Q1| 2019
BRAINSTORMS Quarterly Publication of the University of Miami Department of Psychiatry and Behavioral Sciences
In This Edition: Commentary by Dr. Phil Harvey: Smoking Cannabis and Acquired Impairments in Cognition CNSA Receives $3.2M to Study New and Advanced Cognitive Stress Tests Faculty and Staff Represent Department at Events Throughout the City
A Message from the Interim Chairman ear Friends, We have just released our 2018 Annual Report detailing some of last year’s major achievements and I could not be prouder of our Department. Our faculty, staff, students, residents and fellows work determinedly every day, and there is no shortage of accomplishments to share. With big visions and even bigger hearts, I am humbled to not only be a part of, but lead, this extraordinary group of individuals. Please take a moment to read through some of our highlights from 2018 by visiting issuu.com/umpsych. I am pleased to welcome several new psychiatrists to the Department. Dr. Maria Rivas Torres will provide inpatient care and work with our colleagues at the Miami Transplant Institute; Dr. Michelle Rodriguez-Diaz will focus on cancer patients and inpatient consultation-liaison service at Sylvester Comprehensive Cancer Center; Dr. Zelde Espinel, who is finishing her psychosomatic medicine fellowship at UM, will also work at Sylvester with the cancer support team; and Dr. Daema Piña, who recently completed her postdoctoral fellowship at UM, will focus on psychotherapy with medically compromised individuals such as cancer patients, and neuropsychological testing. Last but certainly not least, Dr. Martin Strassnig will return to the Department after taking a three-year break to focus on research interests. In May, 15 residents and fellows will travel to San Francisco to present a combined 24 posters at the American Psychiatric Association’s Annual Meeting. Presentations will cover topics such as anxiety, depression, stigma, psychosomatic medicine, physician well-being, and addiction psychiatry. I am immensely proud of this group for their accomplishments and participation at one of the largest psychiatry conferences of the year. We just completed Match Day and can’t wait to welcome 13 outstanding new residents this July. Recently, Dr. Joan St. Onge, Senior Associate Dean for Graduate Medical Education and Associate Professor of Clinical Medicine, hosted a faculty development seminar aimed at helping faculty navigate difficult interpersonal situations. There was also discussion around how to reach one’s fullest potential in the dynamic and demanding field of medicine. This is the first of a new series that the GME office will be implementing this year. Among all this exciting news to report, I am saddened to announce the departure of Dr. Jeffrey Newport, Professor of Psychiatry and Behavioral Sciences and the Director of our Women’s Reproductive Mental Health program. Dr. Newport’s expertise has significantly helped expand our services to an important patient population and he will be missed. We wish him the best in his next endeavor.
D
Sincerely,
Radu V. Saveanu, MD 2 | BrainStorms | Q1 | 2019
Smoking Cannabis and Acquired Impairments in Cognition: Starting Early Seems Like a Really Bad Idea | Philip D. Harvey, PhD, Chief, Division of Psychology ocietal attitudes toward cannabis use are changing rapidly. There has been a wide-ranging movement toward removal of criminal sanctions on cannabis use. This movement has raised some concerns about whether we understand the full implications of cannabis use, particularly in young individuals. Cannabis use is legal for over 200 million residents of the US and 37 million Canadians.The most recent large-scale legalization of cannabis use has occurred in Canada. Effective October, 2018, Canada removed all criminal sanctions on marijuana use. Morin et al. [1] studied changes in cognitive performance associated with cannabis use in 3,826 students in Montreal who were examined annually for a four-year period, starting in seventh grade. First, both alcohol and cannabis use increases annually. Second, the effects of cannabis are considerably greater than those of alcohol. Third, use of cannabis has persistent cognitive effects that worsen with continued use. Although the differences in cognitive performance associated with cannabis use do not wipe out all maturation-associated improvements, they are substantial. Tenth graders who have concurrent use and past year use of cannabis perform like seventh graders who have never used cannabis on measures of inhibitory control. This is a four-year disadvantage.
