BrainStorms 2020 Winter Edition by University of Miami Department of Psychiatry and Behavioral Sciences

Winter Edition 2020â&#x20AC;&#x201C;2021 The publication of the University of Miami Department of Psychiatry and Behavioral Sciences

In This Issue

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Distance Learning: A New Normal Dr. Nicole Mavrides, Medical Director of Child Psychiatry Consultation Service, shares her observations from treating children during a pandemic.

How Are You Coping? Mental Health in the Time of COVID-19 Dr. Radu Saveanu, Professor of Psychiatry and Behavioral Sciences, weighs in on the hesitancy for some to seek mental health help.

Miller School Researcher Wins NIH Avenir Award to Pursue Innovative Opioid Addiction Research

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Doomscrolling: It's Not Good

Postpartum Life in the Midst of a Pandemic

Assistant Professor of Psychiatry and Behavioral Sciences Dr. Luis Tuesta on his prestigious $2.3M grant.

Dr. Felicia Gould advises on kicking the habit of searching out negative news online.

An Academic Looks at 40 Dr. Daniel Jimenez describes the life events that have influenced his impressive career thus far and how his identity has evolved as a Cuban-American straddling two worlds.

The postpartum period is challenging enough, but throw in a worldwide pandemic and conventional wisdom goes out the window. Dr. Vanessa Padilla on adapting to the â&#x20AC;&#x153;new normalâ&#x20AC;? with a newborn.

Letter from the Chair Dear Friends, The closing of a year is an opportunity for reflection, when we can pause to look back at professional and personal achievements, milestones, and unique and memorable occasions. While 2020 was unconventional to say the least, it cannot detract from our collective pride in the work we have accomplished within the Department. We have reason to be deeply grateful for the teamwork, tools and resources that allowed us to continue taking care of our patients over the past year. Mental health is and will continue to be a top priority in understanding the devastating impact of the losses we have experienced, of loved ones, livelihoods, and communities as we have known them. Physician-scientists around the world are working nonstop to develop vaccines for Covid-19 at breakneck speed. UM is one of 89 U.S. sites participating in clinical trials for the vaccine from Moderna Therapeutics. Recently, preliminary data demonstrated an impressive 94.5% efficacy. Vaccines are now available for the UM-JMH healthcare workforce. A silver lining in the pandemic is what has been termed the ‘Fauci Effect,’ named for Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. In a December 7th piece NPR reported that the Fauci Effect is driving a record number of medical school applicants—up 18% this year, according to the Association of American Medical Colleges (AAMC)—as undergraduates find themselves inspired by the work of public health figures and dedicated medical workers on the front lines of this unprecedented event. And here at UM, the usual applicant pool is around six to seven thousand; this year, it exceeded ten thousand. There is a critical need for physicians in the U.S. The AAMC projects that by 2033, there will be a shortage of between 54,000 and 139,000 physicians. The specialty of psychiatry is already facing a significant decrease in the workforce. We’re optimistic this trend is being reversed, as we’ve also noticed an increase in the number of students choosing to

pursue a medical career in psychiatry. In fact, my colleague and our wonderful Residency Program Training Director Dr. Radu Saveanu, recently said, “We received over 1400 applications this year and the quality of applicants has been spectacular. We invited 120 for interviews and it was a painful process to select this group. It's been a great season so far.” That said, the events of this year will stand out forever. But there is hope on the horizon. Please stay safe, vigilant, and patient, and have a happy, healthy holiday season. Let us welcome 2021 and getting back to “the new normal.” Most Sincerely,

Barbara

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Distance Learning: A New Normal Observations from a Child Psychiatrist in 2020 By Nicole Mavrides, M.D.

At the end of August, students and teachers usually return to school, but this year due to COVID, school began diﬀerently than ever before. In March, the majority of schools shut down and started with virtual learning primarily because of inadequate time to prepare and implement the new safety recommendations set forth by public health experts. Teachers were tasked with learning how to teach remotely while their students had to adjust to this foreign style of instruction. In October, many schools reopened with the option for a limited number of children to come in while others remained at home. Virtual learning has been a struggle for parents, students, and teachers alike—but for different reasons. Working parents are struggling because many are also transitioning to a work-from-home schedule; those with younger children may have to help them sign into classes, address technical difficulties, and encourage their kids to remain focused while still trying to get their own work completed. Other adults have returned to the workplace and thus have been struggling to find safe places for their children to distance learn or find a school where they can return to in-person education. Teachers are struggling with how to effectively teach a full day’s worth of material to students who are both at home and in the classroom, and some teachers with high-risk situations have elected not to return to the classroom. These abrupt changes have kids more easily distracted than ever before. The adults' issues are real but some of the more troubling issues lay with the children. Kids need social interaction as much as they need quality teaching. Virtual learning, especially for the youngest students, is difficult because social interactions are limited. Many high school and college kids seem to be having an easier time because they already know how to stay focused, can be home alone, and have other ways of interacting with friends. The youngest group of children, those in elementary school, tend to thrive in in-person classes where they also learn skills such as sharing, collaborating, and interpersonal communications. These necessary skills lay the foundation for future academic successes. It’s the students in transitional grades—kindergarten, 5th, 6th, 8th, 9th and 12th—who are also having difficulty. These students

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are either in their first or last year of elementary, middle, and high school and have had to begin the year in unprecedented ways. Traditionally, at the beginning of school, the challenge for these students is learning how to get to classes, but this year, students have had to learn new technology and develop ways to learn more independently. Students are struggling with attaining an education while also trying to maintain social friendships and relationships while social distancing and/or being virtual. Some of the psychiatric issues that we are seeing stem from some children being at school and some still being virtual. We are seeing an increase in depression in both children and teens; those who feel cut off from their friends and social groups as well as those who are just isolated and feeling sad at home. There has also been an increase in anxiety for many kids, especially as cases of COVID-19 are rising again. We are also working with young patients who are worried about their parents, grandparents, and teachers getting sick. They wonder who will take care of them or teach them if these people get sick. There is also a subset of kids who are anxious about their own likelihood of contracting COVID-19—to the point that they don’t want to go back to school, ride a bike, or even go on a walk with family members. Another big mental health issue concerns those who are struggling to focus. It’s difficult for most of us to maintain concentration on a virtual platform. But for those who were previously predisposed to ADHD, for example, being on a screen the entire day has been a challenge. Kids more quickly fall behind in their learning and parents and teachers feel

pressure to help them achieve academic milestones. Our offices are busier than ever, with parents reaching out for help because they are worried about their childrens’ mental, emotional, social and academic well-being. A question being asked is, ‘are our children safe returning to school when masks are worn, except when playing outside or while eating, having students and teachers washing hands throughout the day and if teachers, support staff or kids are sick, they have to stay

home’? We really do not have the answers because we are still seeing outbreaks at schools throughout the country. With the increase in cases and arrival of vaccines, what will school look like in Miami-Dade County and the rest of the nation in 2021? And what mental health issues are going to continue to be prevalent in our children and adolescents because of COVID-19? Dr. Nicole Mavrides is Assistant Professor of Psychiatry and Behavioral Sciences and Medical Director of Child Psychiatry Consultation Service.

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How to Overcome Anxiety and Panic Attacks By Nancy Moreland

As if 2020 weren’t anxious enough, the holidays are here. It’s enough to make you crawl in bed, pull a blanket over your head, and stay there until next year. There is a way to keep calm and carry on, says Felicia Gould, Ph.D., a clinical psychologist with the University of Miami Health System. “Anyone can experience symptoms of intense anxiety, but we don’t want it to dominate our lives,” Dr. Gould says. She acknowledges that 2020 rolled out a perfect storm of stressors. “We’re being deprived of things that enhance our mental health. The pandemic requires us to take new safety precautions and fear things that used to be commonplace in our lives, which creates anxiety. We can’t see it, but we know it’s there.” Although people with post-traumatic stress disorder (PTSD) may experience panic attacks, PTSD has its own set of symptoms, diagnostic benchmarks, and treatments. Panic attacks by themselves do not necessarily translate into any one specific mental health disorder.

with respect to panic attacks could lead to an actual panic disorder. Is this a one-time occurrence or a chronic problem?

How do you know if you’re feeling intense anxiety, a panic attack, or panic disorder? Dr. Gould says a true panic disorder has four characteristics: l l

What does a panic attack feel like?

When we feel threatened, Dr. Gould says, “Our autonomic nervous system gets revved up.” Whether you experience a fleeting moment of panic or a full-blown attack, one or more of the following symptoms may suddenly happen: l l l l

Rapid heartbeat (tachycardia) Shortness of breath Feelings of choking Dizziness

l l l l

Trembling or shaking Sweating Numbness or tingling Abdominal distress

Why is this happening to me?

What triggers a panic attack is as different as the people experiencing it. Anything from a car accident to public speaking, undergoing surgery, or only grocery shopping during a pandemic could provoke an episode.

