Q3| 2017
BRAINSTORMS Quarterly Publication of the University of Miami Department of Psychiatry and Behavioral Sciences
In This Edition
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Interactive Screening Program Launches, Aimed at Preventing Suicides on Campus Welcoming Our New Division Chief of Child & Adolescent Psychiatry, Dr. Barbara Coffey
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vm Georges Gilles de la Tourette More about our new tics & Tourette’s program plans on p.8
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A Message from the Chairman ince my last message, we have witnessed the consequences of Hurricanes Harvey, Irma, and Maria—severe human suffering and trauma the likes of which we have never seen, at least, in such rapid succession. Before Houston could recover fully from the massive flooding, Irma and Maria tore through the Caribbean with Florida and the Caribbean islands witnessing much destruction. Because Miami is the gateway to (and from) Latin America we were not only the recipient of Irma, in terms of flooding, loss of power, gasoline and food/water shortages but our close ties with the islands, especially Puerto Rico, has made our involvement in relief efforts absolutely essential.
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Of course, many of our faculty, students and their family members were directly impacted by these disasters. I could not be prouder of our residents, staff, and faculty who stepped up to man our services at the Jackson Behavioral Health Hospital, University of Miami Hospital, and the Miami VA Medical Center. Space constraints preclude listing all of these individuals but know that they spent hours and hours and hours in these hospitals taking care of patients and when needed, staff and family members. We also learned a great deal from this experience which will translate into a better preparedness plan for such emergencies in the future. This is a time of rapid change in American healthcare and in the past several months a number of leadership changes have occurred at the University of Miami. We have welcomed a new provost, Jeffrey Duerk, Ph.D. from Case Western Reserve University and a new Dean of the Miller School of Medicine, Edward Abraham, M.D. from Wake Forest University. He is also serving as acting CEO and Executive Vice President for Health Affairs as Steven Altschuler, M.D., has moved on to explore other opportunities. On the research front, the Department faculty are truly excelling with several
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new grants from the National Institutes of Health recently received. They include very basic neuroscience and epigenetics research (Drs. Ayad and Zeier), stem cell/inflammation research on depression (Drs. Salloum/Harvey/ Nemeroff), Aging/Alzheimer’s research (Drs. Czaja, Loewenstein, Crocco, and Curiel), and cancer (Dr. Pirl). We are particularly excited about the launch of the American Foundation for Suicide Prevention (AFSP) Interactive Screening Program (ISP) to all of our medical students-a program I helped to develop many years ago that has been adopted by over 80 universities to reduce suicide on our campuses. It is residency recruitment time again and we have a large number of applications for our 16 first year adult psychiatry residency positions. The current first year class, here since mid-June, are enthusiastic, bright, and industrious. Our External Advisory Board, now led by Alfredo Frohlich, is very busy with the planning of our annual golf tournament benefiting the Department, which is taking place on October 27, 2017. We are delighted that it is actually oversubscribed. More on www.GolfUMPsych.com. Finally, as I write this essay, comes the news of an additional trauma—the
mass shooting at a concert in Las Vegas with, as of now, 59 dead and more than 500 wounded. The traumatic consequences to the fatal and injured victim’s families and loved ones and all of those present at the concert are inestimable. Our hearts go out to all of those suffering with this tragedy. Sincerely,
Charlie
Dr. Nemeroff traveled to Argentina for the INECO Foundation meeting. The Foundation supports neurobiological research programs and academic projects directed at enhancing the prevention, detection, and treatment of neurological and psychiatric disorders. Dr. Nemeroff and great friend and supporter of the department Karen Taylor traveled to D.C. where they spoke to Congress about mental health.
Dr. Sara Czaja & the CREATE team were recognized for their transformative work with older adults and technology. Read more. Dr. Nemeroff participated in two panels in Mumbai, India at Frontiers in Psychiatry III, an annual summit focused on recent advances in diagnosis and treatment of major psychiatric disorders.
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The UM Department of Psychiatry and Behavioral Sciences extends a warm welcome to new members of the team:
Carlos Almirola Research Associate Doris Caldwell Project Manager Research Support
Barbara Coffey, MD Division Chief, Child & Adolescent Psychiatry
Shiyue Sun Programmer Qingzhou Zeng Programmer
Jessica Garcia Research Assistant
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Part 2 | By Dr. John Soloski
A Woman’s Journey Down the Long and Winding Road of Depression This is the second part of a 2-part story about a woman’s struggle with depression. To read the beginning, please visit BrainStorms Q2 at https://issuu.com/umpsych/docs/brainstorms_q2/6
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ngela had been transferred to this bank branch only three weeks before. The slower pace and lower-stress work was more suited for her than her previous branch. She also bonded with a co-worker.
