UAB Insight Psychiatry Volume 2 - Page 2

N E W P H YS I C I A N S Miriam Sevilla Saez-Benito, MD, has joined the faculty as an assistant professor in the Division of Child and Adolescent Psychiatry. Sevilla received her medical degree from the University of Granada, Granada, Spain, and completed her general psychiatry residency training at Jamaica Hospital Medical Center, Queens, New York. She completed her child psychiatry residency at UAB, serving as chief resident for the 2011-2012 academic year. Sevilla sees patients at UAB and at Children’s of Alabama hospital emergency department. Fluent in Spanish, she seeks to educate parents in the Spanishspeaking community about mental illness and to improve their access to services. Wendell Dean Bell, MD, MBA, has joined the UAB Department of Psychiatry as an assistant professor in the Consult Liaison Division. He subspecializes in medical, surgical, and obstetric consultations when requested by an attending physician. He also will assist with electroconvulsive therapy (ECT) services and lead in the development of a new psychosomatic medical fellowship. Bell earned his medical degree from the Medical College of Wisconsin and completed his residency at Sheppard and Enoch Pratt Hospital in Baltimore, Maryland. Still at Risk: Rethinking Suicide Prevention Is it possible to disrupt a suicidal thought once the process begins? Current psychiatric medications target symptoms and treat underlying illnesses, but take time to treat and have shown limited efficiency in reducing suicidal behaviors. Suicide is the 10th leading cause of death overall in the US, and the fourth leading cause of death for adults under age 65. “This suicide rate is important when treating acutely depressed patients in the Each year US emergency departments see more than a half-million admissions for depression. UAB researchers are studying the use of intravenous infusions of the drug ketamine to circumvent depressive thoughts that lead to suicidal behavior. eme rgency room,” says Cheryl McCullumsmith, MD, PhD, assistant professor of psychiatry and president of the Alabama chapter of the American Foundation for Suicide Prevention. “Inpatient drug ketamine to circumvent depressive thoughts that lead to hospitalizations are always a solution to the immediate problem suicidal behavior. Until recently, there were few options for rapid but typically are of short duration and may not be associated with intervention in depression. However, studies have demonstrated significant reduction in depression or suicidal potential. In fact, that intravenous infusion of ketamine, an NMDA-receptor the period of highest risk for suicide is the first two weeks post- antagonist, at a sub-anesthetic dose (0.5 mg/kg), produced discharge, which represents a third of all post-discharge suicides.” antidepressant effects within hours of administration. Subsequent Each year US emergency departments see more than a halfmillion admissions for depression. The range of outcomes includes studies have shown benefits in treatment-resistant patients. Of significance to the current UAB study, one small, open-label Advancement in the Management of Major Depressive Disorder. Ziprasidone (Geodon) was approved by the FDA in 2001 but has not been studied in the treatment of major depressive disorder (MDD). The study aims to add ziprasidone to a standard antidepressant and record the effectiveness as an add-on medication. The only antidepressant used in this study is escitalopram (Lexapro). NCT00633399. PI: Richard Shelton, MD. Contact: Samantha White, 205.934.9189. 2 attempts, making depression associated with suicidal potential suicidal ideation in patients with depression. UAB is seeking to a deep concern for public health. “However, presentation in the determine whether IV ketamine infusion is safe, tolerable, and emergency setting presents an opportunity for quick and effective more effective than placebo in reducing both depression and suicidal ideation in suicidal patients presenting for acute treatment mortality, functional impact, and cost savings. There is a clear Medication Comparison in the Treatment of Bipolar Disorder. The comprehensive goal of this trial is to compare lithium and Seroquel, which is currently one of the most prescribed drugs for the treatment of bipolar disorder. Both drugs are FDA-approved for the treatment of bipolar disorder, but no study to date has compared their effectiveness. NCT01331304. PI: Richard Shelton, MD. Contact: Nicholas Bossaller, 205.934.2484. test demonstrated that ketamine infusion is effective in reducing interventions, which have a high likelihood of reducing morbidity, F E AT U R E D CLINICAL TRIALS hospitalization, intensive outpatient care, and subsequent suicide in emergency departments. The study also seeks to determine and compelling case for the development of rapidly effective the decreased length of stay in the emergency room and inpatient interventions for suicidal depressed patients in the emergency psychiatric hospital due to the rapid antidepressant effects. department,” she says. “Professionals saw suicidal thoughts McCullumsmith aims to use ketamine to rapidly elevate moods as the end result of another condition, rather than as a separate and decrease suicidal behaviors of patients who arrive to the phenomenon, but now we are rethinking that paradigm.” emergency department in a suicidal state. “Disrupting the cycle of McCullumsmith and other UAB researchers are now studying a new approach: the use of intravenous (IV) infusions of the suicidal thoughts is the best option for the interruption of suicidal tendencies,” she says. continued from first page Teenagers with schizophrenia statistically gain weight, smoke and education plans focus on promoting family involvement and cigarettes, isolate themselves from others, and struggle with school emotional support, as well as providing guidance to aid in the attendance. She says, “It is possible to