You are intensely fearful. You avoid activities because they might trigger an attack. For example, an increased heart rate is one of your symptoms, so you avoid exercise because it raises your heart rate. You experience a panic attack, then persistently worry over the next month that you will have another. Your attacks are frequent, disabling, and disrupt your life.

When should you seek professional help?

If any of those situations apply to you, Dr. Gould recommends getting medical help. Start with your primary care doctor, who will rule out other conditions that could be exacerbating or mimicking panic-related issues. Once any underlying medical issues are ruled out, see a psychologist or psychiatrist. “Panic attacks occur in many different situations. It’s important to see a professional and get properly diagnosed. Therapists can design a treatment plan using cognitive behavioral therapy (CBT) and Exposure Response Prevention (ERP). Over time, they build up your confidence, increase your ability to tolerate stress, and help you regain your normal life.” continued on page 17

How long will it last?

Symptoms usually last five to 20 minutes. Dr. Gould says 15 minutes is average. Though some episodes may last up to an hour, that’s less common. “Your nervous system can’t sustain a full-throttle state for long periods.” Knowing there is an end in sight is key to coping with the situation. Although most attacks are short, they are incredibly unsettling. “If you have an intense fear of losing control or dying from the symptoms, it further escalates the attack,” Dr. Gould says. Living in a chronic state of anxiety and dread

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How Are You Coping? Mental Health in the Time of COVID-19 By Ana Veciana-Suarez

We have learned more about brain chemistry and mental health illness. But the stigma of being diagnosed with a psychiatric condition persists. “We've made some progress in the past 30, 40 years, but we still have some of those negative attitudes,” says Radu Saveanu, M.D. Executive Vice Chair of psychiatry and behavioral sciences at the University of Miami Health System. “Some still believe that it's a kind of character ﬂaw, that if you're strong enough, you can conquer it.” Consequently, these long-held misconceptions have often led to shame and resistance to seek help. During the COVID-19 pandemic, when reports show that anxiety and stress has worsened among adults and children, those attitudes can be particularly problematic. A new Centers for Disease Control and Prevention (CDC) survey revealed that more than 40% of U.S. adults experienced some form of “elevated” mental health condition associated with the coronavirus in late June. Of those, almost 31% reported anxiety or depression symptoms and 26% symptoms of trauma or stressorrelated disorder. Slightly more than 13% said they had either started or increased substance abuse to cope with their emotions. Minorities, younger adults, essential workers, and adult caregivers were disproportionally affected, reporting significantly higher risk for suicidal ideation. Published online in the CDC’s Morbidity and Mortality Weekly report, the study recommends a more robust public response in prevention and intervention. “Addressing mental health disparities and preparing support systems to mitigate mental health consequences as the pandemic evolves will continue to be needed urgently,” the authors conclude. Children’s mental health is concerning experts.

A Gallup poll of parents with school-aged children found that 29% say their child is “already experiencing harm” to their emotional health because of physical distancing and closures. Another 14% believed their kids could continue physical distancing for only a few more weeks until their mental health suffered These reports don't come as a surprise to clinicians who have fielded calls.

After all, the toll of the pandemic is more than physical.

As school and social activities remain restricted and high unemployment lingers, the helplessness and hopelessness that accompany isolation and financial insecurity will inevitably become a public health problem. More worrisome: “those who need help won't get it because of the pandemic,” adds Dr. Saveanu, adding that fear of contracting COVID-19 may add yet another obstacle to accessing treatment. However, there are ways to offset the pandemic’s impact on our mental health and that of our children. l Don’t be embarrassed to seek help. Dr. Saveanu suggests starting with your general practitioner. “About 65% of mental health care is provided by primary care physicians,” he says, “and that’s entirely appropriate.” More severe disorders will be referred to psychiatrists. l Take your medications, if prescribed. l Stay connected even as you physical distance. “Human contact is very important,” Dr. Saveanu says. “You need someone to share your fear, your anger, your hopelessness. Someone who will listen.” l Find ways to make life as normal as possible in these fraught times. A new routine can help. Zoom calls with friends might provide an outlet. l Remember that parental distress is often related to children’s heightened anxiety or stress. So make sure to look after your stress levels and seek psychological care for your child if you notice an increase in distress or unhealthy behavior. l Practice self-care. Cultivate optimism and healthy family relationships. Research shows these help kids adjust to the stress and trauma of this crisis. Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. This article originally appeared in UMiami Health News.

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Miller School Researcher Wins NIH Avenir Award to Pursue Innovative Opioid Addiction Research By Maya Bell

Luis M. Tuesta, Ph.D., assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Miami Miller School of Medicine, has been awarded the Avenir Award from the National Institute on Drug Abuse, part of the National Institutes of Health, to study the epigenetic mechanisms of microglial activation and their role in shaping the behavioral course of opioid use disorder. The goal is to ﬁnd new therapeutic targets to prevent opioid relapse and achieve long-term abstinence. Dr. Tuesta and the Miller School will receive $2.3 million over five years from the NIH. He is one of four researchers in the country to receive the award grant in 2020. Dr. Tuesta joined the University’s medical faculty in 2019 following a postdoctoral fellowship at Harvard Medical School. A Prestigious Grant

“This is one of the very best and most prestigious grants that a young researcher can receive,” said Claes Wahlestedt, M.D., Ph.D., associate dean for therapeutic innovation at the Miller School. As a former chair of the NIH Avenir Award Committee, Dr. Wahlestedt recognizes the distinct honor of receiving this competitive award. Dr. Tuesta explained his lab’s novel approach to understanding opioid addiction. “Throughout the history of addiction research, the neuron has usually played the protagonist role,” he said. “We are now setting our sights on the brain’s supporting cast of cells and how these can shape drug craving and relapse.” Namely, he and his lab are studying microglia, the resident immune cell of the brain. “Opioids can hijack the very tools that microglia use for sounding the alarm in case of a physical, chemical or biological injury,” Dr. Tuesta explained. “This artificial state of alarm can lead to neuroinflammation and shape the way we crave for opioids, ultimately leading to relapse. We believe epigenetic regulation in microglia plays a fundamental role in orchestrating this chain of events.” “Epigenetics” refers to factors that determine how genes are expressed without involving changes in the DNA sequence itself. Dr. Tuesta’s team will explore how microglial genes become “open and closed for business” across various phases of opioid addiction, and how specific epigenetic remodelers can contribute to this regulation.

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Exploring New Therapeutic Avenues

Results from these studies have the potential not just to broaden our understanding of the epigenetic mechanisms underlying opioid use disorder, but also to push the field of addiction epigenetics beyond the neuron and explore a cell type that could yield exciting and completely different therapeutic avenues for the treatment of this devastating disease. Ideally, a treatment drug would reverse changes in microglia brought on by opioids and curb the intense craving associated with opioid abstinence and withdrawal. Such an approach could help reduce the likelihood of relapse in recovering individuals. “Ultimately, we want to manipulate the root of the craving with a drug to change the behavioral course of addiction,” Dr. Tuesta said. Dr. Luis Tuesta in his lab.

Miller School Study Finds Linkage Between Depression and Bacteria in the Gut By Richard Westlund

A new laboratory study by researchers at the Univesity of Miami Miller School of Medicine has found a linkage between depression and the signals sent by bacteria in the microbiome of the digestive tract or gut. The ﬁndings could point the way toward potential therapies targeting the signal pattern or enhancing an individual’s mood through a healthy diet. “Microbial imbalances have been linked to major depressive disorders, but the mechanisms affecting mood remain poorly understood,” said Eléonore Beurel, Ph.D., associate professor of psychiatry and behavioral sciences, and biochemistry and molecular biology. “We have identified a new bacterial signaling circuit that Eleonore Beurel, Ph.D. promotes depressive-like behaviors in mice, linking the fields of microbiology and psychiatry.” In the study, Dr. Beurel looked at Segmented filamentous bacteria (SFB), a component of the microbiota of the digestive tract in many animals. “SFB can induce inflammation as part of the immune system’s response to infection,” she said. “We showed that SFB-deficient mice were resilient to the induction of depressive-like behavior, but were re-sensitized when SFB was reintroduced in the gut. To our knowledge, this is the first time that such interactions have been demonstrated.” Dr. Beurel was the lead author of the study, “Identification of a Signaling Mechanism by Which the Microbiome Regulates Th17 Cell-Mediated Depressive Like Behaviors in Mice,” published July 31 in the American Journal of Psychiatry. Miller School co-authors were Eva M. MedinaRodriguez, Ph.D., Derik Madorma, Gregory O’Connor, Ph.D., Dongmei Han, Ph.D., Sapna Deo, Ph.D., Mark Oppenheimer and Sylvia Daunert, Pharm.D., M.S., Ph.D. Charles B. Nemeroff, M.D., Ph.D., former chair of psychiatry, now with the University of Texas at Austin, was also a coauthor. The study analyzed how SFB in the gut use “quorum sensing” to determine if they are alone or in a group. Based on that signaling pattern, the bacteria work together to generate large numbers of Th17 cells, which increase inflammation and help defend against infection. However, overproduction of Th17 cells can lead to damaging vital organs including the brain.

