Spring 2020 The publication of the University of Miami Department of Psychiatry and Behavioral Sciences
Special Section
Coping with COVID-19 Managing your mental health during a worldwide pandemic
In This Issue SPECIAL SECTION
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Coping with COVID-19 Managing your mental health during a worldwide pandemic
Get to Know Dr. Barbara Coffey Our new Department Chair talks career interests, the changing landscape of psychiatry, and COVID-19
CNSA and Team Science Take Center Stage at Dean’s Interdisciplinary Research Seminar
After 35 Luminous Years at UM, Dr. Mahendra Kumar, Beloved Professor and Colleague Set to Retire
Dr. Phil Harvey & Colleagues First to Publish on Implementing a Protocol to Assess Real-Time Mental Health Challenges of COVID-19 in Individuals with Serious Mental Illnesses
Letter from the Chair Dear Friends, my name is Dr. Barbara Coffey and I am pleased to be writing this letter to you as the new Chair of the Department of Psychiatry and Behavioral Sciences at the University of Miami Miller School of Medicine. I joined UM in 2017 as the Division Chief of Child and Adolescent Psychiatry, and in 2018 was designated as Co-Director of our Tourette Association of America UHealth Center of Excellence. Since my appointment as Chair in February, I could never have imagined how rapidly the public health sector would change due to COVID-19. Our nation is reeling from the troubling diagnoses and loss of loved ones, including many here in Miami. When tragedy strikes so close to home, it is difficult to deny the severity of the situation. As physicians, we swear to treat our patients to the best of our abilities – our UM/JMH doctors, nurses, medical personnel, support staff and residents have been exemplary in their fight for patients, and the tools needed to best beat this disease. These outstanding individuals are taking enormous personal risk in the face of a worldwide pandemic, the likes of which the majority of us have never seen before. We must all be deeply grateful. While we are focused primarily on physical health right now, it is also important to try to stay in tune with our mental well-being. There is no substitute for a healthy population, sound in both mind and body. Changes in routine, forced self-isolation, lack of our usual interaction, and absence of social gatherings for both celebratory and mournful occasions are truly a test of our resilience. We have come to realize the economic and emotional implications of COVID-19 are bound to have major impacts. Many adjustments will need to be made, not just physically but also mentally, and in our approach to re-entering society and adapting to “the new normal.” Fortunately, the nature of psychiatric and psychological treatment offers the opportunity to provide services via Telehealth. An already established and expanding sector of medicine, Telehealth is evolving into a critical tool that allows providers to continue and maintain services in unprecedented times like we are facing today. Research has shown that sudden interruption or discontinuation of treatment can have deleterious effects on individuals. I would like to take this opportunity to thank our Department’s teams who have worked to get our telehealth technology up and running and adapting quickly to a new method of serving our patients. And a very special thank you to our patients for embracing and accepting our decision to administer treatment through this online platform.
Your patience, support and goodwill during this challenging time is so meaningful. Thank you for doing your part to help combat this pandemic, and to keep yourselves and others safe. Please continue to follow our health organizations’ guidance to help us mitigate the impact of this devastating virus. Most Sincerely,
Barbara
photo credit: Instagram @jacksonhealth
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The Power of Positivity During the Coronavirus Pandemic By Mousa Botros, MD and Spencer Eth, MD
The emotional impact of the viral pandemic is undeniable. We will all experience unwelcome changes in our activities of daily living routine that increasingly aects almost everything we do. And in the coming weeks, many will suer the loss of loved ones to the disease. It is important to remember that we are not alone in this crisis and that, although we may feel helpless, there is much we can do.
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Finding a purpose and a meaning to this struggle will sustain our mental wellbeing. Since the spread of COVID-19 started in December 2019, it has quickly become a progressively threatening public health menace that has claimed many lives and disrupted many others worldwide. In the aftermath of a natural disaster, we face a cascade of stressors, such as shortages of necessities, school closures, economic recession, unemployment, and the ever-present fear of serious illness or death in ourselves and our loved ones. No one will be unaffected, and some people, especially those who are emotionally vulnerable, may show signs of irritability, anxiety, sadness, mood swings, anger, poor frustration tolerance, and disturbed sleep disturbance. This is a time for everyone to remain mindful of our mental wellbeing and to practice positive coping strategies. Social distancing can be a stressful experience. It is, however, far less difficult when people understand that we are not only safeguarding ourselves but also benefiting others, especially those who are susceptible, such as the elderly and the immunocompromised. Quarantine is a historically validated measure of containing pandemics, such as leprosy, the plague, and the Ebola outbreak. Although it may seem like “detention,� it is an affirmative preventive action that is available while
waiting for the deployment of vaccines and treatments that are under investigation. Our feelings towards others during this stressful time can be of great help as well. Coming together as a community is a cornerstone in slowing the progress of the pandemic and in strengthening our resolve. Taking personal hygienic measures such as washing hands, coughing away from others into our elbows, eliminating unnecessary travel, and avoiding gatherings and eating in public places in groups, will be beneficial not only to blunt the infection but also a way of emphasizing our role as good citizens. Our attitudes towards family, friends, neighbors, and strangers can be a meaningful way to cope with stress positively. As we further appreciate our duty to show concern and care for one another, starting with the simple public hygiene steps, we embrace our moral selves and seek a degree of gratification in knowing that we helped. This piece was originally published in UMiami Health News on March 19, 2020. Dr. Mousa Botros is a Forensic Psychiatry Fellow at the University of Miami Miller School of Medicine, and Dr. Spencer Eth is Professor of Psychiatry and Behavioral Sciences and Chief of Mental Health at the Miami VA.