S
As these children grow older, it is very likely that their opportunities for cannabis use will increase. It might be expected that additional cognitive changes would accrue with sustained cannabis use. Meier et al. [2] previously studied cannabis use in an age period similar to the current study (ages 7-13). Participants were reassessed at 18, 21, 26, 32, and 38 years of age. No baseline differences in intelligence between the different use groups were detected; the baseline IQs of those who never used cannabis and those with persistent abuse at age 38 were identical at 99.84 and 99.68 respectively. The cognitive effects of persistent cannabis use were substantial: 6-point declines in total IQs. Informant reports of cognitive limitations were substantial as well. In contrast to recent research on smoking cessation and cognition, reducing cannabis use did not lead to restoration of cognitive functioning. These studies suggests that cannabis-related cognitive changes are detectable and important during middle school and high school years and persistent cannabis with early onset use leads to major cognitive challenges by the late 30’s. There are signs of early-onset and persistent effects of cannabis use on cognition in quite different but very comprehensive studies. If that was the only potential effect of early onset
cannabis use, there would be considerable reason for concern. However, there is a whole other set of risks associated with early-onset cannabis use: increased risk for development of psychosis. Research has suggested that the risk for schizophrenia among cannabis users is about two percent, which is more than double the population base rate. This risk is also increased within individuals with genomic risk, life-stress related factors, and very early onset of use. These studies suggest a need for considerable concern about the impact of the anticipated wider access to cannabis. As the adverse cognitive effects of early-onset cannabis use appear clear, education and prevention efforts will be needed in order to prevent academic decline and other consequences of cannabis use early in life. This piece has been edited for length and clarity. For the full paper, please email psychiatry@med.miami.edu
References [1] Morin JF, Afzali MH, Bourque, J, Stewart SH, SeĚ guin JR, O’Leary-Barrett M, Conrod, PJ. A Population-Based Analysis of the Relationship Between Substance Use and Adolescent Cognitive Development, Am J Psychiatry, [2] Meier MH, Caspi A, Ambler A, et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci USA. 2012;109(40):E2657-64
3 | BrainStorms | Q1 | 2019
How One Family’s Search for Mental Health Treatment Led to Extraordinary Advocacy and Awareness Efforts uring his freshman year in college, Susan and David Racher’s son began acting out of character. A bright, happy, well-liked and well-adjusted young man, Matthew began to lose interest in his schoolwork, his music and his social life. Susan, a financial professional, and David, a neurologist, attributed their son’s lack of engagement to the stress of transitioning to college and a persistent thought that he perhaps made an error in his choice of college; after all, he was attending a very rigorous university in a Midwestern city far from home and sunshine. What the family and the community psychiatrist treating their son after freshman year did not know until much later was that Matthew was exhibiting prodromes, or early symptoms, of a serious mental illness and not an “adjustment issue.” Eventually, Matthew would experience a severe psychotic break, setting the Racher family on a journey to find help and culminating in a newfound commitment to mental health advocacy.
D
Susan, how did you navigate the existing options for mental health treatment in South Florida in 2011? When mental illness strikes, people are frightened and confused and need help navigating a fragmented and often irrational system of care. I discovered this extreme lack of parity between mental health care and other medical care— with a broken bone or surgery a patient receives care coordination and weeks of rehabilitation services. With mental illness, the patient is stabilized in a hospital or crisis unit setting and released to a family that does not know what to do, or worse, released to the streets. Following Matthew’s hospitalization, the next steps were completely trial and error. He received excellent outpatient care from UM, but also required other dimensions needed for full recovery: a place to go to during the day, a place to live independently, a sense of purpose obtained from having a job, and a social support network to
4 | BrainStorms | Q1 | 2019
From left: Sue and Alan Snyder; Matthew Racher; Andrew and Robin Gallagher; Susan; Daughter Maggie, Dr. David Racher and friend and FOGDOG partner, Carlos Larrauri
mitigate the isolation that occurs when a young person’s life gets derailed by mental illness.
Neither of you were very familiar with the mental health community; how did the team at UM help you through the process of learning about mental health disorders as both a family and a patient? The UM team was unique in that they understood well that a mental health crisis affects the whole family and that the family and the individual in crisis must be at the center of the treatment decision and implementation process. Too often, in other settings, the family is closed out of the conversation and the patient is managed as if they are no longer sentient. Even in the throes of illness, there is still a person in there and the UM team showed great respect for Matt and what he was experiencing, and took time to get to know our son as a person and not just an ill patient. And, they took time to inform, educate and help support our family in this crisis. Matthew, you had some suspicions about what may have contributed to your mental break. What were they and how did you arrive at that conclusion? Two well-known triggers to psychosis are stress and marijuana, and in my early college years, prior to my break, both were present. I now know that these, along with lack of sleep, changes in eating habits, social isolation are both symptoms of and can worsen an underlying mental health disorder.
There is no magic bullet for treating mental health disorders. Each case requires independent evaluations and personalized treatment plans. The physicians at UM are known for enlisting a team of specialists and working collaboratively to diagnose and treat mental health disorders. How was this beneficial in Matthew’s specific case? Because a blood test or x-ray can’t detect mental illness, and because many different diagnoses have similar presentation, the best standard of care entails a team that engages in discussion not only with one another but also with the family and the patient. That UM followed this approach gave us great confidence that the diagnosis and treatment plan were carefully considered. In my opinion, the result was better precision in diagnosis and treatment, and we were able to avoid the very disruptive process of trial and error in medications. Susan, you’ve become a well-known and well-respected advocate for mental health in South Florida and beyond. What does it mean to you to receive recognition for your important work in an area you never thought you would be a part of? My sense of right and wrong was really outraged when I looked at the mental health landscape in Miami outside of our UHealth setting—a landscape that is the consequence of poor state funding (Florida ranked #50 in US for mental health funding)
and fragmentation of services. I saw opportunities to constructively channel my outrage into trying to connect the fragments and to change the system so that people with mental illnesses and their families would get the quality care and support they need and deserve. I never expected to be in this role, yet I now feel that the sum of my professional, educational, and personal experiences converge in this magnetic sense of purpose. I have been enriched by the impactful work, dedication and courage of the people I’ve met and worked with. The real recognition I seek is for the state and our South Florida mental health care and properly advance
philanthropic community to prioritize it financially and through systems transformation. Our kids and our families deserve a much better system of care. Matthew, you now speak openly about your diagnosis. In fact, you’re currently a peer counselor at Jackson Behavioral Health Hospital. Mental health is often a sensitive subject; when did you feel comfortable discussing your experience, and was there any trepidation about entering the field professionally? One of the organizations we turned to for support was the National Alliance on Mental Illness (NAMI).