“We found that reintroduction of SFB in SFB-deficient mice resulted in an increase in Th17 cells that led to depression-like behaviors in otherwise resilient mice,” Dr. Beurel said. “Mice that were deficient in Th17 cells were able to resist the induction of depressionlike behaviors.” Dr. Beurel noted that a high-salt diet has been shown to increase Th17 cells, leading to neurovascular and cognitive impairments. On the other hand, oleic acid, a component of olive oil, blocked the excess production of Th17 cells and has been associated with mental well-being and the ability to cope with stress. She added, “A healthy diet could potentially enhance mental health as well as physical well-being.” This article originally appeared in INVENTUM. Dr. Sylvia Daunert with researchers in the laboratory.

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Doomscrolling: It's Not Good By Wyatt Myers

When it comes to keeping up with what’s going on in the world, there’s no question that social media feeds have made it easier. But all this simple scrolling can come at a cost, especially when it seems the news is all bad. As days go by, that idle and absent-minded scrolling can negatively impact your mental and even physical health. It’s why the habit has recently gained the trending moniker, “doomscrolling.” What is doomscrolling?

“Doomscrolling is using social media, news apps, or other digital means to search for or consume negative news, disturbing news or anything with a negative spin,” says Felicia Gould, Ph.D., a clinical psychologist at the University of Miami Health System. “Since the outset of the pandemic, the availability of this kind of news has exploded. With rising death tolls, damages to the economy, job losses, family hardships, and racial discrimination dominating recent headlines, doom and gloom are easily accessible.” Doomscrolling can take its toll on almost anyone’s mental health.

If you’re an individual who is already prone to anxiety or depression, the toll can be even more significant. “This varies from individual to individual, but people with depression often have trouble managing negative rumination and negative thoughts,” she says. “By doomscrolling, they are essentially reinforcing a negative and depressive thought process and possibly even intensifying a pre-existing depressed mood.” As a person continues to excessively absorb negative information, the result can be a genuine impact on their day-to-day lives, says Dr. Gould. “Doomscrolling is likely to produce negative thoughts about one’s life, others around them, and the world. These thoughts can then be paired with potentially unhealthy behaviors such as social withdrawal and withdrawal from physical activity, leading to a more depressed emotional state,” she says. “For example, people may stop engaging in self-care, eating and drinking healthfully, and doing things for others. They may withdraw from talking to friends and engaging in other positive behaviors, because they don’t see the purpose in such a bleak world.” When you throw the social media component in the mix, the shock value of doomscrolling becomes even more pronounced. “Negative news is highlighted and sensationalized to increase views and reader engagement,” she says. “Online ‘trolls’ and their unfiltered comments and online arguments can make the impact of doomscrolling even more toxic.”

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Getting a handle on doomscrolling and your mental health

Luckily, you can take some simple steps to keep doomscrolling in check and manage its impact on your health. Here’s what Dr. Gould recommends: l

Timebox your scrolling. One of the simplest ways to prevent negative news consumption from getting out of hand is to put limits on it, notes Dr. Gould. If you have trouble doing this on your own, some apps can track your social media use and even put self-imposed limits on them. Find reliable, positive news sources. Putting a stop to doomscrolling doesn’t mean that you have to be uninformed. Instead, vet a select few reliable, informative news sources to depend on for your daily intake, rather than a social media feed. If the sources mix in some positive news, as well, that’s even better. Watch out for warning signs. If you find yourself depressed or angry while scrolling through social media, even if you’re viewing happy posts, then you might have a problem that’s worth keeping an eye on. Also, ask for help if you find leads to depressed mood, social withdrawal, and other warning signs. Take a social media break if needed. Many people take breaks from social media from time to time for this exact reason. “I have many patients who feel a lot better when they take a break from social media,” says Dr. Gould. And if you want to try it again at a later time, you can always come back to it if you feel like you’re ready. Talk to friends and family. A healthier way to engage in the daily news is to discuss it with trusted friends and family members. This can help you maintain social engagement and discuss your feelings about what’s going on in the world positively and constructively.

Wyatt Myers is a regular contributor to the University of Miami Health System. This article originally appeared in UMiami Health News.

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In Good Times and Bad, Emotional Resilience is Key By Dana Kantrowitz

Normal life can be hard. Disappointments and failures are unavoidable. But the challenges of 2020 have created a new normal—complete with increased anxiety and depression. “I think it’s super common to be a bit down and overwhelmed right now with everything going on around us,” says Nicole Mavrides, M.D., a psychiatrist with the University of Miami Health System. “It’s important to build up resiliency so that if/when something else challenging comes along, you know how to get through it or, at the very least, deal with it better.” What is resiliency?

Avoid negativity.

“Being resilient is having the capacity to recover from something difficult. It can be an internal or external struggle,” says Dr. Mavrides. “It doesn’t mean that resilient people never face adversity, stress, or problems. It means they are able to move past it without letting it define them.”

Limit your exposure to the news, social media, and individuals who trigger strong negative feelings. “This is one of the most important things I tell my patients,” Dr. Mavrides says. “I ask them to turn off alerts to the news (especially about COVID-19 and the election) and check it only three times a day.” When experiencing negative thoughts and feelings, allow yourself time to work through these reactions and come out on the other side.

Hardy people tend to be better at: l l l l l l

keeping setbacks in perspective not blaming themselves and others dealing with uncertainty responding to unexpected challenges avoiding feelings of helplessness and pessimism reaching their goals

How can you build up resiliency in the face of challenges? Prioritize your strong relationships.

Take care of yourself.

Limit alcohol and recreational drug use. Don’t allow yourself to stress-eat your way through hard times. Be patient and forgiving with yourself, as you would witha loved one. “Prioritize getting enough sleep,” Dr. Mavrides says. “If sleep is difficult, try a meditation app or speak with your primary care physician about it.” Accept change.

Keep in touch with your family, friends, and colleagues. Reach out to those with whom you’ve lost touch. Be more social. Join a hobby/interest-based group in person or online. Try to stay connected while socially distancing.

Life changes are unavoidable. Some are not positive, but learning to frame your new reality more optimistically can help you become a healthier and more content person. Imagine feeling excited by change and the new experiences it can bring, rather than being scared of it.

Practice daily mindfulness.

Be consistent with physical exercise.

Take breathers when you are stressed. Meditate. Pause to acknowledge your surroundings and your emotional reactions to them. Be more present and proactive in your responses to stressors/challenges. Dr. Mavrides reminds patients, “This is something that can be very helpful.”

Try walking, bike riding, playing sports, running, yoga, or HIIT workout videos. Regular exercise can lower your blood pressure, improve your sleep quality, and help you maintain a healthy weight. It’s also a productive way to spend time with others while encouraging each other to stick with it.

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Make yourself feel useful/find some purpose.

Identify a cause that inspires you, volunteer, help a friend or family member in need, or adopt a pet. Helping others will improve your self-esteem, take your mind off your stressors, and make you feel productive. Discover/rediscover your interests. Start a new hobby or pick up one that you used to enjoy. Read more for pleasure, listen to podcasts, make art, learn to cook, plant something in a garden, or join a group in person or online. Expand your daily or weekly to-do list to include activities that lift your mood and distract your mind and body. Set new goals for yourself.

These can be small, attainable tasks, like cleaning the kitchen. Or, they can be longer-term goals like learning a new language or how to code. Or focus on more significant objectives you need to accomplish, like polishing your resume and landing a job. Seek help when you need it. Ignoring or denying anxiety and depression will only make them worse over time. Hiding these feelings can deepen the experience of isolation and trigger feelings of shame. Reach out to a professional. Speak with loved ones you trust. Sometimes, just talking it out can relieve negative thoughts and feelings and help you realize you’re not alone. Learn from your mistakes.

“Growing from a mistake is way better than wallowing in it and repeating it,” Dr. Mavrides says. “There is real truth in

working through something difficult and not letting it happen again.” This approach can help you avoid crippling guilt and regret, which can inhibit your growth. Maintain your perspective.

What may seem overwhelming at the moment may not be a significant issue over the long-term. Try not to blow things out of proportion. This will help you manage your reactions to day-to-day challenges like running late for an appointment. Parents can help their children by letting them fail once in a while.

“I think young people don’t need to do anything different than adults—other than allow their experiences to shape them,” Dr. Mavrides says. “Failure helps them build resilience and makes them not want to repeat it. Don’t always allow kids to get whatever they want or do whatever they want. Having rules and structure can only help,” she says. “And when a child or teen is struggling, encourage them to try all of these tips and get the professional help they need. “We should teach kids that there will be stumbling blocks along the way. If we always expect things to work out perfectly, of course, we’re going to be disappointed. When we eventually reach our goals, it means a lot more to us because it wasn’t super easy. It’s all about perspective.” Dana Kantrowitz is a regular contributor to the University of Miami Health System. This article originally appeared in UMiami Health News

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An Academic Looks at 40 Daniel E. Jimenez, Ph.D.