“We both have very strong religious beliefs. We prayed together a lot and read verses in the Bible,” Angela said. Angela decided to tell her friend how she felt and what she planned to do. “For some reason I decided to go to a co-worker who I trusted and told her I just didn’t want to live.” Her friend took action. She immediately called the bank’s Human Resources office and then drove Angela to the local hospital. Looking back on what her friend had done, Angela said, “I owe her so much. God put her there in my life on that particular day.” At the hospital, Angela was put into an isolation room and evaluated. After being admitted, “I called my family. None of them realized how severe my depression was,” she said. Angela’s supervisor at work was supportive, telling her that her job would be waiting for her when she returned to work. She was given a three-month medical leave. Angela went back to the mental health facility she had been in 15 years before, this time as an outpatient. She didn’t think her treatment at the facility helped much. “We colored pretty much all of the time. It was as though I was in kindergarten again. We colored and talked.” While she was there, she did meet with one therapist but never saw a psychiatrist or any other physician. But for the first time in her life, she did receive a diagnosis of her illness. She was told she was suffering from severe depression. She also received a referral to see a psychiatrist. “Each appointment, I would see her [the psychiatrist] for about 15 to 20 minutes. She would take my weight and 4 | BrainStorms | Q3 | 2017
vital signs. We would talk for a few minutes and she then would write a prescription.” Never did they talk about how Angela was feeling or explore the potential causes of her depression. “I didn’t feel any different when I left her and I was asking myself ‘why am I doing this?’” Angela said. During an annual physical, Angela told her internist that her antidepressant didn’t seem to be doing any good. The internist told her that she had had some success with her patients using a different drug than the one Angela had been prescribed. Angela called her psychiatrist and told her what the internist had said. The psychiatrist responded, “Okay, let’s try that,” and prescribed the drug without an in-person visit or any further discussion. Angela took the drug and her vision soon began to bother her. She had severe headaches and her eyesight began to fade. She had a difficult time reading. When she asked her psychiatrist if this could be caused by her new antidepressant, the doctor assured her that it was not. Her vision had gotten so bad that Angela went to see an eye specialist. He conducted a number of tests and found nothing wrong with her eyes. But he did tell her that her vision problem was likely caused by the antidepressant. Angela told her psychiatrist this and again she was adamant that the vision problem was not caused by the drug she had been prescribed. Angela took matters in her own hands and stopped taking her antidepressant. “I came off the drug and the eye issue resolved itself.” “When she told her psychiatrist this, “she didn’t believe me.”
By now, Angela had given up any hope of ever feeling better. “I just thought that this was how my life would always be,” she said. Antidepressants are powerful and unpredictable drugs. A drug that works for one person will not necessary work for another. Not only is the effectiveness of a drug unpredictable, getting the dosage correct can be challenging. Too small a dosage won’t make much of a difference in a person’s depression, but it can cause some awful side effects. To get both the drug and dosage correct, a doctor needs to have training in psychiatry. Yet, a rotation in psychiatry during residency training is not required. “With few exceptions such as family medicine and neurology, the only experience most physicians experience in assessment and treatment of psychiatric disorders is 3-6 weeks during their third year of medical school. Clearly, this is not sufficient, yet the majority of patients with, for example, depression are treated by non-psychiatric physicians,” stated Dr. Charles Nemeroff, Leonard M. Miller Professor and Chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami Medical School. In the 15 years since she first talked to a doctor about her depression, Angela has been prescribed over 20 different drugs and none have worked. But the doctors she was seeing were not trained in psychiatry. Yet, they can and do prescribe powerful antidepressants. Angela trusted these doctors.