Pictured below: Matthew Racher and Carlos Larrauri performing original music as FOGDOG. NAMI Miami and UM are co-hostingthe 2019 REEL Minds Miami Mental Health Film Festival, a vital outreach and educational event, on May 19 in recognition of Mental Health Month.
They had chapters all over the country, but the Miami chapter had become defunct. Realizing the value and need for a NAMI Miami, my mom and like-minded people came together and relaunched the local chapter. As I attended various meetings and met wonderful people who were also in recovery from mental illness, I began to divest the feelings of shame over becoming ill. It helped too that my parents were so involved and educated, and became part of a network that could support each other in managing the complexities. Having peer support and a group of friends and colleagues who understood the experience of mental illness were essential to my recovery. I ran several NAMI support groups and become a certified peer support counselor. Starting a new field after being the same job for seven years was a bit unnerving, but I felt I was ready to do it. Do you think the mental health landscape is changing? What are your hopes for the future? The landscape is changing and the importance of addressing mental health care is gaining traction in a number of different ways: 1) the peer advocacy community has grown; 2) celebrities, athletes and public figures have begun opening up about their struggles and successes in living with mental illness; and 3) innovative, new treatments for people with mental illnesses are helping people recover to lead full, productive lives. These illnesses manifest in youth and most can be successfully treated if early intervention occurs, averting a lifetime of disability and economic hardship. Parity funding, expectations of recovery and not just containment of those with a mental illness... these are my hopes for the future but I do think there will be a lot of work required to get there. Parts of this interview were adapted from the article ‘All in the Family’ from our 2018 Annual Report.
5 | BrainStorms | Q1 | 2019
Events University of Miami Hosts Town Hall Meeting Addressing Addiction, Anxiety & Depression in the Legal Profession On February 28th, the Bolch Judicial Institute of Duke Law School, the University of Miami, and the Dade County Bar Association came together for a two-day conference, The National Town Hall Meeting Addressing Addiction, Anxiety & Depression in the Legal Profession. The conference emphasized that no one—lawyers, firms, legal departments— is immune from mental health disorders. In fact, it’s a growing concern in the field with an unprecedented number of lawyers committing suicide, developing substance abuse issues, and burning
Dr. Barbara Coffey Speaks at 2019 American Professional Society of ADHD and Related Disorders (ASPARD) Annual Meeting On January 20th, Barbara Coffey, MDMS, Chief of the Division of Child and Adolescent Psychiatry, participated in the 2019 ASPARD Symposia in Washington, DC. APSARD is the premier, multidisciplinary organization devoted to the advancement of both the science and clinical practices benefitting individuals with ADHD throughout the lifespan.
6 | BrainStorms | Q1 | 2019
out, and courts and corporations are taking action, allocating resources to monitoring and supporting these professionals’ well-being. Medical experts, judges, and legal practitioners from around the country attended and presented on a multitude of topics. Felicia Gould, clinical psychologist and Assistant Professor of Clinical Psychiatry and Behavioral Sciences, sat on the panel discussing existing treatment programs, including mindfulness and therapy. It focused on the use of mindfulness in the legal community and the UM law school as well as the neural mechanisms behind the benefits of mindfulness. Dr. Gould discussed stigma, the development of stigma and its cognitive underpinnings. Additionally, she spoke about the impact on accessing care and how to best combat stigma. The theme of this year’s meeting was ADHD: Exploring the Boundaries and mental health experts from all over the world gathered to discuss a variety of topics including the genetics of ADHD, benefits and challenges of psychosocial treatment, bipolar disorder as it relates to ADHD and more. Dr. Coffey was part of the Seizures, Tics, and OCD in ADHD: Impact on Management panel. Her talk, ‘ADHD and Tics: Boundaries, Overlap and Disentanglement’, explained of the overlap of ADHD and tic disorders; the observation that ADHD symptoms usually persist but tic symptoms remit over time; behavioral treatment tics is recommended, while stimulants can be used safely for pharmacotherapy. Though, there are several other options including a combination, and symptoms should be carefully disentangled by severity and potential outcomes to ensure best management and intervention. Recently, Dr. Coffey launched the UHealth Tics, OCD and Related Disorders program at UM. For more information, visit https://issuu.com/umpsych or email mxc1668@med.miami.edu.