For most of my life, I have lived straddling two diﬀerent worlds at once. I am ﬁrst generation Cuban-American—the son and grandson of Cuban immigrants who emigrated to the United States in the hopes of making a new and better life for themselves and their children. I heard heart breaking stories of separation, loss, and incredible hardship. Yet, despite the great adversity, I saw examples of great perseverance and resilience. Absent of material possessions, my family brought with them a wealth of traditions and values which they passed down to subsequent generations. Rice, beans, and plantains were served alongside the turkey and stuffing on Thanksgiving. We would roast a whole pig for dinner on Christmas eve. Ultimately, what these traditions did was to heal the wounds of immigration. They preserved what Castro could not take (i.e., their Cuban spirit) and brought the family together, tightening those bonds that had been stretched to their limits. Growing up in Miami, I was surrounded by people who looked and talked like me. We would speak Spanglish, flowing between Spanish and English in the same sentence. We would convert English words into Spanish and vice versa, creating neologisms in the process that only people in Miami would understand. Older adults speaking heavily accented or broken English and Cuban talk radio voicing anti-Castro, anti-communist sentiment, along with salsa, merengue, and mambo were the soundtrack of my daily life as a child. While I had an inkling that my experiences were not the norm, I had no idea just how different my upbringing was. That life lesson came when I left home to go to college. When I was growing up, going away to college was a foreign concept. It was something people did in TV and in the movies. It did not match the reality I saw all around me. The majority of my family members, friends, and high school classmates chose to go to local colleges. So, it was no surprise that I wanted to stay home as well. However, my parents had other ideas and told me, in no uncertain terms, that I had to go. In conversations with them now, they told me that they received a lot of grief from family and friends over their decision, but they thought it was in my best interest. I reluctantly chose the University of Florida in Gainesville. My thinking was that I would be a 5-hour car ride from home, and when my 4-year banishment was over, I would return to the friendly Cuban confines of Miami. Little did I know how drastically my life was going to change over the next 4 years. When I arrived in Gainesville, I immediately knew what Dorothy felt when she landed in Oz. I was so

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disoriented. My first class had more students in it than my graduating high school class. Luckily, I had a cousin, who is a year older, to help guide me, but that did little to offset the loneliness and isolation I felt. I struggled at first to make friends. I reached out to the Cuban American Student Association which was part of a larger Latin American Student Association, but I always felt like I was an outsider— I was among them, but I was not one of them. I felt spurned by them as if I was not Cuban enough to be part of that club. The reality was that I wanted to experience something different, something beyond my early life experiences. Eventually, I found a circle of friends with a great diversity of backgrounds (SES, religion, life experiences, points of view, etc.). With my time in Gainesville increasing and the bonds I forged becoming stronger, Again, I found myself straddling two worlds: the Cuban centric, Spanglish speaking one of my childhood and the one I built on my own as a college student in the American South. The upheaval in my personal life mirrored that of my academic life. Since I could remember, I have wanted to be a doctor, specifically a pediatrician. I was fascinated by medicine at an early age and charted a career path in that direction. In high school, I volunteered at the county hospital working with children, which only served to fuel my passion. So, when I arrived at the University of Florida, I knew that I was going to be pre-med. Since there was no pre-med major, I chose psychology thinking that in the unlikely event

that I did not get into medical school, I would have a backup option in graduate school. During my sophomore year, knee deep in chemistry and biology and with the prospect of organic chemistry, biochemistry, microbiology, and the other science classes looming, I had never felt further from my dream. At the same time, I was studying abnormal psychology and social psychology. The things I was learning in class were alive and all around me. I was so captivated by the field. I looked forward to my psychology classes and dreaded my pre-med science classes. After much soul searching and discussions with trusted professors and my family, I made the decision to switch my goal to graduate school instead of medical school. My life’s goal of becoming a pediatrician had taken a detour. I would become a child and adolescent psychologist instead, or so I thought. The reality was that the seeds for a career focusing on Latino older adults were sown from a very early age. My grandmother was, in essence, my third parent. She took care of my brothers, my cousins, and me after school and during the summer. I kept going to her house long past the time when I needed someone to take care of me. During summer break when I was home from school, I would often drive to her house to eat lunch and listen to her tell her story. In a small duplex in Miami without central air conditioning, I would sit for hours listening to her reminisce about her life as young girl, as a wife, as a mother, and as an immigrant. The stories brought to life a time, a land, and people that I had never known and added color and dimension to those whom I did know (i.e., my father, grandfather, uncles, aunts, etc.). My career path was staring right at me, but it took me moving to the other side of the country to realize what was in front of me all along. After 4 years in Gainesville, my curiosity was piqued. I no longer wanted to return to Miami to do my graduate work there. I wanted to expand my horizons. I wanted to explore and see what other opportunities existed beyond the state of Florida. When the opportunity arose to go to graduate school in Palo Alto, CA, I jumped at the chance. I packed up my small car; picked up one of my closest friends in Jacksonville; and drove the length of I-10. Once we hit Los Angeles, we headed north to Palo Alto. My advisers were Dr. Larry Thompson and his wife, Dr. Dolores Gallagher-Thompson. It was in their lab that the seeds planted long ago began to sprout. For the first time, I was able to work with older adults in a professional setting, and I was hooked. I began to see how I could combine my cultural, clinical, and research interests. I was stimulated to think unconventionally when delivering psychotherapy to older adults burdened by mental health service use disparities. I was challenged to think of various strategies to make a standardized intervention (CBT) as culturally relevant as possible in order to ensure uptake of the intervention. As a result, I acquired basic skills in three key areas: 1) conducting intervention research with underserved, disadvantaged older adults; 2) the identification of people at greatest risk for depression and anxiety; and 3) understanding the relationship between age, culture, physical, and

psychological stress. Beyond that, Larry and Dolores gave me the opportunity to publish, present, and network. They even allowed me to use some of their time with Dr. Helena Kraemer so I could consult with her regarding the methods and data analysis of my dissertation. I was too young and naïve to realize what incredible opportunities they provided, but I do now, and I am eternally grateful for what they did. As it had done before, my personal growth matched my professional growth. For the first time, I saw and truly understood just how diverse the Hispanic population is. My eyes were opened to the privilege I experienced by being a Cuban in Miami. Working with predominately Mexican immigrants in the clinic and in research, I heard heartbreaking stories of immigration, being led through the desert by violent and unscrupulous “coyotes.” I saw a level of immigration-related stress, poverty, illiteracy, stigma, discrimination, and marginalization that I had never seen before since Cuban immigrants were the only Latino immigrant group in the United States to receive political and legislative protection in the form of the Cuban Readjustment Act. In addition, Cubans report the lowest levels of everyday discrimination; experience distinct forms of privilege not afforded to other groups of Latinos; and tend to be the highest earners and have the greatest amount of economic resources than any other Latino subgroup. I learned quickly that in order to address the mental health needs of older Latinos, I had to be aware of the considerable variability between Latino subgroups, highlighting the need for cultural case conceptualizations of individual patients, and tailoring interventions to the unique circumstances and backgrounds of the patient. At the same time, it was necessary to consider the extent to which common elements and interventions can generalize across Latino cultures. I found that certain cultural values and experiences (e.g., importance of family, language, shared ancestry, religion, etc.) play a powerful role across multiple Latino subgroups. The awareness and explicit acknowledgment of cultural similarities and differences allowed me to build rapport and provide a service that was, and remains, sorely needed. On the first day of graduate school, I met Sheba Kumbhani, the woman who would eventually become my wife. She, like me, is a child of immigrants. Unlike me, her parents emigrated from India. I marveled at the cultural differences (e.g., religion, dress, food, language, traditions, etc.), but I was blown away by the similarities. Hearing my mother-in-law talk about her experiences, the fears, anxieties, perseverance, and resilience in a foreign land was no different than the stories I grew up hearing. In Sheba, I found a kindred spirit who knew and understood what it was like to live straddling two different worlds at once. Little did I know the impact that this chance encounter before my very first class in graduate school would have on my life and career. At the end of internship at Baylor College of Medicine in Houston, Sheba, who is a neuropsychologist, matched at Dartmouth for her postdoctoral fellowship. A quick, panic-filled google search