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Kindness in the Time of Coronavirus By Ana Veciana-Suarez
Kindness is a miracle drug, and its potent effects are especially needed in these fraught times. Perform a kind act for a friend, neighbor, or stranger, and it will boost your mood. Kindness remaps the brain. “When you’re kind,” explains Dr. Felicia Gould, a clinical neuropsychologist with the University of Miami Health System, “it’s not only the other person who feels good. You feel good too. It’s a win-win situation.” Felicia Gould, PhD
An overview of brain studies recently published in NeuroImage revealed how kindness is expressed in the brain—and it’s visually uplifting. When scientists looked at brain scans of people performing generous acts or even thinking altruistically, the “kindness”centers of the brain lit up. They also noted that there were two kinds of kindness: strategic and altruistic. As the name implies, with the first type, you expect something in return for your good behavior. In type two, the action has no reward in mind, except for wanting to do good. Both resulted in a rush of positive feelings. Still, each activates different parts of the brain: the striatal region for when you're expecting some reward, the subgenual anterior cingulate cortex when doing altruistic good. What's more, a generous act also affects the ventromedial prefrontal cortex, which plays a big part in making those decisions that bond us together. So what does all this surge in brain activity mean? “Kindness has incredible health benefits,” Dr. Gould adds. “And it doesn't have to be a big thing. It can be a small act.” Years of research have shown that acting kindly releases essential brain chemicals that help us feel better. For example, kindness pumps up serotonin production. This neurotransmitter has a calming and anti-anxiety effect. Some believe it can even give your immune system a boost. Kindness also releases dopamine, a chemical messenger that, among its many duties, can make you feel good. It’'s been nicknamed “helper’s high.” Even witnessing a kind act prompts your body to
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produce oxytocin. Often referred to as the “love hormone,” oxytocin is released when we're physically intimate and when mothers breastfeed. It's the chemical that makes us feel more loving, more optimistic, more trusting, and more generous. There's more evidence of the health benefits of kindness: Doing good is a natural painkiller because it produces endorphins. It tends to reduce stress. (Kind people have been shown to have 23% less cortisol, the stress hormone.) Kindness can also lower blood pressure. (Oxytocin releases nitric oxide, a chemical that dilates blood vessels.)
photo credit: Instagram @thehungrypost
“In a way, while we’re helping others and helping communities, we're also helping ourselves,” Dr. Gould says. In the era of COVID-19, when people are fighting over toilet paper, and the mere sound of a cough can scare us, Gould believes an act of kindness, random or otherwise, can go a long way in defeating anxiety. Here are her suggestions: l
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Start with kindness towards yourself. Eat healthy, get enough sleep, physical activity, and outdoor time. Follow the doctor’s orders. “You have to be kind to yourself and take care of yourself, to be able to take care of others,” she says. Be gentle in your language. You may be tempted to make a snarky comment on social media—after all, we’re all under stress—but resist the temptation.“Instead, use words of affirmation. Use supportive, kind language. That goes a long way.” Be patient. “Don’t honk at the car in front of you when the light turns,” she says. “You don’t know what’s going on in that person’s care, health, and life.” Use social media to connect and be kind toward others. Socializing remotely and “rallying your friends to connect, while being as inclusive as possible” is an act of kindness. Do a Zoom chat with friends. Set up a virtual group playdate for your child. Being proactive in maintaining social connections helps you and others.
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Don’t hog up supplies. “Somebody might need it more than you do.” Donate to charity if you are able. Pick one that is likely to be most affected by this crisis— food banks, say, domestic violence shelters, United Way. Use your imagination to recreate the milestone events social isolation has canceled. “Celebrating helps everyone involved.” Keep in touch. Send funny videos of yourself. “I have a friend who anonymously sent flowers to all her friends with a note that read ‘pay it forward,” Gould says. “That makes everyone feel good.”
Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. This article originally appeared in UMiami Health News.
photo credit: Instagram @umneighbors
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Mental Health Experts Reach Out to Stressed Caregivers By Maya Bell
University of Miami mental health professionals are ramping up to help the health care workforce cope with the toll of treating COVID-19 patients. The confidential questions that health care providers asked at the University of Miami’s first wellness webinar were as difficult to hear as they were to read out loud. How do I deal with being afraid to go to work? What happens if my anxiety gets out of control? How do you ease a panic attack? How do I deal with the anger and irritability I am feeling constantly? “For me, the questions were really heart wrenching,” said clinical psychologist Deborah Jones Weiss, professor of psychiatry and behavioral sciences, who has spent decades helping vulnerable people navigate life with HIV. “When I was reading the questions, I felt their fear.” That palpable fear underscored the urgent need for the new UHealth Wellness Program that Jones Weiss and a small army of other mental health experts eagerly joined to help health care providers cope with the psychological toll of treating patients with the highly infectious novel coronavirus that has disrupted every facet of our lives— and significantly compounded the stressors providers normally face. As Jones Weiss, the co-director of the Center for HIV and Research in Mental Health (CHARM) said, “How can we ask health care providers to take care of us if we aren’t willing to care for them?” Organized by the Miller School of Medicine’s Department of Psychiatry and Behavioral Sciences, in collaboration with CHARM and the Department of Psychology at the Colleges of Arts and Sciences, the wellness group recently kicked off a series of webinars and group sessions for physicians, nurses, residents, fellows, and support staff. They are aimed at providing self-care strategies and resources for minimizing distress, fostering resilience, and preventing burnout that was common among health care providers even before the pandemic required them to risk their lives to take care of gravely ill patients—and stand in for family members who can’t visit them. Nearly 100 people tuned into the first webinar, which Jones Weiss and CHARM director Steven Safren, an international expert in cognitive behavior therapy and anxiety disorders, led earlier this month. The first two of a set of four weekly group sessions begin Tuesday evening,
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one focusing on grief and the other on mindfulness. The next two, which will take place Thursday evening, focus on managing anxiety and on parenting and family issues. More than 70 Department of Psychiatry and Behavioral Sciences faculty members and community clinicians also have joined forces to offer free, confidential, and individual telephone or telehealth coaching sessions for health care professionals who need help coping with the new demands of their jobs. The sessions are designed to help them draw on their strengths and build their resilience. If needed, they can get referrals for additional mental health care. As Safren noted during the first webinar, there should be no shame or hesitation in seeking such coaching. “Please continue to do what you can. But don’t burn out, because we need you. And, the way that you don’t burn out is that you take care of your mental health,” he said. “It’s just like having a physical health problem. If you think you may need help or guidance, you should get it.”
