I am so pleased that UM and its CNSA in collaboration with many other UM Departments and Institutes have the opportunity to advance state-of-the-art research in AD and related disorders.” Mission of the 1Florida ADRC A consortium of Florida institutions helping to change the current understanding of Alzheimer’s disease and related dementias from being incurable, inevitable and largely untreatable to a new reality in which these diseases are curable, preventable and treatable.
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At the Center for Cognitive Neuroscience and Aging (CNSA), Elizabeth Crocco, MD, Medical Director of the Memory Disorders Clinic, received $250,000 from the Florida Department of Health. The grant, Building an advanced cognitive biomarker registry for African American older adults at risk for Alzheimer’s disease, will leverage the expertise of investigators who have been actively and successfully working to engage African American communities in their research and clinical care. A growing body of evidence suggests that the prevalence of AD may be two to three times higher among older African Americans as compared to non-Hispanic whites, yet they are significantly underrepresented in research. “In a region as diverse as South Florida, it is especially important we reach our minority communities and help break through barriers that have historically prohibited them from seeking and obtaining care. This grant will help us do just that,” Dr. Crocco said.
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The aim of the project will be to build an advanced registry of 120 African American older adults at risk for Alzheimer's disease and related disorders using state-of-the-art and culturally relevant novel cognitive tests, as well as advanced neuroimaging of the brain and genetic analyses. This project fills a critical gap and is expected to become the foundation of current and future NIH-funded projects in Florida that include this underserved group of individuals.
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UNIVERSITY OF MIAMI HEALTH SYSTEM
Psychiatry & Behavioral Sciences
Common Purpose Our mission is to conduct research that deepens our understanding of the development, pathophysiology, and prevention of psychiatric illness; offer comprehensive treatment and care to our patients, their families and the community; and provide outstanding mental health education and multidisciplinary training to the next generation of healthcare providers and investigators. Soffer Clinical Research Center 1120 NW 14th Street | Suite 1457 Miami, Florida 33136 Telephone: 305.243.4000 psychiatry@med.miami.edu Executive Editor Samantha Richter Director, Communications & Strategic Initiatives
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