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brought up Steve Bartels and the T32 postdoctoral fellowship in geriatric mental health services research. It came as a shock to Steve that a Latino researcher interested in older Latino mental health would want to go to New Hampshire, a place not known for its racial/ethnic diversity. I was advised to keep things professional and not mention the real reason why I wanted to go to Dartmouth, but Steve saw right through it and asked what was really going on. I explained the situation, and Steve agreed to bring me onboard, under one condition—that I be comentored by Maggie Alegría in Cambridge. Despite never having met either Steve or Maggie in person, I quickly agreed to the arrangement. Steve and Maggie challenged me in ways that I had not been challenged before. Steve had a simple question: why older Latinos? My answer, a combination of this is the population I am most passionate about and demographic shifts, was not enough. His directive to me was to find the scientific rationale behind working with this population. Maggie showed me a world beyond interventions research. She showed me a world of big datasets and sample sizes of tens of thousands as compared to the hundreds I had been used to. Both encouraged me to ask any and all questions and allowed me to find the answers in any of the datasets they had. Their mentoring styles differed drastically. Steve’s approach, as described to me by a previous T32 fellow, was to “give you enough rope to hang yourself with,” while Maggie’s was much more guided with clear directions. The contrasting styles worked. This unique arrangement allowed me to make something that was my own. Having spent a lifetime straddling two worlds, I felt at home switching between Dartmouth and Cambridge. After 2 years, I was able to answer Steve’s questions and had laid the foundation for my K award. The next step was going to be what to do now that I answered the why. From the very beginning, Steve and Maggie espoused the importance of building relationships. Through them, I have been fortunate to meet giants in geriatric psychiatry and in Latino mental health—circles that often do not intersect. One of those giants was Chip Reynolds. I met Chip at the Summer Research Institute (SRI) of Geriatric Psychiatry where he was assigned to me as a mentor. During my interactions with Chip at SRI, I was fascinated by his work in depression prevention. I knew that I wanted to work with him—a sentiment that was not reciprocated since he invited all of the SRI attendees in our small group to Pittsburgh except me. Undaunted by this snub, I kept trying to figure out how all of my experiences to this point fit and how could I incorporate this new interest in prevention. Following some good advice from Steve, I took some time off to relax and clear my head. That is when the proverbial light bulb went off in my head, and the Happy Older Latinos are Active (HOLA) intervention was born. Steve, Maggie, and Chip helped guide me through the initial submission process, which went unscored,as well as the resubmission, which resulted in funding my K23 award. I always heard Steve say that if at the end of your K

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award, you end up exactly where you thought you would, then you did something wrong. When he told me those words, I did not know just how prophetic those words would be. A month before I received the notice of grant award for the K award, my father fell and had to be taken to the hospital. The very next day, my wife found out that her mother had to be taken to the hospital for cardiac concerns. Fortunately, nothing came of these health scares, and my father and mother-in-law remain in good health. However, at the time, it put into sharp focus the importance of being around family, especially for our son, who was 1 at the time. We made the very difficult decision to leave New England to be closer to either my wife’s family in the San Francisco Bay Area or my family in Miami. Ultimately, the University of Miami gave me an offer I could not refuse, bringing my story full circle. My relocation to the University of Miami caused some delay in the start of the pilot trial as part of my K23. However, once the study was up and running, recruitment went quickly and smoothly thanks to the tireless effort of the community health worker, Doris Perdomo-Johnson. The preliminary study provided invaluable information about some of the needed modifications and enhancements to HOLA, and I learned several key lessons that were implemented in the study design of the R01, which was ultimately funded. At Miami, I have been able to expand my research in ways that I never imagined when I was awarded the K23. I have been able to build relationships with faculty in the departments of psychology and public health and in the school of nursing. I received two pilot awards to adapt HOLA for use in older Latinos living with HIV. The first pilot study aims to reduce cardiometabolic risk while the second pilot study focuses on preventing cognitive decline. I am excited to see the evolution of my program of research and will eagerly follow wherever the science takes me. Marty Bruce said that a scientific autobiography “is an opportunity to reinterpret history in a way that makes the steps along the way logical and coherent,” and I would add that nostalgia lets us overlook some of the rougher spots in our narrative. In writing my own, I have found this to be true. The reality is that there were times in my journey that I was overcome with self-doubt. The long nights at the trial by fire known as SRI and its companion ARI combined with rejection letters from NIH will do that to you. I have experienced microaggressions. A supervisor once told me that I was too deferential. She understood that respeto, which dictates deferential behavior toward others based on age, gender and authority, was a Latino cultural value. However, she said that if I wanted to succeed in academia, I needed to stop being that. In essence, she was telling me that I had to stop being who I was. On more than one occasion, I have been insulted and belittled by senior faculty members who thought it was appropriate to question my character and intelligence when providing feedback about my job performance. While these slings and arrows have hurt and knocked me down, I have been fortunate to be surrounded by a team of mentors that have helped me get back up every single time.

In May of 2019, I was awarded my first R01 and in June of this year, I was promoted to associate professor. I have been able to achieve success in academia because I have stood on the shoulders of giants—Steve, Maggie, Chip, and Yeates Conwell whom I was paired with at ARI. I have been very fortunate to have great mentors who have nurtured my passion and have dedicated countless hours in the service of helping me to succeed. They have supported and challenged me to pursue my own research interests, not an extension of their own. They encouraged me to stay true to who I am and provided a nurturing environment that allows for my voice to be heard. They recognized that who I am directly influences what I do. This has allowed me to 1) ask the questions that those around me are not likely to come up with and 2) answer those questions taking into consideration how the impact of culture (e.g., sense of community, values, beliefs, stigma, etc.). While, I can no longer call myself a new investigator, early career scientist, junior faculty, or any other term used

Our 2019–2020 Annual Report is out! We consolidated this report to reﬂect our work over the last two years. Despite the coronavirus pandemic, the members of our Department worked tirelessly to keep our patients healthy, our programs aﬂoat, and even initiate new programs. We hope you enjoy reading about our activities.

to describe an academician at the nascent of their career, I still rely on their wisdom and counsel. I don’t see this changing no matter how far along in my career I may be— much to their chagrin, I imagine. Never in my wildest dreams did I ever think my life and career would have unfolded this way, but I am grateful that it has. I have met some truly amazing and brilliant people that are not only my colleagues but also my friends. I still feel like I am straddling multiple worlds at once. It is not always easy to go back and forth between these worlds, but that is what I have always known, and I would not have it any other way. As I look back on my journey, I am reminded of a line from “Changes in Latitudes, Changes in Attitudes,” one of my favorite Jimmy Buffett songs: “Yesterdays are over my shoulder. So, I can’t look back for too long. There’s just too much to see waiting in front of me, and I know that I just can’t go wrong.” This editorial originally appeared in the Journal of Geriatric Psychiatry made available online on December 9th.

To view the digital version of our Annual Report, please visit issuu.com/umpsych. To request a print copy, please email psychiatry@med.miami.edu.

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Postpartum Life in the Midst of a Pandemic By Vanessa Padilla, M.D.

In the postpartum period, all new parents may face challenging adjustments related to their new baby such as changes in daily routines, sleep disruptions, and new family dynamics to accommodate a newborn. The coronavirus pandemic has added increased stress to new parents including feelings of loneliness or isolation, limited support, and concerns about safety and the risk of contracting or spreading the virus, either at the hospital during delivery or via contact with visitors or other family members. As stress can precipitate or worsen mood symptoms, it is imperative to closely monitor the mental health of new parents during the coronavirus pandemic. Specifically, Postpartum Depression (PPD) is a common condition affecting women at any given time during the first year after delivery. Now, experts have raised concerns on how the pandemic may impact or exacerbate the incidence of postpartum depression and anxiety. Mood and anxiety symptoms that should be screened and monitored include: sadness, guilt, lack of appetite, changes in sleep pattern, poor motivation, lack of energy, irritability, thoughts of self-harm or harming others, fear of harming the baby or not bonding adequately with the newborn, overwhelming worries, obsessive thoughts, and excessive anger. It is easy to confuse some of these emotions with milder symptoms related to the “baby blues” or “postpartum blues” which are frequently experienced right after delivery. For example, new mothers may experience brief episodes of sadness or fluctuating mood, irritability, or anxiety, as well as fatigue, isolation, and tearfulness in the early postpartum weeks. However, these feelings usually start a few days after delivery, peak around one week after delivery, and resolve on their own by the end of the second week postpartum. If mood symptoms persist or worsen after 10-14 days postpartum, a comprehensive screening for postpartum depression is necessary. Depression and anxiety in the postpartum period are treatable conditions; the key is recognizing them early and intervening. It is important not to blame or stigmatize those suffering with symptoms. Instead, reach out and offer support to new parents impacted by the coronavirus pandemic. The postpartum period is traditionally an exciting time for families to come together, to meet and celebrate a new baby, but in the midst of a pandemic, many are wisely foregoing immediate celebrations to protect the newborn and the parents. This can be heartbreaking and open the door to stressors and those symptoms previously mentioned.