“For me, the questions were really heart wrenching. When I was reading the questions, I felt their fear.” Dr. Deborah Jones Weiss, Co-Director, CHARM
Dr. Radu V. Saveanu, professor and executive vice chair of the department, said planning for the wellness program began before China confirmed the existence of the virulent pneumonia-like disease in December. By then, Dr. Joan St. Onge, the Miller School’s senior associate dean for faculty affairs and interim chair of the Department of Medical Education, had asked him to develop an ongoing program to address the psychological and emotional needs of clinical faculty and staff. The primary goal, Saveanu said, was to help health care professionals develop a healthy work/ life balance and avoid burnout. But as COVID-19—which has infected more than 3 million people and killed more than 210,000 around the world—began its relentless march to South Florida, the program took on a new urgency. Suddenly, it had to address a rapidly unfolding crisis for health care workers, many of whom can no longer unplug and recharge at home. There, they often worry about infecting and comforting homebound loved ones, who are struggling with their own fears and anxieties over their disrupted lives. “You can call what we’re doing an emotional BandAid,” Saveanu said. “It’ll get us through right now, but what we’re talking about is what we need to have in place for the next wave—when the pandemic begins to wane and the psychological needs begin to surface. Generally, when there’s a crisis, we deal with the crisis and push
our mental health needs aside. So right now, we’re providing a lot of support and coping strategies. But I’m afraid the next wave will be more treatment-intensive.” For now, the personal coaching and group webinars, which Jones Weiss likens to President Franklin Delano Roosevelt’s “fireside chats,” will continue to deliver the kind of informative and reassuring messages like those that helped a traumatized nation get through the Great Depression and World War II. During the first webinar, Jones Weiss and Safren concentrated on strategies that can help health care providers find the middle ground between feeling they must be strong and do it all and feeling too overwhelmed to do anything. While they assured listeners that such feelings are normal, they emphasized that they must be dealt with. “Anxiety is a natural reaction to unpredictable, uncontrollable stress, and it’s a very natural reaction to a threatening situation, which this is,” Safren said. “We are in a situation with COVID-19 where the stress is continued, and we’re trying to mitigate that and slow down the reaction to prevent the conversion of acute stress to chronic stress.” Maya Bell is Senior Editor for the University of Miami University Communications. For a list of available mental health resources visit charm.miami.edu. For more information, email umpsychewellness@med.miami.edu or charm@miami.edu.
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How to Keep Your Anxiety Levels Down During the Coronavirus Outbreak By Vanessa Padilla, MD and Lujain Alhajji, MD Special to The Miami Herald on March 21, 2020
The novel coronavirus (COVID-19) pandemic puts our communities not only at risk of a medical crisis, but also increases stress and anxiety to many people, including children and adults. Uncertainty, excessive fear, irritability, anger, headaches, palpitations, stomach issues, changes in sleep and appetite—and yes, even boredom—are common reactions to a pandemic like the one we are facing. This is due to the perceived sense of loss of control, vulnerability and isolation from family, friends, and colleagues. People living with chronic medical issues, mental illness and substance use may see their symptoms exacerbated. Healthcare providers and first responders may also experience high levels of anxiety. It is important to keep calm and stay informed. Guidelines from the CDC and WHO are credible sources of information to review and share with your loved ones. Avoid spreading rumors or sharing non-reliable information. Too much exposure to social media can be overwhelming. Be mindful to take short breaks, stay grounded, and find things that bring joy to your life.
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Try to maintain a healthy lifestyle, including washing your hands, eating a balanced diet and exercising, avoiding alcohol or drug use, and connecting with others via phone or video calls. It is vital for those suffering from health issues to continue their medical treatment, to communicate with their health providers if symptoms get worse and to ensure that they have adequate support. If you are in a medical facility or have an upcoming medical appointment, ask your health provider if it would be possible to schedule a remote appointment via available phone/video technologies. While there is no clear road map for how to navigate the challenges we’re facing, we are all in this together. Vanessa Padilla and Lujain Alhajji are assistant professors in the Department of Psychiatry and Behavioral Sciences at the University of Miami Miller School of Medicine.