In Angela’s case, she did end up seeing a psychiatrist who was prescribing an antidepressant for her but at such a low dosage that the drug had little beneficial effect. By chance, Angela’s life was about to change dramatically. She and the author of this article had a passing acquaintance. In a noisy restaurant, Angela learned that the University of Miami’s Department of Psychiatry and Behavioral Sciences specialized in treating patients who did not respond well to traditional drugs and therapy. Angela committed to going to Miami for treatment. “I was really excited about going. I had hope again. But I was worried about the money situation,” she said. To do a thorough evaluation, the patient needed to spend at least three full days in Miami. The evaluation is performed by a team of physicians, psychologists and therapists. The cost is about $7,000. The Comprehensive Diagnostic and Treatment Evaluation Program is based in the Department of Psychiatry and Behavioral Sciences. It is unique in the nation as it addresses complicated patients or those who have failed previous treatments. The patient is independently evaluated by three psychologists chosen based on the patient’s chief symptoms and the faculty’s specializations. A neuropsychologist performs extensive testing and a psychologist meets with family members. Once completed, all of the faculty, including Dr. Nemeroff, meet in consensus conference to arrive at the diagnosis and treatment plan. More than 400 patients have been seen in this program. For Angela and most patients, health insurance does not cover the cost. While this may save insurance companies money, it takes a large toll on America’s economy. According to the Centers for Disease Control, the annual impact of depression on America’s economy and businesses is a staggering $210 billion in combined medical and work loss costs. About 21 million Americans, nearly 10 percent of all adults, will suffer from a major depressive episode each year, causing many of them to miss work. Angela’s insurance would not cover her evaluation in Miami and she could not afford the $7,000. What she could
afford was a one-day visit with the hope it would give the Miami doctors enough time to treat her. “Everybody at Miami was nice and very friendly. I felt at ease,” she said. Angela was assigned as a patient to Dr. Jeffrey Newport, Professor and Director of the Women’s Reproductive Mental Health program at the University of Miami. “I really liked Dr. Newport. He asked so many questions. He knew what to ask and said things that I had never thought about before. This was the first time this ever happened to me,” she said.
“I could have had a different life if I knew about Dr. Newport and the doctors in Miami 27 years ago. I truly think my life would have been completely different.” Dr. Newport recognized that Angela was suffering not only from depression but from severe anxiety, namely panic disorder and social anxiety disorder, as well. Neither her depression nor her anxiety had ever been effectively addressed. “Angela had previously been treated with seven different antidepressants. Unfortunately, her physicians kept repeating the same mistake. They started each antidepressant at a low dose and only made minimal dose increases, if any. Each time Angela failed to derive any benefit from an antidepressant, rather than assertively increase the dose, her physicians instead switched her to an equally low dose of another antidepressant,” remarked Dr. Newport. Dr. Newport changed Angela’s antidepressant to one suitable for both her depression and anxiety. “He told me that one of the biggest issues with the treatment I had been receiving was that the dosages should have been increased.” Dr. Newport started a new antidepressant and increased the dose, in a stepwise
manner, until she experienced a remission of her depression. Ultimately, Angela experienced a remission of her depression and anxiety at a dose 400% higher than the starting dose. “Dr. Newport was confident it would work. He reassured me that I would feel better. And it has worked,” Angela said. Upon Dr. Newport’s recommendation, Angela has also started seeing a therapist. The therapy sessions have been going on for just a short time and it is too early to tell whether they will help Angela. But she already has some frustration. “The therapist just sits there and doesn’t say anything. I have to do all the talking. I want her to ask me questions. I want some feedback from her,” she said. It has been nearly two years since Angela went to Miami and her life has turned around. She is back scuba diving and very active in her church where she feels most at peace. Angela talks openly about her depression. “People come up to me and ask what they can do about their depression,” she said. “I try to help them because without help I would not be where I am today.” Her goal is to help end the stigma associated with depression. “It’s an illness just like cancer and just like cancer it can be treated and cured, but you have to get the right treatment,” Angela said. “I could have had a different life if I knew about Dr. Newport and the doctors in Miami 27 years ago. I truly think my life would have been completely different.” This piece “A Woman’s Journey Down the Long and Winding Road of Depression” was written by guest author Dr. John Soloski.
John Soloski, PhD is Professor of Journalism at the University of Georgia. He was dean of the college from 2001-05. Previously, he was the Daniel and Amy Starch Professor of Journalism and the director of the School of Journalism and Mass Communication at the University of Iowa. He serves on the External Advisory Board of the UM Miller School of Medicine’s Department of Psychiatry and Behavioral Sciences. 5 | BrainStorms | Q3 | 2017
New Initiative Launches at Medical School to Increase Suicide Prevention Efforts On Campus
hanks to the tremendous success of the 2016 Inaugural Golf Tournament, the Department of Psychiatry & Behavioral Sciences has been able to fund an Interactive Screening Program on the medical school campus. Developed by the American Foundation for Suicide Prevention (AFSP), the program’s goal is to prevent suicides among medical students who may benefit from the help of a mental health professional. It is completely anonymous, a unique and helpful tool to aid in keeping the UM community safe and healthy.