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Fortunately, there are things new mothers can do to help healthily adapt to life with a new baby during the pandemic. Some recommendations are: l

Focus on self-care strategies. For example, establish scheduled feeding and sleeping routines for both baby and parents; take breaks; set time for reflection; indulge into something you like; and be kind to yourself. Mother-baby bonding time is crucial to enhance the connection with the new baby—be mindful of all shared moments. Promote bonding with the baby through activities like reading and talking to him/her.

l l

Exercise regularly and responsibly. For safety during the pandemic, remember to socially distance, wear a mask appropriately, and opt for outdoor activities. Maintain healthy eating habits. Breastfeeding mothers should consult with their obstetrician about any specific foods to limit during this period. Avoid all substance use, which can precipitate and worsen mood symptoms, in addition to affecting your physical health as well. Seek support, even virtually, from family and friends. Seek professional mental health treatment if you have signs of a mental health condition. Support groups, psychotherapy, and proper prescription of psychiatric medications can be safe and effective alternatives to target depression and anxiety in the postpartum period.

l l l l l

If you have thoughts of harm, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Recommendations for family and friends of the new parents during the coronavirus pandemic: Provide support to the new parents by staying connected via video or phone calls. Consider arranging a grocery or meal delivery for the new parents. Encourage them to ask for help if and when they need it. Allow the new parents to talk about their feelings. Help stop stigma around mental health by encouraging anyone who is struggling to seek proper mental health treatment if needed.

continued from page 4

12 ways to calm down

Sleep.

While panic attacks and disorders are emotionally and physically disturbing, therapy and practicing specific calming techniques help.

A good night’s sleep relaxes the mind and body and puts things in perspective. Eat right.

Pay attention.

Feed your body and brain nutritious foods. An occasional treat is fine, but try to maintain a healthy weight and good nutrition. Foods with high sugar content or caffeine and caffeinated foods can increase jitteriness.

Panic attacks don’t happen as randomly as they may seem. Pay attention to your stressors.

Write vs. worry.

Acknowledge your feelings.

Tell yourself, “‘This is a panic attack. It’s going to end, and I am not going to die from it.”’

Breathe. Practice and become skilled at diaphragmatic relaxation breathing.

Can’t sleep or focus due to worrying? Get those troubling thoughts out of your head and down on paper. You can discuss those thoughts later with a therapist, counselor, or even a trusted friend or jot down items to address at another time.

Release tension.

Muscle tension and shallow breathing can trigger an attack. Deep breathing and stretching relieves stress and induces relaxation.

Socialize safely.

Move.

Change the scene.

Exercise significantly increases physical and emotional health. If an increased heart rate triggers your anxiety, start gradually with gentle yoga, tai chi, moderate walking, swimming, or cycling.

Healthy outdoor activity boosts your mood and energy. Get out in nature and see something besides your house.

Engage with others outside, while wearing a mask, and staying at least six feet apart.

Don’t doomscroll.

Anxiety is here to stay. We may complain about 2020 stress levels, but at least we’re not running from saber tooth tigers like our ancestors. “Anxiety is there to protect us. Although it is part of our DNA, we’re in an unchartered territory (with the pandemic). We can’t isolate for over a year and let our mental health deteriorate. There are ways to engage in healthy social activity, and there is help available.”

Practice good mental hygiene. Avoid scrolling through headlines or watching the news first thing in the morning or before going to bed. Take an occasional news break if necessary.

Nancy Moreland is a regular contributor to the University of Miami Health System. This article originally appeared in UMiami Health News.

Decaffeinate.

Caffeine and stimulants increase heart rate and increase muscle tension. Reduce or eliminate your consumption.

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Advocate for Yourself During the Pandemic Navigate New Normal With Grace and Grit By Nancy Moreland

In Florida, most schools have reopened for in-person instruction, restaurants and bars serve customers, and sporting events carry on. Now the holidays have arrived with their own set of social expectations. And yet, the pandemic continues. Reopening society is a dicey dance, moving one step forward, two steps back, as COVID-19 cases rise and vaccines remain out of reach. The full impact of pandemic fatigue is upon us. Must we sacriﬁce safety to maintain our sanity and social connections? The COVID-19 conundrum

“We don’t know how to act in a pandemic. We’re learning as we go. It’s difficult to digest all the information and ever-changing (public health) guidelines. Our work, school, and personal lives overlap, yet we’re expected to multitask and keep it together. We need to face and reconcile these challenges to protect our mental and physical health,” says Dr. Vanessa L. Padilla, a psychiatrist with the University of Miami Health System. Unfortunately, the very thing that strengthens emotional health—the human connection—is the same thing that could kill us—depending on our risk factors. People cope differently in a crisis

People react very differently to the coronavirus. Understanding the possible reasons behind those reactions may help us be more empathetic. “Some people are better at identifying their emotions and values, communicating expectations, and making decisions to protect themselves and others. Based on different values, understanding, and expectations, other people may struggle to set boundaries or follow public health advisories.” Dr. Padilla says that people who feel more comfortable when they’re in control of a situation tend to mask up, sanitize, and social distance. “They tell themselves, ‘I will get through this.’” Others are fearful but don’t acknowledge their feelings. Like those who use denial as a coping tool, nervous individuals may minimize the danger or ignore public health guidelines. Others go to the opposite “isolate and ruminate” extreme. When this isolation coincides with an existing mental illness, these people need additional support. If empathetic family and friends cannot help, professional counseling—even through a Zoom call or mental health app—is a wise choice. “At a therapeutic level, my goal is helping people make healthy choices

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and monitor their feelings to see how it affects their interpersonal relationships,” Dr. Padilla says. Let’s talk about risk

Before we discuss staying safe and sane, let’s tackle risk. “When we’re tired, frustrated, and we want our ‘normal’ back, we are more prone to let our guard down. Risk is just a risk until it happens to you. Young people especially need to remember this,” says Dr. Padilla. When evaluating risk—a friend wants to meet at a restaurant or invites you to a party—Dr. Padilla suggests asking yourself, “If I catch the virus, how will it change my daily life?” Instead of inciting fear, this exercise makes you stop and weigh the risks versus benefits before responding. Get back to the basics

Though she specializes in treating issues affecting the mind, Dr. Padilla says that everything depends on the body. “In the absence of physical self-care, emotional self-care is not enough. We must be physically healthy to protect our mental health.” If the pandemic forced you to juggle a job, homeschooling, and running a household, get back to basics. “We only have 24 hours in a day. Reprioritize those hours to meet your basic needs for sleep, food, exercise, etcetera.” Here are Dr. Padilla’s suggestions for handling some of the most common and confounding social situations created by the pandemic. To mask or not to mask.

People who wear masks can become frustrated when others don’t. “With all the changes and societal pressures, some individuals feel frustrated when their needs aren’t met or understood. It’s important to acknowledge and not avoid our feelings. Otherwise, we build up resentment,

anger, anxiety, guilt, or sadness.” Masking should not devolve into a competition of personal beliefs or confrontations, she says. She follows the advice of public health experts. “We need to focus on science and prevention. To minimize virus transmission and exposure, the recommendations are clear: wear a mask, keep your distance, and wash your hands.” One is the loneliest number.

Dr. Padilla acknowledges isolation’s negative impact on mental well-being. Netflix parties and Zoom happy hours work for a while, but if you crave interaction beyond your dog, cat, immediate family, or yourself, consider safe in-person options. Small group gatherings outside, with people you trust and who share your values, boost your sense of connection, and reduce stress while maintaining safety. With proper planning and communication, you can social distance, mask, and visit at the same time. Whether you go alone or with a friend, exercising in nature is another way to boost your mood. Consider Dr. Padilla’s straightforward approach to a recent social interaction. “I called a friend and said, ‘I want to take my dog to a dog beach, Sunday, from 5-7 p.m. I will drive myself, wear a mask, and bring my own water. Would you feel comfortable meeting me there?’” She set the rules, and her friend happily accepted the invitation. When meeting a friend for coffee, Dr. Padilla chose an uncrowded coffee shop with outdoor seating. The pandemic often requires a risk versus benefit decisions. Dr. Padilla’s friend works in an emergency room but wears full protective gear at work. Watch your language.

As the dog beach example shows, communication is the key. This is especially important when you live with others. If your family’s communication skills aren’t solid, Dr. Padilla suggests working with an “external mediator or therapist.” Each family member’s health habits may differ, depending on their age, expectations, and needs. Maybe your teenager craves social interaction, but grandma’s health requires caution. (The incubation period for COVID-19 is typically two to 14 days, although in some cases it may be longer.) Dr. Padilla recommends a compromise. “You could respectfully say, ‘If you want to

attend that gathering, you must wear a mask and continue to inside the house.’” The same rules apply if your spouse goes out for lunch with co-workers, with an interesting caveat, “Tell your spouse, ‘We will sleep in separate rooms and wear a mask inside the house.’” Situation: An out-of-town friend wants to visit for the weekend.

But, you have risk factors. And your friend works in a busy office and dines out socially. Remember, “I” statements allow you to speak on your own behalf while navigating tricky social situations. “If you receive somebody in your home, you’re entitled to set the rules. Say, ‘I’d love to see you, but COVID cases are rising in my area. Let’s postpone our visit and check in with each other next month.’ Make it about you, not their behavior. That removes any judgement,” Dr. Padilla says. Walk the walk.