Florida Department of Health Awards $500,000 in Grants to our Expert Scientists Studying Alzheimer’s disease In the Center for Cognitive Neuroscience and Aging (CNSA), Elizabeth Crocco, MD, Medical Director of the Memory Disorders Clinic, received $250,000 from the Florida Department of Health. The grant, Building an advanced cognitive biomarker registry for African American older adults at risk for Alzheimer's disease, will leverage the expertise of investigators who have been actively and successfully working to engage African American communities in their research and clinical care. A growing body of evidence suggests that the prevalence of AD may be two to three times higher among older African Americans as compared to nonHispanic whites, yet they are significantly underrepresented in research. The aim of the project will be to build an advanced registry of 120 African American older adults at risk for Alzheimer's disease and related disorders using state-of-the-art and culturally relevant novel cognitive tests, as well as advanced neuroimaging of the brain and genetic analyses. This project fills a critical gap and is expected to become the foundation of current and future NIH-funded projects in Florida that include this under-served group of individuals. In the state of Florida alone, the Department of Elder Affairs (FLDOEA) estimates more than 500,000 people currently live with Alzheimer’s disease; and the Alzheimer’s Association assesses that it cost Medicaid about $2.6 billion to care for these patients in 2019, not including costs to Medicare and private health insurance. Previous Phase III clinical trials—those that test the safety and efficacy of a new treatment vs. a standard treatment— have yielded disappointing results. Fortunately, the team at the Center for Therapeutic Innovation (CTI) in the Department of Psychiatry & Behavioral Sciences has just received $250,000 to investigate a novel therapeutic strategy for Alzheimer’s disease! “We hypothesize that increasing the activity or expression of a specific epigenetic enzyme that appears to regulate several key Alzheimer’s disease targets will be protective for
Alzheimer’s disease,” asserts Claude-Henry Volmar, PhD, co-Principal Investigator for this grant and Research Lab Director at the CTI. “We intend to test our hypothesis in different Alzheimer’s disease central nervous system (CNS)-relevant models,” he added. “Positive results from the experiments delineated in this proposal would mean that selective activators of that enzyme would have the potential to one day alleviate Alzheimer’s disease for Florida patients and beyond,” affirms Claes Wahlestedt, MD, PhD, co-Principal Investigator for this project, Associate Dean for Therapeutic Innovation and Director of the CTI. The CTI houses teams of experts in neuroscience, pharmacology, chemistry, drug discovery, and Alzheimer’s disease who are dedicated to carrying out the experiments necessary to complete the work proposed here. University of Miami Project Personnel include Dr. Ines Lohse (Assistant Scientist), Dr. Farzaneh Modarresi (Research Associate), Ms. Natalie Ricciardi (Graduate Student) and Ms. Jessica Dennison (Graduate Student). Above: Elizabeth Crocco, MD. From left, Claes Wahlestedt, MD, PhD and Claude-Henry Volmar, PhD.
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Get to Know Our New Department Chair Dr. Barbara Coffey joined the UM Department of Psychiatry and Behavioral Sciences in October 2017, following five years at the Icahn School of Medicine at Mount Sinai in New York. She has dedicated her career to understanding the phenomenology and clinical course of children with tic disorders, Tourette Syndrome and related problems, and to identification of novel and innovative treatments, and has hundreds of original publications and numerous pioneering grants to her credit. Shortly after arriving at UM, she established a flagship program, the UHealth Tics, OCD and Related Problems Program. In 2018, the program was designated a Tourette Association of America Center of Excellence. Can you tell us a bit about what brought you to UM nearly three years ago? For family reasons! We had been thinking of moving to Florida for many years, as we have family in the area, and 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 completed 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.
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Dr. Coffey received the Virginia Q. Anthony Outstanding Women Leader Award in 2019.
Tanya Sokol (TAA), Dr. Coffey, and Amanda Talty (TAA) at the Mental Health America 2019 Annual Conference
With Dr. Karen Wagner, President of the American Academy of Child and Adolescent Psychiatry
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 individuals with Tourette’s, and thus come to the attention of child and adolescent psychiatrists because of their childhood origin. 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, since these conditions may be ultimately more impactful on quality of life than the tics.
Needless to say, starting this new role at the same time coronavirus was taking off has been very intense, and at times, somewhat stressful. But the dedication, support, and teamwork of Department members has been essential in this process, allowing us to continue to work to transform lives through patient care, teaching and research during this critical period. It has been amazing how each individual has pitched in and given his or her best, which has really eased the transition.
Assuming a major leadership role at any time entails a learning curve, but you became Chair in the middle of a pandemic; and arguably, in a city deemed a “hotspot” for coronavirus. What have been some of the biggest challenges and how are you working through them? A very important question! I had not actually applied for the Chair position, and as a result it took some persuasion on the part of the Dean and UHealth leadership for me to decide to step up to the plate and “take one for the team.” This was particularly true because I knew I would be following very strong leaders, Drs. Nemeroff and Saveanu. Nevertheless, I had gotten to know many of our Department faculty and staff as the CAP Division Chief, and was well aware that I had a wonderful group of colleagues with whom to work.
How do you think peoples’ mental health will be affected in these unprecedented times? There is no question that there will be a major and widespread impact of the coronavirus/ COVID-19 on our community’s mental health, at several levels. The impacts will vary widely depending on a number of factors, including whether one has worked on the frontlines in the acute crisis, been ill him/herself, or lost a loved one to complications of the virus. The impact of these factors, as well as protracted “social isolation” and quarantine, will also vary, depending at least to some degree on pre-existing mental health. Certainly for some this will constitute a major trauma that will need to be dealt with long after the acute health care crisis recedes. Others will draw about their own resilience and the support of family and friends to weather the storm. Can you share anything about your vision for the Department post-COVID-19? Unfortunately the coronavirus interrupted my strategic planning with our Executive Committee, which was going to be kicked off in April. And the impact of and recovery from COVID-19 will need to be integrated into our Department of the future, since it is quite likely that mental health care will be transformed by our experiences of dealing with the virus. My first job as Chair has been to get to know the faculty, and conduct “listening tours” to better understand their needs and aspirations. I am confident that as we work through this process, and integrate our collective COVID-19 experiences, we will emerge a stronger and more cohesive Department, striving for excellence in our academic mission.
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Swedish Ambassador to U.S. Visits Miller School to Discuss Research Collaborations and Exchanges By Damian McNamara
Karin Ulrika Olofsdotter, Swedish diplomat and Ambassador to the United States, visited the University of Miami Miller School of Medicine campus in February. She was here to talk about future collaboration, to gather ideas for increasing the exchange of researchers and students between countries, and to tour the Center for Therapeutic Innovation laboratory.
From left, Cecilia Lif, Claes Wahlestedt, M.D., Ph.D., Karin Ulrika Olofsdotter, Per-Olof Loof and H. Peter Larsson, Ph.D.