Dr. Felicia Gould University of Miami
Dr. Coffey Hosts First Tic Talk at Miami Springs Senior High School On March 20, Dr. Coffey hosted the first of a series of Tic Talks, discussions about Tourette Syndrome, OCD, ADHD and related disorders. The talk was an excellent opportunity for Dr. Coffey to share information about her recently launched program addressing these issues. The audience was a mix of parents, educators, and students, all of whom found the presentation informative and connected with Dr. Coffey and her team afterwards about personal concerns and available resources. Stay tuned for information on the next scheduled Tic Talk!
More than 1700 peer educators attended HIP Day 2019
Faculty and Staff Represent UM Department of Psychiatry at 2019 HIP Day
Miami is home to the fourth largest school district in the nation comprised of 392 schools, 345,000 students and more than 40,000 employees. Managing a population this size comes with unique challenges, but also unique opportunities. In the last several years, curriculum at schools around the country has evolved, but many programs on health— specifically mental health—remain stagnant. (In Florida, public schools are not required to offer health education classes) Recognizing the importance of covering this topic in the formative years of high school, two Miami women
Drs. Ingrid Barrera and Joy Lee Present at Stupid Cancer Summit
In February, Ingrid Barrera, PsyD and Assistant Professor, and Dr. Joycelyn Lee, PhD and Assistant Professor, gave a presentation titled, ‘Managing Relationships’ at the Stupid Cancer Summit presented by the Sylvester Comprehensive Cancer Center (SCCC). Stupid Cancer is a non-profit organization geared toward helping adolescents and young adults (AYA’s) with cancer. They work on education, cancer advocacy, research, and support, and this summit was a free one-day conference for the South Florida young adult cancer community. Their talk spoke to the personal and social impact of cancer on AYA’s. “AYA’s only represent five percent of all
Maria Cruz and Cynthia Fundora staffing the UM booth
founded the Health Information Project (HIP) on the notion that “the best way to influence teens is for them to be taught by their classmates, their friends, their peers.” Through classroom discussions,a resource site, and campus-wide health campaigns, HIP trains juniors and seniors in high school to teach health education to their freshmen peers and hosts a HIP Day each year to bring these schools and students together. At HIP Day 2019, Dr. Felicia Gould, PhD, clinical psychologist and Assistant Professor, Maria Cruz, Research Assistant, and Cynthia Fundora, Research Associate, hosted a booth to greet more than 1700 peer educators who attended the event. With a focus
on Tourette’s Syndrome awareness and activism, along with its more common comorbid disorders of ADHD and OCD, the Department partnered with the Tourette Association of America (TAA). The groups teamed up to offer students the opportunity to participate in interactive activities that mimicked some of the symptoms of Tourette Syndrome, which all proved difficult to complete. Ensuring students walked away having learned a new fact, staff administered short quizzes to participants, awarding them with UM goodies. Dr. Gould led more in-depth conversations about various mental health topics of interest to the students. The event was a huge success and we look forward to attending in 2020!
newly diagnosed cancers, so it’s very hard for these patients to find or connect with people who are going through what they are going through, leading them to feel isolated/alone,” Dr. Barrera said. AYA’s face many different challenges compared to other cancer patients which puts them at risk for more distress and, for some, depression and anxiety. It can affect their identity, autonomy/independence, self-esteem, body image, fertility, sexuality, and social support. They also discussed how the cancer impacts each of these areas—so they could understand that these obstacles and feelings are all normal and common concerns for their age group and developmental stage. The doctors finished by encouraging them to discuss these issues with their health care team, and seek social support through Stupid Cancer and similar organizations.
Dr. Joy Lee presenting at the Stupid Cancer Summit.
7 | BrainStorms | Q1 | 2019
Staff Star | Ines Lohse, PhD The tumor microenvironment was a perfect way to study that and I got kind of stuck in pancreatic cancer. I still have some projects investigating the tumor microenvironment now. Specifically, evaluating how the pancreatic tumor microenvironment impact the response to anti-cancer agents is fascinating. The majority of my time, however, is spent on by our drug sensitivity testing efforts in leukemia, sarcoma and ovarian cancer. We are evaluating the utility of the platform for treatment stratification in different clinical trials.
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!
T
You are originally from Germany. What led you to UM? I saw a job ad online and it felt like it was written for me. I came for an interview and really liked everyone and thought that the project was a great fit. And the weather. After being in Toronto and Michigan the weather definitely helped! Did you always want to be a scientist? No. I wanted to be a physician originally but realized very, very early that I liked the idea of understanding diseases more than the treatment part of being a doctor. Tell us about your role at UM’s Center for Therapeutic Innovation. I am an Assistant Scientist and work on cancer related projects in the CTI.