Transparent talk lets others know where you stand—as long as your behavior aligns with your words. “We cannot make false promises or break the boundaries we agreed upon. If you wear a mask, wear it appropriately and at all times. Be a role model for others. Be straightforward and empathetic when educating others about your safety measures,” Dr. Padilla says. Whatever you do, don’t try to reason with or “lecture” people on scientific facts. “Their responses may emerge from fear or feeling out of control, which clouds their thinking, despite the facts.” If you’re exhausted from tiptoeing the tightrope between personal safety and etiquette, “Take a break and focus on self-care.” As challenging as it is, “we need to feel comfortable talking about the uncomfortable truth,” she says. Sometimes, agreeing to disagree with others who don’t share our opinions is the best way to care for ourselves. When her clients complain of pandemic fatigue, Dr. Padilla reminds them, “We do the best we can with what we have. We are already resilient. We have made it to November! We just need to boost our skills.” Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the Centers for Disease Control and Prevention. Her writing also appears in the Chicago Tribune and U.S. News & World Report.

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Clinical Trials Clinical trials are the backbone of evidence-based medicine. Broadly speaking, clinical trials evaluate the safety and eﬀectiveness of a medical strategy, treatment, or device. Moreover, clinical trials provide an opportunity for the general public to participate in the process of developing novel treatments for a variety of conditions.

The results from these clinical trials provide the data necessary to assist in future medical decision-making. The Department of Psychiatry & Behavioral Sciences is dedicated to generating the scientiﬁc knowledge behind the clinical best practices we incorporate in the treatment of diﬃcult and complex

mental health conditions. The Behavioral Research Assessment Center (BRAC ) is the research hub that fulﬁlls the Department’s mission to develop the next line of treatments. For more information on participating in available clinical trials, please email brac@miami.edu or call 305.243.5840.

Tics & Tourette's Syndrome

Schizophrenia & Bipolar Disorder

Cognition & Memory

Study #: 20180013

Study ID:IRB202000212 Date Approved: 2/4/2020

Effective Date: 3/13/2019

Communication of Dementia Diagnoses: Investigating Patient, Family, & Physician Experiences and Developing Best Practices

Share your experiences with receiving a diagnosis of dementia. We want to learn about the experience that individuals with memory and thinking problems and their care partners had when receiving a dementia diagnosis. This information will help healthcare providers know how to better give this diagnosis.

What’s involved? Volunteers will participate in a telephone interview about their experiences. Interviews will be scheduled at your convenience. Interviews will last no longer than one hour.

Are you eligible? To participate, you must be:  A person with a diagnosis of dementia given in the past 2 years OR the care partner/caregiver of a person who received a diagnosis of dementia in the past 2 years  Fluent in English or Spanish  Able and willing to participate in a phone interview

Study #: 20190826

If you’re interested in learning more or participating, call or email a member of the study team: Noheli Gamez, MHA Study Coordinator Noheli.gamez@neurology.ufl.edu 352-733-2419

Compensation Participants will receive:  $25 gift card mailed after completion of the interview Funded by the Florida Department of Health Ed and Ethel Moore Alzheimer’s Disease Research Program

Effective Date: 5/21/2020

Follow us on facebook for the latest information and opportunities to help advance science. Dr. Barbara Coffey's Tics, OCD, & Related Disorders Clinic at UHealth 305-243-6489 mxc1668@miami.edu

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@ PsychatUM

Cognition & Memory y

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UNIVERSITY OF MIAMI HEALTH SYSTEM Center for Cognitive Neurscience and Aging

Communication of Dementia Diagnoses: Investigating Patient, Family, & Physician Experiences and Developing Best Practices

What’s involved? Volunteers will participate in a telephone interview about their experiences. Interviews will be scheduled at your convenience. Interviews will last no longer than one hour.

Are you eligible? To participate, you must be:  A healthcare provider who gives patients dementia diagnoses (rarely or commonly)  Fluent in English or Spanish  Able and willing to participate in a phone interview  ervious chronic pain treatment

Did You Know? More than 15 million Americans provide unpaid care for people with Alzheimer’s or other dementias.

Share your experiences with giving dementia diagnoses. We want to learn about healthcare provider experiences when giving diagnoses of dementia, including barriers and facilitators to giving dementia diagnoses, comfort with discussing dementia, and suggestions for optimal communication. This information will be used to help develop strategies for giving dementia diagnoses that reflect the challenges faced in daily clinical practice.

Care Partners Program

Every 66 seconds someone in the U. S. develops Alzheimer’s disease. African-Americans are about twice as likely to have Alzheimer’s or other dementias as older whites.

If you’re interested in learning more or participating, call or email a member of the study team: Noheli Gamez, MHA Study Coordinator Noheli.gamez@neurology.ufl.edu 352-733-2419

Compensation Participants will receive:  $25 gift card mailed after completion of the interview Funded by the Florida Department of Health Ed and Ethel Moore Alzheimer’s Disease Research Program

Hispanics are about one and one-half times as likely to have Alzheimer’s or other dementias as older whites. Approximately, two-thirds of caregivers of Alzheimer’s are women, and 34% are age 65 or older. If you are caring for a loved one with Alzheimer’s or other dementias, you might be eligible to take part of a research study that the University of Miami Center for Cognitive Neuroscience and Aging is conducting. You will learn strategies to reduce stress, enhance caregiving skills, and improve overall well-being. Your loved one will receive cognitive training or mental stimulating exercises. The study has a duration of 12 months. You and your loved one can participate from the comfort of your home at no cost. You will receive a laptop with Wi-ﬁ capability during study participation to access study-related material and content. You will also receive ﬁnancial compensation for your time and effort.

For more information, please contact us at:

(305) 355-9200 or coainfo@med.miami.edu The research study is conducted by University of Miami Center for Cognitive Neuroscience and Aging. It is sponsored by the Florida Department of Health and National Institutes of Health

African American Registry

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

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

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

WHAT’S INVOLVED?

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

WHO CAN JOIN?

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

Aja M. Scott, M.S. |Senior Coordinator|305.355.9076 | ascott2@miami.edu UM/Jackson Behavioral Health Hospital | Center for Cognitive Neuroscience and Aging 1695 N.W. 9th Avenue, Suite 3202, Miami, Florida 33136 http://cnsa.med.miami.edu/ “Drs. Rosie Curiel and David Loewenstein are co-inventors of intellectual property used in the study.” “This research is not sponsored or endorsed by the U.S. Department of Veterans Affairs administration. “

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Flu and Pneumococcal Vaccines May Help Prevent Alzheimer’s By Dana Kantrowitz

According to new research, getting seasonal ﬂu and pneumococcal vaccinations may help reduce your risk of developing Alzheimer’s disease. This ﬁnding was released at this year’s Alzheimer’s Association International Conference. Researchers behind one study reviewed over 9,000 health records. They found that a single flu, or influenza, vaccination is associated with a 17% reduction in Alzheimer’s. Getting the flu vaccine year after year is associated with an additional 13% reduction in Alzheimer’s. This protective benefit appears to be strongest for those who get their first flu vaccine at a younger age. More vaccinations mean fewer flu deaths

Doctors and researchers are hopeful that this news will motivate more people, including children and younger adults, to get these yearly vaccinations. If the flu vaccine becomes more widely received, far fewer people will get very ill and die from influenza. In 2018-2019, an estimated 35.5 million people got sick with the flu, and 34,200 died from the virus.

The U.S. health care system is already stretched thin due to the coronavirus pandemic. Many of the COVID-19 infection symptoms are similar to those of the seasonal flu (including fever, sore throat, cough, chills, headache, and fatigue). Suppose more Americans get the flu vaccine this season. In that case, it will greatly reduce the number of people who experience these symptoms and need to see a doctor and cases of severe illness and death due to complications from the flu. Seniors could get an improved protection level

The researchers behind another study found that receiving the pneumococcal vaccination between ages 65 and 75 can reduce Alzheimer’s risk by up to 40% (depending on an individual’s genes). If you carry a particular gene that increases the risk of developing Alzheimer’s Disease, getting this vaccine may not prevent its onset. The Centers for Disease Control and Prevention recommends the pneumococcal vaccine for all children younger than two years old and adults age 65 and older. Pneumococcal disease (which ranges from painful ear/sinus infections to pneumonia) is common in young children. Still, older adults have a greater risk for severe illness and death from this infection.

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Should my family get vaccinated?

The findings from both of these new research studies are very promising. Additionally, large-scale studies are still needed to determine the vaccines’ abilities to prevent Alzheimer’s Disease. “Annual influenza vaccines, as well as a pneumococcal vaccine in older individuals, is essential to help prevent infectious illness, especially with the current influx of COVID-19,” says Elizabeth Crocco, M.D., a psychiatrist with the University of Miami Health System who specializes in Alzheimer’s disease in the elderly. “Their correlation with a reduced risk of Alzheimer’s disease in both of these significant studies signify additional potential benefits for these simple preventative measures.” If you’re interested in receiving these vaccines or have questions about their risks and benefits, speak with your primary care physician. The risks for all vaccinations currently available in the U.S. are considered significantly lower than the potential for illness and death due to the infections and diseases the vaccines can prevent. Find out more about vaccinations at uhealthclinics.com. This article was written by contributing writer Dana Kantrowitz and originally appeared on the UMiami Health News blog at news.umiamihealth.org.