“We are a small but research-intensive country. From an embassy’s perspective and the government’s perspective, it’s very important for us to increase the movement of talent,” Ambassador Olofsdotter said. “How do we get Swedes to come out here to learn more, and how do we get Americans to come to us and do research?” Along with colleague Cecilia Lif, Counselor at the Embassy of Sweden in Washington, D.C. and Per-Olof Loof, Honorary Consul of Sweden in the U.S. for Florida, based in Fort Lauderdale, the Ambassador met with several Swedish-born faculty from the Miller School and the University of Miami Patti and Allan Herbert Business School.
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The Ambassador learned about the focus of research from Claes Wahlestedt, M.D., Ph.D., Eva Widerstrom-Noga, D.D.S., Ph.D., and H. Peter Larsson, Ph.D. She also asked each of them for advice on how to increase U.S.-Sweden cooperation on health and medical research. “Research has really increased a lot in the last few years here at the University of Miami. The NIH funding has increased every year,” said Dr. Wahlestedt, Leonard M. Miller Professor and associate dean for therapeutic innovation at the Miller School, who hosted the event. An academic medical center like University of Miami is an ideal setting, added Dr. Wahlestedt, who is also vice chair for research in the Department of Psychiatry and Behavioral Sciences. “We do translational research – and you need to be close to clinical experts.” He explained his research on the human genome and various diseases, including Alzheimer’s, a common condition lacking effective treatment options. Dr. Widerstrom-Noga completed her Ph.D. education in Sweden, moved to Miami and was invited to start a pain program at The Miami Project to Cure Paralysis. “There was some resistance at first. ‘Why would you study pain in spinal cord injury?’ some asked, assuming paralyzed people do not experience pain. “I didn’t believe that—I figured they had some sort of neuropathic pain.” When she asked patients, “everyone I spoke to had pain. . . but did not mention it.” Addressing this unmet need is one focus of the research by Dr. Widerstrom-Noga, who is a professor of neurological surgery at the Miller School. In terms of other Swedish-born researchers, “I pretty much know all the people in the world who do this kind of work,” she said. “Some come here from Karolinska Institutet [in Solna, Sweden], but we don’t have a formal exchange program.” “For me, something like that would be awesome,” Dr. Widerstrom-Noga told the Ambassador.
From left, Per-Olof Loof, Cecilia Lif and Karin Ulrika Olofsdotter.
Also Swedish born, Dr. Larsson got his Ph.D. at University of California in Berkeley. His research focuses on developing effective medications to help prevent sudden cardiac death. The alternative, placement of an implantable cardioverter defibrillator, can be “pretty expensive and invasive,” he said. Approximately one person in 2,000 has Long QT Syndrome, a major cause of sudden cardiac death. Many people remain asymptomatic, and it is “mostly children and teenagers who die,” said Dr. Larsson, who is professor and vice chair of research in the Department of Physiology and Biophysics at the Miller School. The Larsson lab has identified and filed a patent on a compound-based on fish oil. Dr. Larsson foresees the day when people at risk of sudden cardiac death can take a daily preventive medication, analogous to taking low-dose aspirin to prevent a heart attack. “We would love to have Swedish Ph.D. students here,” Dr. Larsson told the Ambassador. “For some reason we don’t have any applicants from Sweden.” Following the discussion, Therapeutic Innovation Laboratory researchers Claude-Henry Volmar, Ph.D., and Ines Lohse, Ph.D., led the Swedish delegation on a tour. They explained their work on pancreatic cancer cell lines, how they are repurposing existing drugs to treat this aggressive malignancy, and the latest advances in Alzheimer’s disease in this setting, also known as the Wahlestedt Laboratory. Ambassador Olofsdotter, in her official capacity, also promoted Sweden. Conducting research at a university in a different country can offer career advantages, for example. “To advance science and research, you really need new contacts and new collaborations.” In addition, the country is very family friendly, for example, with “excellent day care included in the taxes,” so it is possible to work and have a family, she said.
The workplace culture in Sweden is very egalitarian, she added, so input, opportunities and responsibilities are shared among all employees. “Many attest when they come to Sweden that they like the non-hierarchical structure,” Ambassador Olofsdotter said. The quality of life is “very high,” she added, with Sweden ranking No. 7 on the World Happiness Report in 2019 of the happiest countries, for example. “We are top 10 in everything, and that does not mean we do not have challenges, because we do, but compared to others, it is very good.” And in 2019, Sweden placed No. 1 for the second year in a row in the annual rankings of countries’ reputations as reported by the Reputation Institute, a reputation measurement and management services firm. “We would love to have all Americans come to Sweden, live it, and see for yourself,” she said.
From left, Claude-Henry Volmar, Ph.D., Claes Wahlestedt, M.D., Ph.D., and Ines Lohse, Ph.D.
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CNSA Presents on the Power of Team Science at Dean’s Interdisciplinary Research Seminar David Loewenstein, PhD, Director of Center for Cognitive Neuroscience and Aging and Rosie Curiel Cid, PsyD, Chief of Cross-cultural Neuropsychology at CNSA, presented to a full house at the Dean’s Interdisciplinary Research Seminar at the UM Clinical & Translational Science Institute (CTSI). Focusing on Team Science, they highlighted our worldwide collaborations with other medical/scientific institutions, and shared information on their latest and most promising work in the fight against treating and curing Alzheimer's disease and related dementias. Assembling an effective interdisciplinary team and enhancing group cohesion can help maximize the benefits and positive outcomes of a research project. Uniting specialists with the aptitude to offer a variety of perspectives from related fields allows investigators to consider and apply measures that could have tremendous impact on the furthering of science.
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In particular, state-of-the-art brain science requires a dedicated team of experts spanning cognitive neuroscience, neuropsychiatry, psychology, neurology, neuroradiology, image processing, biostatistics, computer science, genetics, anesthesiology, and other specialties. Outcomes stemming from these unique collaborations include scientific advancements as well as significant extramural NIH-funding.