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“After accidents, suicide is the most common cause of death among medical students,” explained Dr. Hilit Mechaber, Associate Dean for Student Services at the University of Miami Miller School of Medicine. “This is an alarming fact and serious steps must be taken to reverse this trend and support our students. We hope that the anonymity and confidentiality offered by the Interactive Screening Program will resonate with people, and provide reassurance that it’s perfectly acceptable to seek help.” The initiative is only part of a greater effort to help promote general well-being among students. The implementation of this program will help recognize and offer support to anyone struggling and fighting the stigma, or fear of getting help. Simultaneously, the aim is to continue expanding programs and opportunities to focus on physician well-being. Undoubtedly, the stigma around mental illness plays a significant role in students’ hesitancy to discuss any
challenges they may be facing. Demanding rotation schedules, exams, and eventually, the competitive application process for residency programs may all perpetuate individual expectations to excel in every aspect of the training process. But, depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and up to 19.5% of females. Depression is even more common in medical students and residents, with 15-30% of them screening positive for depressive symptoms. Physicians are actually among one of the professions with the highest suicide rate, with an estimated 300-400 deaths by suicide each year (it is impossible to estimate an exact number because of inaccurate cause of death reporting and coding). This is the equivalent to a doctor a day. “Physician burnout is at an all-time high, with an estimated 50% of doctors reporting symptoms of burnout,” said
Symptoms of burnout may include:
About ISP
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Exhaustion—feeling fatigued energetically, emotionally, and/or spiritually.
Cynicism—losing the ability to care, empathize, and connect with patients, staff and co-workers. Doubt—doubt that your work really makes any difference or questioning the quality of what you do. A low sense of personal accomplishment.
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85% of participants who completed the Questionnaire had serious depression or other suicide risk factors; 90% were not receiving treatment. Those who exchanged online messages with the ISP counselor were three times more likely than those who did not come for an in-person meeting, and three times more likely to enter treatment.
Dr. Charles Nemeroff, Leonard M. Miller Professor and Chair of the department. “Many of these symptoms – fatigue, anxiety, stress – manifest in medical school as students are under incredible pressure to perform. The university is committed to supporting our medical students to maintain optimal wellness so they may in turn help others achieve their highest degree of well-being.” Whether the burnout symptoms among those in the medical field emerge in school or as a fully licensed and practicing physician, the fact remains that these mental health issues exist, are underreported, and the rates of doctors affected are climbing. The Department of Psychiatry and Behavioral Sciences has plans to scale the Interactive Screening Program to make it available to staff and faculty on the medical school campus, and, eventually, adapt for the entire population of students, faculty and staff across all University of Miami campuses.
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75% of participants who entered treatment were described by counselors as not likely to have sought professional help with the ISP. 27% of students, residents and faculty who participated in the ISP at a leading medical school were found to be at significant risk for depression and suicide; 48% of this group received referrals for further evaluation and treatment from the ISP counselor.
An estimated
300–400 physicians
are lost to suicide each year—nearly one per day An estimated
50% of doctors
Depression is at least as common in the medical profession as in the general population, affecting an estimated
19.5% 12% of males and up to
of females
report symptoms of burnout
Depression is even more common in medical students and residents, with
15– 30%
of them screening positive for depressive symptoms
Recently Funded Grants Family Based E-Health Obesity Prevention Intervention for Hispanic Adolescents Funded by NHLBI; PI Dr. Sara Czaja Harmonizing Multidisciplinary Perspectives and Resources to Advance Precision Gerontology Funded by NIA Research Centers Coordinating Network (U24); PI Dr. Sara Czaja Supporting the Use of the PTSD Coach Mobile Application in Older Veterans Funded by VA Rehab R&D, PI Dr. Sara Czaja Understanding Factors Influencing Financial Exploitation among Diverse Samples of Older Adults RO1 subcontract; PI Dr. Sara Czaja Augmenting Cognitive Training in Older Adults – the ACT Grant Funded by NIH/NIA; PI Dr. Sara Czaja
Stress Management Effects on Affect and Influenza Vaccine Response in Older Breast Cancer Patients Funded by Florida Health BankheadColey Cancer Research Program; PIs Dr. Michael Antoni and Bonnie Blomberg; Co-I Dr. Sara Czaja A Tailored Technology Intervention for Diverse Family Caregivers of AD Patients Funded by NINR/NIH; PI Dr. Sara Czaja Health Literacy Assessment and Intervention to reduce disparities FLIGHT VIDAS II Funded by NIH/National Heart, Lung & Blood Institute, Subcontract from Nova University; PI Dr. Sara Czaja Novel Detection of Early Cognitive and Functional Impairment in the Elderly Funded by NIH; PIs Dr. David Loewenstein, Dr. Sara Czaja
Stem Cell Therapy, Inflammation and Treatment Response in Alcoholism-Depression Comorbidity Funded by NIH; PIs Dr. Charles B. Nemeroff, Dr. Ihsan Salloum Workshop on Methods in Supportive Oncology Research Funded by NIH; PI Dr. Bill Pirl Elucidation of specific nucleocytoplasmic trafficking pathways that are disrupted in C9ORF72 ALS Funded by NIH; PI Dr. Zane Zeier Epigenetic and Kinase Pathway Interactions in Medulloblastoma Funded by NIH; PI Dr. Nagi Ayad Positive Connections: COPA2 Funded by NIH; PI Dr. Deborah Jones VA Merit Research Award Recipient, Dr. Richard Jope (4 years) 7 | BrainStorms | Q3| 2017
Welcoming Dr. Barbara Coffey, New Division Chief of Child and Adolescent Psychiatry
t’s no secret that there’s an extreme shortage of child and adolescent psychiatrists across the nation. With a 1:1,760 ratio of doctors to patients, an astounding number of children are not receiving the treatment they need to lead healthy and productive lives. At the fore front of novel and innovative treatment for children is Dr. Barbara Coffey. After spending the last five years at Icahn School of Medicine at Mt. Sinai in New York, we are ecstatic to welcome Dr. Coffey as our new Division Chief of Child and Adolescent Psychiatry. A worldrenowned and highly respected psychiatrist, Dr. Coffey specializes in tics and Tourette Syndrome. Repeatedly recognized by America’s Best Doctors, and with hundreds of original publications plus and numerous pioneering grants to her credit we are elated Dr. Coffey is here!