Faculty Recognition Awards | Grants | Publications Awards Dr. Luis Tuesta NIH Avenir Award Recently, Dr. Luis Tuesta was presented with the Avenir Award from the National Institute on Drug Abuse, part of the National Institutes of Health. The prestigious award will allow him to study the epigenetic mechanisms of microglial activation and their role in shaping the behavioral course of opioid use disorder. The goal is to find new therapeutic targets to prevent opioid relapse and achieve long-term abstinence. The award is for 2.3M over five years. Dr. Phil Harvey NPPR Article Award 2020 In a Virtual Joint Social Gathering in August, Dr. Phil Harvey was awarded the Neuropsychopharmacology Reports (NPPR) Article Award 2020 for his paper Blonanserin versus haloperidol in Japanese patients with schizophrenia: A phase 3, 8-week, double-blind, multicenter, randomized controlled study. The paper reported the efficacy and safety of blonanserin, an uncommon antipsychotic, in patients with schizophrenia compared with risperidone, an alternative antipsychotic, in a Japanese multicenter, randomized, double-blind study based on post hoc sensitivity analysis in addition to previously reported results; it discussed the current approaches for schizophrenia treatment.

Grants Dr. Zelde Espinel R01 renewal. Th17 cells as a new therapeutic target for depression. National Institute of Mental Health (NIMH). $1.9M. Dr. Elizabeth Crocco Building an Advanced Cognitive and Biomarker Registry for African American Older Adults At-Risk for Alzheimer’s disease. Florida. $248,590. Dr. Rosie Curiel Cid Communication of Dementia Diagnoses: Investigating Patient, Family, & Physician Experiences and Developing Best Practices. University of Florida/Florida State Department of Health. $64,919. Dr. David Loewenstein University of Florida —Alzheimer's Disease Research Centers—P30. University of Florida/National Institute on Aging. $2.1M.

The award was presented by the Editorial Committee of the Japanese Single Nucleotide Polymorphism (JSNP), a repository of data. Dr. Vanessa Padilla Resident Teaching Award, June 2020 Dr. Dante Durand UM/JMH Psychiatry Residency Training Outpatient Teaching Award Dr. Maria Rueda-Lara Dr. Rueda-Lara was awarded the status of Fellow in the Academy of Consultation-Liaison Psychiatry (ACLP). This action reflects recognition by her peers of her abilities, talents, and contributions to the profession of Consultation Liaison Psychiatry. Fellowship in the ACLP is bestowed upon Academy members who manifest active participation in the Academy and have made exemplary contributions to the field of consultation-liaison psychiatry as educators, researchers, or administrators. Dr. Nicole Mavrides Accepted to American College of Psychiatrists ACP comprises more than 750 psychiatrists who have demonstrated excellence in the field of psychiatry and achieved national recognition in clinical practice, research, academic leadership, or teaching. Dr. Ines Lohse Ex Vivo Drug Sensitivity Testing Platform Automation to Facilitate Clinical Development and Increase Throughout. SebastianStrong/SCCC. $100,000. Dr. Amanda Myers The Human Brainome III: Eqtl Regulation By Natural Antisense RNA In Alzheimer’s Disease. National Institute on Aging. $3.9M. Dr. Raul Poulsen CAT Program_Westcare. Westcare Florida, Inc. $27,025. Dr. Luis Tuesta Microglia and Epigenetic Regulation in Opioid Addiction. National Institute on Drug Abuse. $1.5M. Supplement: Role of Dopamine Neuron-Specific Gene Enhancers in Cocaine Relapse. National Institute on Drug Abuse. $53,717. Dr. Claes Wahlestedt Contributions of Histone Deacetylase 8 (HDAC8) to Alzheimer’s Disease Pathogenesis. Florida State Department of Health. $249,959. BRD4 Inhibitor. National Institute on Drug Abuse. $219,528. Developing the drug sensitivity platform for IDE submission. Wallace H. Coulter Foundation. $125,000

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Publications Dr. Dante Durand World Social Psychiatry A USA Perspective on the COVID-19 Pandemic Dr. Barbara Coﬀey CNS Spectrums 152 Development of Deutetrabenazine as a Potential New Non-Antipsychotic Treatment for Tourette Syndrome in Children and Adolescents

Journal of Child & Adolescent Psychopharmacology Overcoming complications in management of a diﬃcultto-treat adolescent with schizoaﬀective disorder Dr. Mousa Botros Journal of Cardiac Surgery The Relationship between Neurocognitive Decline and the Heart-Lung Machine.

Drs. Rosie Curiel, Elizabeth Crocco, David Loewenstein et al. Journal of Psychiatric Research A novel method of evaluating semantic intrusion errors to distinguish between amyloid positive and negative groups on the Alzheimer’s disease continuum. Drs. Rosie Curiel, Elizabeth Crocco, David Loewenstein, Marcela Kitaigorodsky, Luis Tuesta, Jose Melo, MPH? et al. Journal of Alzheimer’s Disease Semantic intrusion error ratio distinguishes between cognitively impaired and cognitively intact African American older adults. Drs. David Loewenstein, Rosie Curiel et al. Archives of Clinical Neuropsychology Assessment and Brain Biomarkers in an Ethnically Diverse Sample with Normal Cognition, MCI, or Dementia.

Journal of Neuroscience Methods Gaussian discriminative component analysis for early detection of Alzheimer's disease: A supervised dimensionality reduction algorithm.

Journal of Clinical Psychopharmacology Low-Dose Escitalopram-Associated Syndrome of Inappropriate Antidiuretic Hormone Secretion in a Patient with Partially Empty Sella.

Frontiers in Neurology Remitting Multiple Sclerosis using a challenging semantic interference task.

Drs. Vanessa Padilla, Dante Durand et al. Academic Psychiatry Residents Impacted by Adverse Events: The Development of a Pilot Committee for Responding to and Supporting Psychiatry Residents.

Dr. David Loewenstein et al. Brain Imaging and Behavior Alzheimer’s Disease Pathology in a Community-Based Sample in Older Adults Without Dementia: The MYHAT Neuroimaging Study.

Dr. Zelde Espinel et al. Psycho-Oncology Clinical correspondence: Using guidance from disaster psychiatry to frame psychiatric support for cancer patients during the COVID-19 lockdown.

Applied Neuropsychology Cultural factors related to neuropsychological performance and brain atrophy among Hispanic older adults with mild cognitive impairment (AMCI): a pilot study.

Lancet Psychiatry Venezuelan migrants in Colombia: COVID-19 and mental health.

International Journal of Geriatric Psychiatry Neuropsychiatric Symptoms as a Distinguishing Factor Between Memory Diagnoses.

American Journal of Psychiatry Identiﬁcation of a Signaling Mechanism by Which the Microbiome Regulates Th17 Cell-Mediated Depressive-Like Behaviors in Mice. Neuron The Bidirectional Relationship of Depression and Inﬂammation: Double Trouble. Lancet EClinicalMedicine Preparing individuals with spinal cord injury for extreme storms in the era of climate change. Lancet EClinicalMedicine Extreme population exposure: Hurricane Dorian medical response in Great Abaco, Bahamas. ADCES in Practice Supporting persons living with type 1 diabetes during hurricanes.

International Psychogeriatrics Mild Behavioral Impairment as a Predictor of Cognitive Functioning in Older Adults. Applied Neuropsychology The eﬀect of acculturation on cognitive performance among older Hispanics in the United States. Journal of Alzheimer’s Disease Global Vascular Risk Score, not CAIDE Dementia Risk Score, predicts cognitive function in NOMAS. Eduard Tiozzo, PhD, MSCTI, Drs. David Loewenstein, Tanya Rundek, Ralph Sacco et al. Journal of the American Heart Association A Randomized Trial of Combined Aerobic, Resistance and Cognitive Training to Improve Recovery from Stroke.

Journal of Head Trauma Rehabilitation Preparing survivors of traumatic brain injury for catastrophic hurricanes in the time of climate change.

Dr. Joycelyn Lee et al. Autism Research Family History of Eating Disorder and the Broad Autism Phenotype in Autism.

Migration and Development COVID-19 as a tipping point for Latin America’s Sustainable Development Goals: The case of Venezuelan migrants in Colombia.

Dr. Deborah Jones Weiss JAIDS Impact of COVID-19-related stress and lockdown on mental health among people living with HIV in Argentina.

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The Department of Psychiatry and Behavioral Sciences wishes you a happy, healthy and safe New Year!

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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UNIVERSITY OF MIAMI HEALTH SYSTEM

Psychiatry & Behavioral Sciences

BrainStorms 2020 Winter Edition

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