Rosie Curiel Cid, PsyD
David Loewenstein, PhD
CNSA Essentials for Good Team Science Understanding that Working as a Team Strengthens Knowledge Common Scientific Vision with a Compelling Direction Focus on Diversity of Skills and Commitment to Training the Next Generation of Scientists Clear Delineation of Roles Equal Respect for the Contributions of All Disciplines Active Listening and Encouraging Effective Communication
Among Center for Cognitive Neuroscience and Aging and UM Collaborations: Department of Neurology and McKnight Center; Departments of Radiology and Nuclear Medicine, Anesthesiology, Computer Sciences, Psychology, the Hussman Institute for Human Genomics, CTSI, Center for Therapeutic Innovation and The Miami Project to Cure Paralysis. Among Center for Cognitive Neuroscience and Aging state, national, and international collaborations: National Institute on Aging, University of Florida, Florida International University, Florida Atlantic University, Mount Sinai Medical Center, 1Florida ADRC, Florida Health, University of Pittsburgh Medical College, Weill Cornell Medicine, Harvard University, University of South Carolina, FLENI, Complutense University, Instituto Nacional de Salud Publica, and Universität Parma.
The Dean’s Interdisciplinary Research Seminar Series is a monthly event that highlights innovative, collaborative, translational research conducted by University of Miami faculty across all disciplines. The main objectives of this series are to: feature outstanding teams engaged in interdisciplinary translational research across the University of Miami; highlight examples of research that cut across the real and/or perceived silos in academia; and engage the scientific community to think and work more collaboratively in all aspects of translational research.
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After 35 Luminous Years at UM, Dr. Mahendra Kumar, Beloved Professor and Colleague Set to Retire Mahendra Kumar, M.Sc., Ph.D., Professor of Psychiatry and Behavioral Sciences, will retire on May 31st after 35 years at UM. Dr. Kumar joined the Department of Psychiatry as Research Associate Professor in 1986, eventually becoming a Member of the Sylvester Comprehensive Cancer Center and receiving dual appointments as a Research Professor in the Departments of Psychiatry and Psychology. He has served as Chief of the Psychoneuroendocrinology/Psychoneurotransmitters Lab and in 2004 was awarded tenure in the Department of Psychiatry and Behavioral Sciences. Dr. Kumar received his doctorate in India and completed post-doctoral training at the University of California and the University of Pittsburgh. After returning to India, he served on the faculty at the Post-Graduate Institute of Medical Education and Research at Chandigarh. Dr. Kumar returned to the U.S. and joined the faculty of Albert Einstein College of Medicine before moving to Miami where he established a multi-disciplinary HIV research laboratory. Dr. Kumar is a pioneer in investigating autonomic activity in HIV infection. Some of his expertise includes: carrying out investigations on inflammatory markers, e.g., endocrines, neurotransmitters and cytokines, NeuroAIDS and collaborations in neuropsychological investigations. He has extensive experience in national and international research investigations involving drug abuse and HIV and has investigated endocrine responses to both pharmacological and psychological challenges. The first American investigator to receive an R01 by NINDS to study HIV in India, Dr. Kumar encouraged NIMH to sponsor an HIV-related Symposium at the Defense Research and Development Organization of the Government of India. This symposium facilitated HIV research for U.S. Investigators in India. Dr. Kumar has garnered more than $23 million in NIH grants and published over 200 papers in leading scientific journals. Dr. Kumar has been a dedicated member of various learned societies including the Editorial Board of the Journal of Neurovirology; Chair of the International Committee of International Society of Neurovirology; and
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In 2018, the Society of Neuroimmune Pharmacology (SNIP) presented Dr. Kumar with its Lifetime Achievement Award in recognition of the advances he has made in the understanding of HIV and AIDS.
was elected a member to various NIH ad hoc study sections. As a manuscript reviewer for more than two dozen publications, he helped identify and select some of the most powerful scientific findings to share with the medical community. In his time at UM, he was elected to the Faculty Senate, entrusted to oversee the decision-making process for selecting leadership positions at the medical school including Deans and Department Chairs. He also served on the Admissions and Promotions Committee and the Advisory Board of numerous graduate students. Over the course of his tremendously successful career, Dr. Kumar’s work has significantly impacted various fields and advanced HIV research. His mentorship and friendship has touched the lives of countless people and he will be greatly missed. We wish him all the best in retirement and are expressly grateful for his many important contributions to science.