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often refer more complicated patients with the frequently co-occurring problems, such as ADHD and Obsessive Compulsive Disorder (OCD), to child and adolescent psychiatrists.
Can you tell us a bit about what brought you to UM? We had been thinking of moving to Florida for many years, as we have family in the area, and this past year when the faculty position at the University of Miami became available, our thoughts and dreams became a delightful reality! What led to your interest in tics & Tourette’s? I have always had a longstanding interest in neuroscience and the brain-mind interface, but it was my first patient with Tourette’s Disorder that sparked my fascination with tics and Tourette’s. As a young Child and Adolescent Psychiatry faculty member at Tufts University School of Medicine, where I did my training, I consulted to the Pediatric Neurology Division. This patient was an 8-year-old boy with classic Tourette’s: symptoms of eye blinking, shoulder shrugging, sniffing and coughing, but a very unusual family background. His mother had been in a convent for many years, and father in a seminary for many years before they met. They were older parents when he was born, and still very religious. Surprisingly, the child had a very rare Tourette’s symptom of coprolalia (involuntary uttering of obscenities)— but only in one place - church! So I was totally captivated that this rare sign could show up only in church…a possible expression of an inter-generational conflict in the context of a well-established genetic neurodevelopmental disorder. 8 | BrainStorms | Q3 | 2017
Many people do not associate tics & Tourette Syndrome with mental or psychiatric disorders; how are these medically classified and how should a parent determine what kind of physician to bring their child to if they think they may be experiencing symptoms? Tic disorders, including Tourette Syndrome are classified as neurodevelopmental disorders in the DSM (Diagnostic and Statistical Manual of Mental Disorders). These and several other psychiatric disorders, such as Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), are included in the neurodevelopmental disorders section, which indicate onset in childhood. Neurodevelopmental disorders are theoretically in the domain of both pediatric neurologists and psychiatrists. Many pediatricians or family practitioners, who are usually the first to evaluate children with tics and Tourette’s Disorder, refer uncomplicated patients with just tics (and not other co-occurring problems) to neurologists. Neurologists
You’ve stated that one of your major research interests is the co-occurring conditions including Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD). What have you discovered to be most interesting or significant about how these disorders co-exist? These co-occurring disorders, and others such as mood, anxiety and learning disorders, are frequent in patients with Tourette’s, and thus come to the attention of child and adolescent psychiatrists. Studies increasingly show that there are underlying neurobiological pathways and genes common to tic disorders, ADHD and OCD. So from a scientific perspective, it is not at all surprising there is co-occurrence. From a developmental perspective, most children with tic disorders and even Tourette’s Disorder, will grow out of their tic symptoms, but ADHD and OCD symptoms tend to persist. So as specialists, we can often reassure parents of children with newly diagnosed Tourette’s that tics will improve by late adolescence, but we need to keep an eye on, and be proactive with, the co-occurring conditions over time. It is these conditions and their course, outcome and relationship with tics that need additional investigation.