Ines Lohse, PhD
A big part of my job evolves around the clinical implementation and further development of the drug sensitivity testing platform. We are currently involved in two clinical trials in leukemia and sarcoma and planning a large Phase 3 clinical trial in leukemia. How did you become interested in cancer research? What are some of the current projects you’re working on? That was a bit of a coincidence. I am interested in how the microenvironment influences the behavior of cells.
Save the Date! The Department is proud to partner with AFSP on several suicide prevention initiatives. One event we especially enjoy participating in is the Out of the Darkness Miami Walk. Devoted to raising awareness and funds to invest in novel research, educational programs, public policy advocacy efforts, and support those who have been affected by a loss to suicide, the Walk is an annual event and takes place in hundreds of cities across the nation. In recent years, the Miami walk has grown to include thousands of people, raising more than $60,000. Team UHealth has been a top fundraiser the last few years—please save the date of Sunday, October 6th and join us to walk in support of suicide prevention. Register: afsp.org/miami
8 | BrainStorms | Q1 | 2019
Laura Hoffman, Manager of the Interactive Screening Program (ISP) at AFSP, Maggie Mortali, Director of the ISP at AFSP, and Samantha Richter at AFSP’s NYC offices.
What do you love most about your job? The challenge. Every project is different and challenging in its own right. I love being able to come up with a hypothesis and work towards testing it. While my job can be very frustrating it is never ever boring. When you’re outside the lab, what do you enjoy doing? I have a 22-month old daughter that is keeping me busy so a lot of my time is dedicated to running after her and doing fun activities. In my quiet time I love to read.
Department Achievements ongratulations to the following members of the Department of Psychiatry and Behavioral Sciences on their recent achievements!
C
Awards Dr. Mousa Botros Inducted into Alpha Omega Alpha Having demonstrated academic achievements, taken on roles of teaching, mentoring and service to others, Dr. Mousa Botros has been chosen for induction into the Alpha Omega Alpha (AOA) Honor Medical Society on March 21st. Election to Alpha Omega Alpha is an honor signifying a lasting commitment to professionalism, leadership, scholarship, research, and community service. A lifelong honor, membership in the society confers recognition for a physician’s dedication to the profession and art of healing.
Dr. Daniel Jimenez Receives Funding for New Trial to Address Mental Health Needs of older Latinos Later in Life Given the prevalence and morbidity of depression and anxiety in later life, the inadequacies of current treatment approaches for averting years living with disability, the disparities in access to the mental health care delivery system, and the workforce shortages to meet the mental health needs of older Latinos, development and testing of innovative strategies to prevent depression and anxiety are of great public health significance and have the potential to change practice. To address this urgent medical and public health issue, Assistant Professor Dr. Daniel Jimenez and his team have
Alpha Omega Alpha (AOA) Honor Medical Society Inductees. Front row from right: Dr. Mousa Botros.
developed the Happy Older Latinos are Active (HOLA) health promotion intervention. The study has been funded by the National Institute on Minority Health and Health Disparities (NIMHD) and is a randomized prevention trial with three primary objectives: (1) to examine whether HOLA is effective in reducing the risk for and incidence/ recurrence of major depression and generalized anxiety disorder; (2) to examine if the benefits of HOLA are maintained over two years; and (3) to identify variables that predict either therapeutic or adverse outcomes of treatment. In the proposed study, 240 older Latinos age 60+ with subthreshold depression or will be randomized to receive either HOLA or the healthy lifestyles education program. HOLA is a community health worker (CHW)-led, multicomponent, health promotion intervention consisting of: (1) a social and physical activation session; (2) a moderately intense group walk led by a CHW; (3) pleasant events scheduling; and (4) a maintenance phase. The healthy lifestyles education program consists of a notebook containing educational material on mental health, physical activity, and information on community resources as well as biweekly telephone check-in calls. Participants will be followed for 24 months with repeated assessments of clinical, health-related, and psychosocial outcomes.
If HOLA can be delivered successfully by CHWs, then the scalability and potential for dissemination is increased. Health promotion interventions represent a potential solution to the multiple disparities experienced by older Latinos. Treating mental health problems through health and wellness could appeal to older Latinos as a non-stigmatizing and culturally acceptable alternative to traditional mental health services. In addition, the integrated focus on both mental, biological, and physical health outcomes enhances the innovation and clinical impact of this work.
Our 2018 Annual Report is Out! Read all about What You Helped Us Achieve last year. We are so grateful for your support and dedication to the Department and the field of mental health. For the full report, please visit issuu.com/umpsych. To request a print copy please email Samantha Richter at sfr30med.miami.edu.