In 2018, the Society of Neuroimmune Pharmacology
Those who have had the privilege of working with Dr. Kumar over the years shared some of their fondest memories about their time with him. “He is a dedicated, insightful scientist, and has spent many hours reviewing grant applications and manuscripts at home, far into the night. He is a strategist and has the art of grantsmanship mastered. He is a superb mentor and loves to support junior investigators and propel them forward. He is a great teacher and can break down the most complex biochemical information for the uninitiated. He doesn’t mind saying he doesn’t know the answer—but he always knows who does. He was a great husbandand loved to work side by side with his wife, Adarsh, and did so for decades. He is a family man, and cares deeply about his family. He is a great friend and is always willing to help someone needing support. He was a devoted member of the Rotary and is still fund raising for them. He is a connoisseur of all things India: food, art, dance, music.—Deborah Jones Weiss, PhD, Professor, Psychiatry and Behavioral Sciences “Dr. Kumar and I have worked together for over 25 years and I can honestly say that his presence in the Department was “one of life ‘s little treasures” for me. Not that we always agreed with one another, far from it! Unfortunately (for me) he was usually right, as he proceeded to dismantle my carefully constructed arguments. Fortunately, he then proceeded to elaborate his position in a very understandable “non-jargonny” fashion… i.e., he was a “natural-born teacher” as well as “scholar.” I learned a great deal from Mahendra. He readily shared his extensive fund of knowledge with others, whether you were a graduate student or full professor. He and his wife Adarsh, were also very collegial traveling companions on site visits to our projects in India. Finally, we “team-taught” a workshop (Grantsmanship 101) for several years for aspiring NIH grant applicants who wished to become conversant with the art as well as the science of obtaining NIH funding. During these sessions both of us recognized we were somewhat opinionated, which led to lively classroom discussions. Well, I guess we are two old dogs with respect to new tricks and are pretty set in our ways…but I wouldn’t have it any other way.” —Steve Weiss, PhD, MPH, Professor, Psychiatry and Behavioral Sciences
“I have known Dr. Kumar most of my career at UM. He has always been a kind gentleman and over the years I have looked to him for guidance and mentoring. We shared a common interest in HIV and he was always very interested in my work and I enjoyed hearing about his international projects and the impact he was having as a leading researcher in the field. As many of us in the field know, there is no better collaborator or mentor than Dr. Kumar. It was always refreshing to meet him in passing on campus or to have the fortunate ride with him on the elevator, where he always greeted me warmly with his lovely smile. He always took the time to ask about my wellbeing and my work, and you always felt the sincerity of his interest. I had the fortunate opportunity to work with his wife on the IRB and shared in his heartbreak when she passed. I have served with Dr. Kumar on the APT committee and Medical Faculty Council for many years. He is a champion of fairness and advocacy for all faculty and without hesitation would speak up on behalf of all faculty for what was right and important. We could always count on Dr. Kumar to remind administration, without hesitation, about the importance and value of PhD researchers in clinical departments. I am going to miss Dr. Kumar but I am so happy for him and this new phase of his life with his family. Congratulations to a wonderful human and accomplished research scientist for such an outstanding academic career and a legacy of kindness and mentorship.” —Love, JoNell Efantis Potter, PhD, Professor, Obstetrics and Gynecology “Dr. Kumar served the Faculty Council with great attention to the details. He always brought lively and pertinent discussion. He stood up for the greater interest of the faculty, staff and students. These committees could be time-consuming and arduous, but he always addressed issues with great humility, deep insight and perseverance. Dr. Kumar’s avuncular attitude eased and calmed everybody. Often at the beginning of meetings, he made self-deprecating remarks to lighten the atmosphere, but the issues were almost always serious, and his ingenuity was unmistakable. He willingly provided counsel and guidance to anyone who knocked on his office door or rang his phone. He is one of the most seasoned professors who I always approached for serious counseling and advice when I needed.”—Sanjoy Bhattacharya, MTech, PhD, Professor of Ophthalmology, Speaker of UM Medical School Faculty Council
Dr. Deborah Jones Weiss and Dr. Kumar
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Department Awards Philip D. Harvey, PhD, Division Chief of Psychology, Receives the American College of Psychiatrists’ 2021 Stanley R. Dean Award Dr. Phil Harvey, will be the next recipient of the American College of Psychiatrists’ Stanley R. Dean Award. The prestigious annual award recognizes outstanding research and contributions to the understanding and treatment of schizophrenia. Dr. Harvey is Leonard M. Miller Professor of Psychiatry and a VA Senior Health Scientist. He is the author of over 1,000 scientific papers and abstracts and he has written over 60 book chapters. He has been designated annually by Thompson-Reuters since 2010 as beingin the top 1% of all mental health researchers in citations. Dr. Harvey has received continuous Federal funding since 1985. His research has focused on cognition and
CL Resident Amalia Martinez, MD Receives CIR Women in Medicine Outstanding Female Resident Award Consultation-Liaison resident Dr. Amalia Martinez, has received the CIR Women in Medicine Outstanding Female Resident Award! This award goes to female residents and fellows who have displayed excellence in leadership, teaching, academics, research, mentorship, patient care, community outreach, and advancing women in medicine. Dr. Martinez was honored at a ceremony celebrating her accomplishments in December. Congratulations!
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everyday functioning across neuropsychiatric conditions, with a special focus on severe mental illness. His research has also focused on technology in mental health and aging, including novel assessment strategies and technology-based interventions. “I am very honored to have won this award. Although seven psychologists before me have received this award, the last time a psychologist won this award was in 1989. That winner was Irving Gottesman, one of the best-known psychologists in the history of our field. I appreciate the support I receive from the members of our department that makes these achievements possible.” Candidates for the award must be nominated and the winner is selected by the Board of Regents of the College. Past recipients of the award include some of the most prominent psychiatrists in the field whose work has led to novel and transformative discoveries in one of the most complex mental illnesses, schizophrenia. Dr. Harvey will be presented with the award at the ACP’s 2021 Annual Meeting, where he will also give a lecture about his impactful work. Congratulations! The Stanley R. Dean Award for Research in Schizophrenia has been awarded yearly since 1962. It is named for Dr. Stanley Dean, a psychiatrist who in 1957 created a foundation to distinguish schizophrenia from mental illness as a whole and to highlight it as one of the major public health problems of our time.
Clinical Trials Clinical trials are the backbone of evidence-based medicine. Broadly speaking, clinical trials evaluate the safety and effectiveness of a medical strategy, treatment, or device. Moreover, clinical trials provide an opportunity for the general public to participate in the process of developing novel treatments for a variety of conditions. The results from these clinical trials provide the data necessary to assist in future medical decision-making. The Department of Psychiatry & Behavioral Sciences is dedicated to generating the scientific knowledge behind the clinical best practices we incorporate in the treatment of difficult and complex mental health conditions. The Behavioral Research Assessment Center (BRAC) is the research hub that fulfills the Department’s mission to develop the next line of treatments. For more information on participating in available clinical trials, please email brac@miami.edu or call 305.243.5840.