Can you share some of your upcoming plans for the department? I am absolutely delighted to be joining this exciting and robust Department as Division Chief of Child and Adolescent Psychiatry. I will be working very closely with Dr. Nemeroff, Department Chair, and Dr. Shaw, current Division Chief, to make sure there is a smooth transition of leadership. My first job will be to get to know, in depth, faculty and staff and their scope of work. Since there are many currently existing areas of strength in the Department, it will be important to build upon these strengths, and augment areas in need of growth with new faculty, initiatives, and crosscollaboration with other Departments in the School of Medicine, such as Pediatrics and Neurology. I plan to bring research programs, including genetics research in tics and Tourette’s Disorder, and pediatric clinical trials.
What advice would you give a trainee interested in pursuing a career with an emphasis on tics/TS? I plan to set up a new tics and Tourette’s Clinical and Research program in our Department, sure to be a collaborative effort with the aforementioned departments. This new program will serve as a clinical rotation site for all child and adolescent psychiatry (CAP) fellows, and as an elective opportunity for medical students, adult psychiatry, pediatric neurology, movement disorders and psychology trainees. As a former Director of Education and Training at Icahn School of Medicine at Mount Sinai, I love teaching, and will be providing didactics to all CAP fellows and any other trainees interested. In addition, I plan to personally mentor trainees of any discipline who are interested in the field. Lastly, as a former member of the Tourette Association of America (TAA) Centers of Excellence New York State Consortium,
1 out of every 160 children between
Tics are involuntary, repetitive movements and vocalizations. They are the defining feature of a group of childhood-onset, neurodevelopmental conditions known collectively as Tic Disorders and known individually as Tourette Syndrome, Chronic Tic Disorder, and Provisional Tic Disorder.
the ages of 5 and 17 in the United States has TS and
1 out of every 100 children has TS or another Tic Disorder
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I have been invited to join the TAA Southeast Regional Centers of Excellence, which will provide a wonderful networking opportunity for trainees. What advice would you give someone who has been recently diagnosed? Their families/friends in how to cope? We refer all newly diagnosed children and families to one of the statewide chapters of the Tourette Association of America (TAA). The TAA website https://www. tourette.org/ is a good starting point for information. I have already made some local contacts in the area, and plan to reach out to area schools and parent groups to provide information and resources. Although we as clinicians can provide many medical and educational services for these families, it is often other families who can be most helpful to the newly diagnosed, particularly around navigating the health and school systems.
Motor tics: tics that cause a movement Vocal/phonic tics: tics that produce a sound l
Boys are three to five times more likely to have TS than girls. People from all racial and ethnic groups can have TS but non-Hispanic white children are twice as likely to have a TS diagnosis as Hispanic and non-Hispanic black children. Children 12–17 years of age are twice as likely to have TS as children 6–11 years of age.
Among children diagnosed with TS, 86% also have been diagnosed with at least one additional mental, behavioral, or developmental condition, such as: — Attention-deficit/hyperactivity disorder (ADHD), — anxiety — depression — autism spectrum disorder and — learning disabilities.
It’s not clear what causes TS; the conditions are hereditary so genetics plays a role. Environmental, developmental or other factors may also contribute, but currently, no specific event has been identified as the cause. https://www.tourette.org/abouttourette/overview/ https://www.cdc.gov/ncbddd/tourette/facts.html
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Staff Stars | Carmen Alsina Executive Assistant to the Chairman
he Staff Stars column highlights the commitment and accomplishments of an individual in the Department of Psychiatry and Behavioral Sciences. Nominations may be submitted to Samantha Richter at psychiatry@miami.edu. Please include a brief description of the nominee’s job responsibilities and why you believe they should be the next Star!