break this cycle and keep recovery process. teenagers on a functional path.” “There is growing evidence that schizophrenia can be managed Belgium. She completed her internship and residency training be lessened, if aggressive and comprehensive treatment is begun in psychiatry at the University of Michigan and a fellowship in shortly after the first diagnosis is made,” says Lahti. schizophrenia research at the Maryland Psychiatric Research monitored to keep the patient within normal functioning levels. F OR REF ERR A L S: 1- 8 0 0 - 8 2 2- 6 47 8 Alabama Brain Collection Makes Tissue Available The Alabama Brain Collection (ABC) is a resource of the Department of Psychiatry. The ABC was created to promote and encourage research with brain tissue obtained postmortem from individuals with and without neuropsychiatric illnesses. Its primary goal is to provide high-quality tissue, along with comprehensive clinical information, for hypothesis-driven research. Created in 2008, the ABC works in collaboration with the Alabama Organ Center to expand collection opportunities. The ABC is not structured as a brain bank, which provides open access, but is maintained and funded through collaborative research. The tissue collection is available to UAB scientists and to collaborators worldwide. Rosalinda Roberts, PhD, the Kathy Ireland Professor, is director of the ABC. Lahti Collaborates With Auburn University Professor Adrienne Lahti, MD, director of the Division of Behavioral Neurobiology, has begun a collaboration with Auburn University’s (AU) Samuel Ginn College of Engineering and MRI Research Center. The AU center provides access to technical research equipment to UAB and other researchers. Auburn is expecting installation of the state’s first 7T MRI magnet later in 2012. Lahti uses a 3T magnet for research imaging but plans to use the larger AU magnet to measure glutamate levels in the brains of patients with schizophrenia. Volunteers will come from the First Episode Schizophrenia Clinic. Redwine Treats Depression Using rTMS Therapy Repetitive transc ranial magnetic stimulation (rTMS) is a non-invasive treatment that uses highly focused magnetic pulses to stimulate function in targeted brain regions linked to depression. This treatment is FDA-approved for patients with major depression who have not improved on medication. Through a treatment coil, the rTMS therapy system generates highly concentrated magnetic fields which turn on and off very rapidly. These magnetic fields are the same type and strength as those produced by an MRI machine but are more focused. No anesthesia is required, and patients are able to drive home or return to work after their rTMS session. M. Bates Redwine, MD, director of the Division of Geriatric Psychiatry, is medical director of the rTMS program. P U B L I C AT I O N S O F N OT E April and approved continued accreditation status for all three programs. The General Residency and the Geriatric Fellowship each received accreditation for five years, and the Child/ Adolescent Fellowship received accreditation for four years. Vice Chair of Education Lee Ascherman, MD, thanked the residents and faculty for dedicating themselves to making the accreditation possible. Feldman Co-Edits Handbook of Community Psychiatry Professor Jacqueline Feldman, MD, director of the Division of Public Psychiatry, has co-edited the comprehensive reference text Handbook of Community Psychiatry with Drs. Hunter McQuistion, Wes Sowers, and Jules Ranz. The 600-page book presents the organizational structure for community psychiatry and reflects the rapid changes in this field, providing basic and specialized information in areas such as epidemiology, recovery, person-centered planning and care, innovations in practice, and treatment of special populations. Feldman, who is the Patrick H. Linton Professor and Vice-Chair for Clinical Affairs, also authored several chapters of the book. Professor Robert Savage, MD, clinical director of the Division of Public Psychiatry, and Assistant Professor Patricia Cornett, PhD, coauthored the chapter entitled “Program Evaluation and Quality Management.” MEASURES OF SUCCESS Kerman IA, Clinton SM, Simpson DN, Bedrosian TA, Bernard R, Akil H, Watson SJ. “Inborn Differences in Environmental Reactivity Predict Divergent Diurnal Behavioral, Endocrine, and Gene Expression Rhythms.” Psychoneuroendocrinology, 2012 Feb;37(2):256-69. Funk AJ, McCullumsmith RE, Haroutunian V, Meador-Woodruff JH. “Abnormal Activity of the MAPK- and cAMP-Associated Signaling Pathways in Frontal Cortical Areas in Postmortem Brain in Schizophrenia.” Neuropsychopharmacology. 2012 Mar;37(4):896-905. Clark CB, Perkins A, McCullumsmith CB, Islam MA, Sung J, Cropsey KL. “What does self-identified drug of choice tell us about individuals under community corrections supervision?” J Addict Med. 2012 Mar;6(1):57-67. Inpatient Satisfaction Survey Results Lahti received her medical degree from the University of Liege, better, and that complications associated with schizophrenia can She maintains that the onset of schizophrenia needs to be UAB MEDICINE NEWS Center in Baltimore, Maryland. Continued Accreditation for Resident Training Programs The Accreditation Council for Graduate Medical Education (ACGME) recently approved continued accreditation status for the General Resident, Geriatric, and Child/Adolescent Training Programs. The ACGME Residency Review Committee examined the Specialist Site Visitor Representatives’ reports in Inpatient satisfaction scores have risen to their highest point in two years. The improvement, says Steven Nasiatka, director of psychiatric nursing services, can be credited in part to daily cognitive stimulation for each patient, with music, art, and recreational therapies among techniques used to engage patients and allow them to work with the treatment staff to understand the importance of medication compliance and learning coping skills. MOR E INF OR M AT ION: /physician 3