9 | BrainStorms | Q1 | 2019
Center for Cognitive Neuroscience and Aging (CNSA) The CNSA Launches Study of Second Generation Tau Agents for Early Detection of Alzheimer’s disease (AD)
CNSA Director Dr. Loewenstein and his colleagues have been awarded a $3.2 million NIH grant as well as a Florida Department of Health Grant to study new and advanced cognitive stress tests as they relate to early biomarkers of Alzheimer’s disease (AD) such as amyloid tau deposition within the brain. The scientific work that helped secure this grant, done by Dr. Loewenstein and the CNSA, renders the University of Miami the first academic institution in the state of Florida to use neuroimaging to detect the presence of tau protein in the brain and to link these findings to the earliest neurocognitive changes associated with AD and related disorders. Tau is a very important marker of neurodegeneration that is present in persons with incipient Alzheimer’s disease. The CNSA is expected to expand its tau imaging capacity and its relationship to other biological markers of AD. These markers are related to the Cognitive Stress Test®, a new empirically designed clinical outcome measure developed at the CNSA to detect cognitive decline in preclinical Alzheimer’s disease. This study proposes to validate its use for preclinical AD clinical trials in a well-defined cohort of Hispanic and nonHispanic at-risk individuals, and compare its utility to the Alzheimer’s Disease Assessment Scale (ADAS-Cog), the most widely used clinical outcome measure in AD clinical trials. The CST is a computerized measure that builds upon the success of the
10 | BrainStorms | Q1 | 2019
LASSI-L® with additional trials that better probe recovery from proactive semantic interference and failure to recover from retroactive semantic interference, an early cognitive marker of preclinical AD. It builds upon established collaborations between the UM Department of Psychiatry and Behavioral Sciences and the Department of Neurology, the McKnight Brain Institute, as well as the Departments of Radiology, Anesthesiology, Nuclear Medicine, Computer Science and the Bascom Palmer Eye Institute.
UM Takes on Enhanced Role in the NIA-funded 1Florida Alzheimer’s Disease Research Center
CNSA clinician-scientists are expanding their leadership in the 1Florida Alzheimer’s Disease Research Center (ADRC), a consortium of Florida institutions whose mission is to help 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. For the ADRC renewal, CNSA Director Dr. David Loewenstein will serve in the role of Associate Director of the ADRC at-large, and the Clinical Core Leader at the University of Miami, which will focus on early detection of AD in minority subgroups. Drs. Elizabeth Crocco and Rosie Curiel Cid will play a major role in the Clinical Core as well. Dr. Curiel Cid is slated to lead the Outreach, Recruitment and Engagement Core for the ADRC at-large. Under the leadership of Dr. Tatyana Rundek in the Department of Neurology, the University of Miami and the Clinical and
Translational Science Institute (CTSI) will play a major role in the ADRC’s Education Component, which focuses on training the next generation of scientist-clinicians in the field of Alzheimer’s disease and related disorders. Dr. Loewenstein is currently Co-Leader of the 1Florida ADRC Clinical Core, and directs Scientific Project 2 with co-Leader Rosie Curiel Cid. Dr. Loewenstein states, “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 stateof-the art research in AD and related disorders.” This will expand the infrastructure for UM to secure additional NIH funding for program projects, center grants, R01s and training opportunities for the next generation of clinical and translational scientists.
LASSI-L® The Lowenstein-Acevedo Scales for Semantic Interference and Learning, or LASSI-L®, is a cognitive stress test akin to an exercise electrocardiogram. It is highly related to biological AD changes in the brain before the emergence of clinical symptoms such as amyloid load (amyloid are complex proteins deposited in tissues or organs), fMRI functional connectivity, and loss of volume and cortical thickness in the brain. Early detection leads to a better understanding of the pathogenesis of AD, preventive and earlier interventions, and helps more effectively assess participants who may benefit from these newer interventions.
CNSA Center for Cognitive Neuroscience and Aging
Faculty Feature | Dr. Anthony Castro | Assistant Professor, Department of Psychiatry and Behavioral Sciences hat was your career path to UM? I joined UM in 2007. I was in Boston at the time finishing my training when I connected with the department. Miami was in the midst of one a growth spurt, and the University seemed to be following the same path. Having been born and raised in the city, becoming a part of this growth and the specialized services addressing the diverse needs of my hometown seemed like the right move. However, it was the caliber of colleagues, the culture of collaborative professionalism they had cultivated, and the department’s genuine commitment to their patients that ultimately made me decide to join the department.