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Tell us about the bet that brought you to UM. It was the fall of 1984—I had graduated high school in June of that year. One evening, I was talking with a friend of mine about the ‘Canes and mentioned that I had heard that people who worked at UM could go to school there—for free! I told my friend, “you know, I think I’m going to get a job there and go to school.” My friend responded by laughing hysterically and said, “you can’t get a job there—you don’t know how to do anything!” I quickly retorted, “I can type, I know Gregg shorthand, and I speak perfect Spanish. I would be perfect for any job.” My friend said, “I bet you can’t get a job there,” to which I said, “I bet I can.” The next day, I came to the medical school personnel office—a small office in the Elliot Building on 10th Avenue. I passed my typing test and then I was interviewed by the personnel manager. He felt that I would be perfect for a position in the Development Office— which I thought had something to do with construction—I was so naïve! It wasn’t long before I discovered that the Development Office was the fundraising arm of the School of Medicine and I panicked! I immediately told her that I didn’t think this was going to work out for me, that I wasn’t good at asking people for money. She started laughing and said not to worry, I wouldn’t be asking anyone for money. Two hours later, I was offered a job. My friend was in disbelief! My first day at UM was November 2, 1984. A significant part of your job entails protecting Dr. Nemeroff’s time and ensuring he’s prepared for his endless roster of activities. Being that you
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directly support not just the head of a department but one of the world’s leading psychopharmacologists, how do you prioritize projects and combat challenges that arise from literally all over the world? First, let me say that it is a privilege to work with Dr. Nemeroff. I am lucky that he and I have a very good working relationship. Now, I would love to tell you that I have this fantastic system for prioritizing—but I don’t. However, there are a few things that are helpful: Dr. Nemeroff’s level of concern over the completion of a task is directly related to me giving that particular assignment first priority—especially when he voices his concern. Deadlines are like automatic prioritizers, and here’s my new favorite: “tell me the five things you absolutely need for me to do today.” I have never liked the word challenge. I have always thought of that word as having a tinge of negativity, so I much prefer learning experience. I don’t combat with a learning experience—on the contrary, I welcome it. The more I know, the more I know my colleagues, the more I understand a process, the better I can do my work. I’ve said this many times, Dr. Nemeroff and my colleagues deserve the best of me. Has your perspective of mental health changed throughout your time in the department? No. I have a family history of mental illness so I know, intimately, the heartbreaking consequences of mental illness that is untreated or poorly treated. I also know that people with mental illness can have wonderful, productive lives if they try to be compliant patients, receive the proper therapies, and embrace their networks of family and friends. How has UM evolved over the years? What’s always been here is the finest faculty of any medical school anywhere. I think back to 1984 when the landscape of the medical campus was so different and small. The Development office was made up of several hotel rooms at Jackson Towers, the beautiful Sewell Building was the location of our business and finance operations where I would sit with my colleagues there
and count dollar bills—for hours. The site of the Clinical Research and Gautier buildings were parking lots and two of our flagship programs were not yet born—Sylvester Comprehensive Cancer Center and the Miami Project to Cure Paralysis. Many great minds, very generous benefactors, and a very supportive community came together and became a force. You could say that the medical school and I grew up together. What’s a little known fact about the Chairman? Dr. Nemeroff has a great sense of humor and the best “belly laugh” I have ever heard. It’s contagious! If you weren’t doing this, what would you be doing? I am interested in two very different things. One is about being noble and the other is about beauty. The first is grief counseling. Five years ago, I lost my best friend. I was devastated. I had many conversations with many colleagues in the Department. They let me cry, cried with me, smiled, hugged me, held my hand and most importantly, they listened to me. Each time, I walked away from those talks feeling a little bit better and a little bit stronger. I will never forget how important these conversations were to me or where I would be without them. To those of them who are reading this: you will never know the impact you had on me. Listening is no small thing. The other thing I am interested in is interior decorating—creating a beautiful space that people love to be in. Words to live by? “Don’t forget.” Don’t forget to smile, don’t forget to say a kind word, don’t forget to be patient, don’t forget to say please, don’t forget grace, don’t forget humility, don’t forget gratitude. You get the idea.
Department Achievements ongratulations to the following members of the Department of Psychiatry and Behavioral Sciences on their recent achievements!
