DEPARTMENT OF PSYCHIATRY - University Of Michigan
DEPARTMENT OF PSYCHIATRY2019 DEPARTMENT OF PSYCHIATRY ANNUAL NEWSLETTERA LETTER FROM THE CHAIRGreetings,It gives me great pleasure to share our 2019 annual newsletterwith you. Each year, I look forward to the opportunity tohighlight just a few of the many things that our outstandingfaculty, staff and trainees are working on. I hope you will enjoyreading the selected highlights in the pages that follow.This year, you will see examples of efforts to integrate excitingadvances in psychiatric research into our clinical deliverysystems. There might be no area more important in this workthan suicide risk assessment and prevention. We are alsofortunate to have faculty helping us integrate into the largerUniversity of Michigan Precision Health Initiative.Our state of the art Sleep and Circadian Research Laboratory has a wonderfully productiveand active team studying many aspects of sleep and circadian rhythm in diverse populations,all in order to understand how these can impact illness, treatment response and recovery.As always, we want to introduce you to some new faces among our faculty and trainees.We are so proud of the many who have joined our team. Among our training programs, wehighlight the Child and Adolescent Fellowship this year. In addition to their stellar clinicalwork, they are embracing opportunities for scholarship and quality improvement that arehaving an impact locally, regionally and nationally.As our research portfolio grows, we recognize the positive impact of the internal grants reviewprocess that we put in place two years ago, and share some highlights about that initiative.There are also a few surprises in store, including the newest addition to the Nyman FamilyUnit for Child and Adolescent Mental Health and Wellness.Your interest and partnership in all this work helps sustain us day in and day out. We are sograteful for your support.I welcome your feedback and invite you to stay connected as we strive to advance our workand enhance the impact of Michigan Psychiatry.Sincerely,Best wishes,GregoryDalack, MDGregory W.W.Dalack,AssociateProfessor &ProfessorChairInterim Chair and Associate Chairfor Education and Academic AffairsTABLE OF CONTENTSInterventional Psychiatry Updates 2-3Precision Health Initiatives 4-5Sleep Lab Overview 6-7Suicide Research & Implementation ofBest Clinical Practices 8-10The Internal Grant Review Program 10Faculty Briefs 11Trainee Profiles 12Training Program Highlight:The Child Fellowship 13Alumni Profiles 14Awards & Recognitions, In Memoriam 15Nyman Unit New Facility Dog 16Michigan MedicineDepartment of PsychiatryF6327, University Hospital South1500 E. Medical Center Dr, SPC 5295Ann Arbor, MI 48109-5295Visit our website to learn more:medicine.umich.edu/dept/psychiatry
INTERVENTIONAL PSYCHIATRY UPDATE:Better and Faster Results for our PatientsMany treatments in psychiatry, while well supported byresearch, work only for some people. Most treatmentsfor depression or bipolar disorder take weeks to havea noticeable effect, and months to provide major relief,and some do not work at all—which leads to a frustrating“wait and see” approach.Interventional psychiatry — the use of brain stimulationtechniques and other minimally invasive intravenous (IV)drug strategies, leads us to a tipping point towards a new modelof care in psychiatry. Through research, many novel treatmentsunder the interventional psychiatry umbrella are emerging,involving primarily IV medications and novel brain stimulationtechniques. There are a number of interventional psychiatryinitiatives underway within the U-M Department of Psychiatryand Depression Center. Below we lay out a few examples.Electroconvulsive Therapy (ECT)ECT is one of the oldest forms of interventional psychiatry in the country and has been used at U-M fordecades. After a patient falls asleep with the help of sedative medication and has been given a musclerelaxant, ECT is administered with a brief electrical stimulation to the head which produces seizure activityseen on brainwave monitoring (EEG monitor), without significant body movement. A typical course is sixto twelve sessions over three to four weeks. ECT is still the most effective treatment for severe depression,and is useful for various other conditions. Though ECT has been stigmatized in the media for years, itseffectiveness cannot be ignored as it produces remission from depressive symptoms better than any othertreatment.The Michigan Medicine Department of Psychiatry is home to one of the busiest ECT sites in the countrycompleting about 3,600 treatments per year. The program has grown over 50% in three years since openinga new space within the University Hospital in 2016.