W
Is there an area of psychiatry/ psychology/behavioral sciences that you specialize in? My clinical practice focuses primarily in the areas of anxiety and mood disorders. Approximately 300 million people in the world struggle with a mood disorder. Anxiety is estimated to affect another 260 million worldwide. These conditions can affect individuals throughout their life, regardless of age or gender. Even in their milder form, the impact on any individual’s daily experience can be quite significant. The good news is that as a profession we have developed very effective treatments to address these conditions and improve the lives of our patients. The unfortunate news is that only about 35 percent of individuals
N
FACES
experiencing related symptoms end up seeking professional treatment. This tells me that there are many people ‘trying to manage’ and ‘dealing with’ much more in terms of their symptoms than may be necessary. Increasing awareness and access is part of the goal. When not seeing patients, I consult in forensic mental health; assisting the courts, attorneys, and organizations to better understand the complexities of human behavior and psychological functioning as they apply to the legal system and workplace environment. Matters involving claims of psychological injury, wrongful death, impaired professionals, high conflict custody, and violence risk are some examples. What led to your interest in this area? I’m sure Law and Order, the OJ Simpson case, and the occasional James Patterson novel had something to do with it. But reflecting on it more, I think the ultimate motivation came from my experiences while training. My internship training emphasized issues of cultural diversity and mental health. Issues of health disparities, institutional inequality, and the need for greater cultural sensitivity were at the forefront of our studies. A bit naive of me at the time, but the notion that even when it came to healthcare, individuals were being treated differently on a national scale based on issues of race and ethnicity was surprising, and disturbing. Research findings that minorities in the US were more likely to become ill, and yet less likely to received medical care didn’t make
The UM Department of Psychiatry and Behavioral Sciences extends a warm welcome to new members of the team:
Luis Tuesta, PhD Assistant Professor
Maria Teresa Rivas-Torres, MD Assistant Professor
Dylan Hoyos Research Assistant
Michelle Rodriguez-Diaz, PhD Assistant Professor
Raul Banos Research Associate
Paola Rothberg Research Associate
Zelde Espinel, MD Assistant Professor
Bianca Tercero Research Assistant
Daema Piña, PsyD Assistant Professor
sense. I soon noticed similar issues affecting my patients in a legal sense, in instances of immigration, juvenile delinquency, and family disputes. Research questioning why minority groups were so overrepresented in the criminal justice and correctional systems, at times two to three times that of majority groups, further fueled my interest. This underrepresented medical care yet overrepresented incarceration really threw me for a loop. It was at this time that I was introduced to the role of a forensic psychologist. I learned the unique position forensic psychologists are in to help legal professionals also shed light on any intentional or unintentional influence caused by our own hidden biases. This really sparked an area of special interest. I then went on to complete a two year fellowship in forensic psychology. If you weren’t a clinical psychologist, what would you be doing? What first comes to mind is how interesting and satisfying I find this profession, and how grateful I am for my patients who truly make my experience meaningful and particularly special. I am repeatedly impressed and humbled by the level of awareness, courage, and dedication to improving one’s life experience that I get to see on a daily basis. I truly believe that I get to witness some of the most encouraging and comforting displays of human character. For this, I feel blessed. Now, if you are asking outside of my profession, I would have to say something along the lines of a traveling food critic. I am somewhat of a foodie. Traveling to meet new people, experience diverse cultures, and learn about their history through their cuisine for some reason catches my attention. Last book you read? (DSM 5 does not count!) For the past year, ever since my daughter was born, it seems like I have been reading nothing but bedtime stories. God Bless You & Good Night and My First Christmas, which by now I can probably recite in my sleep, are two of her favorites. Probably some of the best reading I have done.
11 | BrainStorms | Q1 | 2019
Worried about PTSD in your student? Here’s what to look for and how to get help | Dr. Nicole Mavrides pon waking on Sunday morning, March 24th, I was completely shocked and devastated to find that another member of the Parkland community, a student from Marjory Stoneman Douglas High School, had killed himself. This marks the 2nd suicide, in the past week, of students who were in attendance last February 14, 2018, when the tragic school shooting took place. As an MSD alumni, a Parkland resident, and a child psychiatrist who has worked in the community, the shock of both the massacre and subsequent suicides has been heart wrenching. The Parkland community has been forever altered because of the horrific shootings and now, when we are trying to heal, we are continuing to lose students in its aftermath. Do you remember that following the Columbine shooting, there were almost as many suicides as there were students killed in the actual massacre? And now, only a year after the March for Our Lives campaign in Washington DC, we have had 2 more young adults taking their own lives. How many more innocent children are quietly suffering without getting the help that they need? Suicide is the 2nd most common cause of death for children and adolescents between the ages of 5-24. Important to note that the majority those that either attempt or actually commit suicide have had a significant mental health disorder like depression or PTSD. We need to be talking openly about Post-Traumatic Stress Disorder with the community, students, teachers, and families to ensure that everyone is aware of what can be considered warning signs, and emotional cries for help. Any child or adolescent (or adult) who experiences a catastrophic event can develop PTSD; the shooting at MSD absolutely qualifies as a catastrophic event. The risk of PTSD is related to the seriousness of the trauma, the proximity to the trauma, and his/her relationship to the victims. In addition to anger and sadness over the shooting, some survivors may also feel