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Awards Dr. Rosie Curiel Recipient, 2017 Chairman’s Choice Award, Society for Biological Psychiatry Dr. Dante Durand Recipient, Senior Faculty Teaching Award, Department of Psychiatry and Behavioral Sciences, June 2017 Dr. Nicole Mavrides Recipient, Sarah Esselstyn Howel Award, Department of Psychiatry and Behavioral Sciences, June 2017 Dr. Ihsan Salloum Chairperson and Committee Member, initial reviews; Committee Member for Stage 2 Review of Specialized (P50) and Comprehensive (P60) Alcohol Research Centers of the National Institute on Alcohol Abuse and Alcoholism, Nationa Institute of Health Dr. Maria Rueda-Lara Certificate of Recognition, Outstanding Clinical Care Award, Cancer Support Services at SCCC
Publications Drs. Claude-Henry Volmar, Hasib Salah-Uddin, Karolina J. Janczura, Paul Halley, Guerline Lambert, Andrew Wodrich, Sivan Manoah, Nidhi Patel, Gregory Sartor, Neil Mehta, Nancy T. H. Miles, Sachi Desse, David Dorcius, Shaun Brothers and Claes Wahlestedt Proceedings of the National Academy of Sciences of the United States of America (PNAS) M344 promotes nonamyloidogenic amyloid precursor protein processing while normalizing Alzheimer’s disease genes and improving memory Dr. Spencer Eth The Journal of the American Academy of Psychiatry and the Law Childhood Trauma, PTSD, and the Cautious Forensic Expert Dr. Stefania Prendez-Alvarez, Dr. Charles B. Nemeroff Neuroscience Letters Personalized medicine: Prediction of disease vulnerability in mood disorders Dr. Shariful A. Syed, Dr. Charles B. Nemeroff Neuroscience Letters Adult glucocorticoid receptor mRNA expression volatility in response to an acute stressor and juvenile CSF corticotropin-releasing factor: A pilot neurodevelopmental study Dr. Elizabeth Crocco, Dr. David Loewenstein, Dr. Rosie Curiel, Dr. Sara Czaja, Dr. Phil Harvey, Journal of Psychiatric Research A novel cognitive assessment paradigm to detect pre-mild cognitive impairment (PreMCI) and the relationship to biological markers of Alzheimer’s disease. Dr. Sara Czaja, Dr. David Loewenstein, Dr. Samir sabbag, Dr. Rosie Curiel, Dr. Elizabeth Crocco, Dr. Phil Harvey Journal of Alzheimer’s Disease A novel method for direct assessment of everyday competence among older adults
Dr. David Loewenstein, Dr. Rosie Curiel, Dr. Elizabeth Crocco, Dr. Sara Czaja Journal of Alzheimer’s Disease Recovery from proactive semantic interference in MCI and normal aging: relationship to atrophy in brain regions vulnerable to Alzheimer’s disease Dr. Charles B. Nemeroff American Journal of Psychiatry Functional connectivity of the subcallosal cingulate cortex and differential outcomes to treatment with cognitive-behavioral therapy or antidepressant medication for major depressive disorder and Effects of patient preferences on outcomes in the predictors of remission in depression to individual and combined treatments (PReDICT) study Dr. Charles B. Nemeroff Biological Psychiatry Amygdala reactivity and anterior cingulate habituation predict posttraumatic stress disorder symptom maintenance after acute civilian trauma Dr. Charles B. Nemeroff JAMA Psychiatry (Journal of the American Medical Association) A consensus statement on the use of ketamine in the treatment of mood disorders Dr. Charles B. Nemeroff Personalized Medicine in Psychiatry Putative biological predictors of treatment response in bipolar disorders Dr. Shariful A. Syed, Dr. Charles B. Nemeroff Chronic Stress Early life stress, mood, and anxiety disorders Dr. Charles B. Nemeroff Journal of Psychiatric Research Suicidal ideation and behavioral in institutions of higher learning: a latent class analysis continued on back cover
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What to Do & Where to Go For a Mental Health Emergency, CALL 911 if you believe someone is in danger of hurting themselves or others. University of Miami Hospital (UMH) Mental Health Admissions/ER 305.689.4444 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 305.355.9028 *Option 1
Common Purpose
Transforming lives through teaching, research and service.
Chairman’s Office 305.243.6400
Soffer Clinical Research Center 305.243.2301
Jackson Behavioral Health Hospital 305.355.9028 *Option 2
Courtelis Center 305.243.4129
University of Miami Hospital 305.689.1352
Deerfield Beach 954.571.0117 Center on Aging 305.355.9081
Boca Raton 561.939.4044
Brain Fitness Pavilion 305.355.9080 *English, Option 3
Child & Adolescent 305.355.7077
Memory Disorders Clinic 305.355.9065
Department Achievements cont. Publications Dr. Sara Czaja Policy & Aging Report The Potential Role of Technology in Supporting Older Adults Dr. Sara Czaja, Chin-Chin Lee, Shi-hua Fu, Dr. Phil Harvey Schizophrenia Research Assessing Functional Performance using a Computer-Based Simulation of Everyday Activities Dr. Sara Czaja Generations Can Technology Empower Older Adults to Manage Their Health?
The University of Miami Leonard M. Miller School of Medicine Department of Psychiatry and Behavioral Sciences is committed to: Conduct 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.
Offer comprehensive treatment and consultation to our patients, their families, and the community. Provide 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
Dr. Sara Czaja, Dr. David Loewenstein, Dr. Samir Sabbag, Dr. Rosie Curiel, Dr. Elizabeth Crocco, Dr. Phil Harvey Journal of Alzheimer’s Disease A Novel Method for Direct Assessment of Everyday Competence Among Older Adults Dr. Sara Czaja, Dr. Joseph Sharit The Gerontologist Social support for Older Adults through Technology: Findings from the PRISM Randomized Controlled Trial
Q3| 2017
BRAINSTORMS Quarterly Publication of the University of Miami Department of Psychiatry and Behavioral Sciences
Don’t miss out on this year’s tournament! Visit www. GolfUMPsych.com for details.
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Executive Editor Samantha Richter Soffer Clinical Research Center 1120 NW 14th Street | Suite 1457 Miami, FL 33136