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Publications JMIR Research Protocols, in press
Academic Psychiatry
Implementing a Protocol to Assess Real-Time Mental Health Challenges of COVID-19 in Individuals with Serious Mental Illnesses Philip D. Harvey, PhD This is a study that will examine COVID-related changes in mental health and behavior in a large cohort people with bipolar disorder and schizophrenia who have been in another immediately prior study. In that study, they were surveyed up to 90 times in 30 days about their symptoms, activities, and general mood state (12,406 total Surveys). WE will ask the same questions and see what is different after the COVID crisis because have such a stable background. People entered the study either because they were experiencing suicidal ideation or because there were concerns regarding their awareness of their symptoms. While taking appropriate safety steps, we hypothesize that individuals with suicidal ideation may experience increased ideation or other signs of hopelessness and that people with evidence of impaired insight may have challenges in grasping the magnitude of the crisis or that they may be particularly vulnerable to believing rumors or considering taking action regarding some of the incredibly bad medical advice that is being promulgated. These findings will help plan for future studies and see which people have the greatest (and least) reactions to large-scale traumatic events.
Neuroimaging Education in Psychiatry Residency Training: Needs Assessment David Martinez Garza, MD The authors investigated the attitudes, selfperceived knowledge, and the need for a dedicated neuroimaging curriculum surveying 183 residents from seven different University-based programs. Although a large majority of residents (83%) believed that neuroradiology education is important to psychiatric training, only 7% reported that they are receiving adequate training in this discipline. The majority (80%) believed that there should be a formal neuroimaging curriculum during their training.
Journal of Clinical Psychiatry Cyberbullying and Its Relationship to Current Symptoms and History of Early Life Trauma: A Study of Adolescents in an Acute Inpatient Psychiatric Unit Philip D. Harvey, PhD The study addressed both the prevalence and factors related to cyberbullying in adolescent inpatients and found that cyberbullying had the impact of amplifying symptoms of depression and post-traumatic stress disorder in young people who were inpatients at an adolescent psychiatric hospital. “Cyberbullying is possibly more pernicious than other forms of bullying because of its reach,” Dr. Harvey says. “The bullying can be viral and persistent. To really be bullying, it has to be personal – a directly negative comment attempting to make the person feel bad.”
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Physical Examination Skills Among Chief Residents in Psychiatry: Practices, Attitudes, and Self-Perceived Knowledge David Martinez Garza, MD The authors investigated the attitudes, self-perceived competence, and the need for a dedicated curriculum on physical examination skills among 79 chief residents in psychiatry. The majority of chief residents want to improve their physical exam skills (64%) and believe that there should be a targeted curriculum aimed at incorporating these skills into everyday psychiatric practice (63%). Over half of the chief residents (57%) reported that they only conduct physical exams on a few selected patients (< 25% of the time).
Cambridge University Press A pilot study of a stepped-care brief intervention to help psychologically-distressed women displaced by conflict in Bogotá, Colombia Zelde Espinel, MD Colombia’s 6.5 million internally displaced persons (IDPs) have been exposed to trauma, loss, and hardships. Common mental disorders (CMDs) are prevalent in this group, yet there are few evidence-based psychosocial interventions for this population. Zelde Espinel, MD, and her team assessed the feasibility and acceptability of a stepped-care intervention for women IDPs in Bogota, Colombia.
The Department of Psychiatry and Behavioral Sciences would like to sincerely thank all of our healthcare professionals at UM and colleagues around the country who are selďŹ&#x201A;essly ďŹ ghting on the front lines of COVID-19. It is because of you that we remain hopeful to soon return to a safe, healthy society.
What to Do & Where to Go
Common Purpose Transforming lives through teaching, research and service.
For a Mental Health Emergency, CALL 911 if you believe someone is in danger of hurting themselves or others. Jackson Behavioral Health Hospital Triage 305.355.7332
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
Silver Alert If your loved one has gone missing, please CALL 911 immediately.
Main Psychiatry Appointment Scheduling 305.355.9028 *Option 1
Silver Alert is a statewide
Chairman’s Office 305.243.6400
Jackson Behavioral Health Hospital 305.355.9028 *Option 2 University of Miami Hospital 305.689.1352 Boca Raton 561.939.4044 Child & Adolescent 305.355.7077 Soffer Clinical Research Center 305.243.2301
Courtelis Center 305.243.4129 Deerfield Beach 954.571.0117 Center for Cognitive Neuroscience and Aging (CNSA) 305.355.9080 Brain Fitness Pavilion 305.355.9080 *English, Option 3 Memory Disorders Clinic 305.355.9065
COVID-19 Resources
Mental Health Resources
For updates on UM actions and policy changes related to coronavirus please visit umiamihealth.org
In addition to UM, these organizations are offering mental health support and information during the pandemic.
Our Center for Cognitive Neuroscience and Aging’s statement on COVID-19 cnsa.med.miami.edu World Health Organization Follow the WHO’s global response to the coronavirus pandemic www.who.int Centers for Disease Control and Prevention The latest guidance and recommendations for fighting coronavirus in the U.S. www.cdc.gov National Institute of Allergy and Infectious Diseases Emerging research on the novel coronavirus www.niaid.nih.gov
The University of Miami Leonard M. Miller School of Medicine Department of Psychiatry and Behavioral Sciences is committed to: 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
American Foundation for Suicide Prevention www.afsp.org National Suicide Prevention Lifeline 1.800.273.8255 suicidepreventionlifeline.org National Alliance on Mental Illness www.nami.org/Home Mental Health America www.mhanational.org/covid19
The publication of the University of Miami Department of Psychiatry and Behavioral Sciences Executive Editor Samantha Richter Soffer Clinical Research Center 1120 NW 14th Street | Suite 1457 Miami, FL 33136
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