U
12 | BrainStorms | Q1 | 2019
fear and have a sense of helplessness. Some kids who experience repeated trauma can develop dissociation, which is an emotional numbing that blocks out the pain. I believe that many of the students attending MSD, have repeated trauma because they see the building where the shooting occurred every single school day. Even though they are not using the building any longer, its sheer presence can trigger trauma to both the students and the teachers. Many survivors avoid situations or places that remind them of the trauma. However, since school is an integral part of a teenager’s life, it is almost impossible to avoid the horrific site where the shootings took place, unless they change schools or no longer attend MSD. If children/teens don’t get help for their PTSD, they can become less emotionally responsive, depressed, withdrawn, or detached. If parents or teachers believe that a student may be experiencing PTSD, symptoms to be aware of can include: l l l l l l l
l l
Frequently worrying about dying Losing interest in activities they previously enjoyed Physical symptoms like headaches/ stomachaches Problems falling and/or staying asleep Being irritable or having anger outbursts Problems focusing/concentrating at school—grades declining Regressing—acting younger than their age (separation anxiety, school refusal, thumb sucking) Showing increased alertness to the environment Having vivid or frequent nightmares/ flashbacks/memories of the traumatic event
We, as professionals, understand that early intervention is key. Helping kids, teachers and families feel safe is of the upmost importance when dealing with trauma. Unfortunately, it seems as
though many students and families are continuing to suffer in silence. Many of the aforementioned symptoms of PTSD may also be signs of depression; which students and faculty at MSD can be suffering from. Oftentimes, teenagers feel confused and/or embarrassed by their feelings and may try to hide them from caring adults. Part of our job as Mental Health Professionals is to make communication nonthreatening. Parents and teachers need to keep lines of communication open by talking to their children, asking about how they are feeling, and inquiring to see if they are sad or depressed. Adults should never be afraid to ask their children if they are having thoughts of suicide—this will not put thoughts into their head, but rather, will help to determine if their child needs urgent psychiatric assistance. If you think that your child is depressed or suffering from PTSD, please get them help. Speak to their pediatrician, a school counselor, a psychologist, or a psychiatrist. If your child is experiencing suicidal thoughts, this should be considered an emergency and they should be evaluated by a mental health professional as soon as possible. The long-term goal should be to get these children and families the help that they so desperately need. Please note, anniversaries of tragedies and subsequent horrific events, like our two students committing suicide, are possible triggers. Parents and teachers, please be diligent as you listen and observe these young adults. Dr. Nicole Mavrides is a graduate of Marjory Stoneman Douglas High School and the medical director of UHealth’s child psychiatry consultation service. This article originally appeared in the Miami Herald in March 25. https://www.miamiherald.com/ living/healthfitness/ article228410859.html
HELP IS AVAILABLE If you or someone you know are in crisis or at risk for hurting themselves or someone else, please use the resources below to seek help immediately.
911 National Suicide Prevention Lifeline
1.800.273.8255 UM Department of Psychiatry and Behavioral Sciences
305.355.9028 13 | BrainStorms | Q1 | 2019
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.
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.
University of Miami Hospital (UMH) Mental Health Admissions/ER 305.689.4444
Office Numbers
Jackson Behavioral Health Hospital Triage 305.355.7332
Main Psychiatry Appointment Scheduling 305.355.9028 *Option 1
Common Purpose
Transforming lives through teaching, research and service.
Chairman’s Office 305.243.6400
Courtelis Center 305.243.4129
Jackson Behavioral Health Hospital 305.355.9028 *Option 2
Deerfield Beach 954.571.0117
University of Miami Hospital 305.689.1352 Boca Raton 561.939.4044 Child & Adolescent 305.355.7077 Soffer Clinical Research Center 305.243.2301
Center for Cognitive Neuroscience and Aging (CSNA) 305.355.9081 Brain Fitness Pavilion 305.355.9080 *English, Option 3 Memory Disorders Clinic 305.355.9065
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
Clinical trials are the backbone of evidence-based medicine. Broadly speaking, clinical trials evaluate the safety and effectiveness of a medical strategy, treatment, or device. Moreover, clinical trials provide an opportunity for the general public to participate in the process of developing novel treatments for a variety of conditions. The results from these clinical trials provide the data necessary to assist in future medical decision-making. The Department of Psychiatry & Behavioral Sciences is dedicated to generating the scientific knowledge behind the clinical best practices we incorporate in the treatment of difficult and complex mental health conditions. The Behavioral Research Assessment Center (BRAC) is the research hub that fulfills the Department’s mission to develop the next line of treatments. For more information on participating in available clinical trials, please email brac@miami.edu or call 305.243.5840.
Q1 | 2019
BRAINSTORMS Quarterly Publication of the University of Miami Department of Psychiatry and Behavioral Sciences Executive Editor Samantha Richter Soffer Clinical Research Center 1120 NW 14th Street | Suite 1457 Miami, FL 33136
Health
UNIVERSITY OF MIAMI HEALTH SYSTEM Psychiatry & Behavioral Sciences
14 | BrainStorms | Q1 | 2019