“Although ECT has been available for over 80 years, research andclinical advancements over the last one to two decades continue to bediscovered enhancing outcomes and minimizing side effects. Whenother treatments fail or depression symptoms are life threatening,ECT is one of the most important options to consider.”— Daniel Maixner, M.D.Daniel Maixner, M.D.Associate Professorof Psychiatry andECT Program Directorfor Michigan MedicineIV Ketamine: Research and Clinical CareIn 2017, the Department of Psychiatry and the Depression Center launched a study on the biomarkers ofresponse to intravenous (IV) ketamine, with the goal of finding a blood test to predict who would mostbenefit from ketamine. This study is a multi-university collaboration facilitated by the National Networkof Depression Centers, funded by philanthropic support to U-M, and is co-led by the Mayo Clinic and U-M.Ketamine has been used for decades and has multiple uses, with one method being to treat treatmentresistant depression when given intravenously. The benefit of administering ketamine via IV is that itimproves the timeline for patients getting back to health.The department uses a low dose of a non-fully sedating dose of ketamine, and three to six sessions aretypically required for patients. The outpatient procedures typically last one or two hours. In some cases,people receiving this treatment achieve remission after their first treatment.The U-M study, being led by Dr. Sagar Parikh and Dr. John Greden, has recruited 14 out of a planned 15patients so far, and has been approved to recruit an additional 15 individuals. After analyzing study results,the team hopes to host a fully functioning IV ketamine clinic at Michigan Medicine by 2020.2
“Ketamine is not a miracle drug — some people respond andothers do not, we still need to figure out who is effected positively.But multiple studies from many countries now show good results,so it is clearly a major advance in the treatment of depression.”— Sagar V. Parikh, M.D.Transcranial Magnetic Stimulation (TMS)Transcranial Magnetic Stimulation (TMS) is a flexible technique for delivering focused magnetic energy intothe brain, non-invasively. Since 2008, it has been approved by the FDA for the treatment of major depressivedisorder, and more recently for the treatment of obsessive-compulsive disorder. TMS is delivered in repetitivepulses; hence, it is often referred to as repetitive TMS, or rTMS.Sagar V. Parikh, M.D.The John F. GredenProfessor of Depressionand Clinical NeuroscienceThe Department of Psychiatry has been offering TMS for refractory depression since 2010. With increasingcoverage by insurers, TMS offers an important alternative therapy for depression when medications are nothelpful. Although it is not quite as effective as ECT, it can be administered in an outpatient setting and doesnot require anesthesia. Ongoing research in the department is combining TMS treatment with computerizedcognitive training (‘brain exercise’) to gain the dual benefit of these two therapies. The department will alsobe implementing new forms of TMS, such as theta burst stimulation (TBS), which can be delivered in lessthan 5 minutes, compared to 30-40 minutes for conventional TMS.New Drug for Treating Postpartum Depression (PPD) QuicklyThe department is currently working withOB/GYN and pharmacy colleagues to explore thepossibility of adding Zulresso (brexanolone) to itssuite of treatment options for women sufferingfrom PPD. Zulresso is the first ever drug designedto specifically treat PPD and shows efficacy within aweek of administration. The downsides of the druginclude high costs and that it requires a 60-hour IVinfusion. However, patients who have received it areshowing signs of remission within two weeks. The newdrug has potential to help the one in nine women whoexperience symptoms of postpartum depression.Interventional Psychiatry FellowshipThe Department of Psychiatry has launched a brand new fellowship inInterventional Psychiatry. The fellowship provides one year of focusedclinical and research training in all modalities of treatment, with particularemphasis on ECT, IV ketamine, and TMS, with the opportunity for trainingin transcranial direct current stimulation. Additional training in otheremerging technologies including e-health (apps, websites, and computertools) as well as other emerging IV medications will be possible. This willbe an opportunity for the department to showcase its leadership in thefield on an international platform as the field hits its stride.Early philanthropic support has made theInterventional Psychiatry initiatives discussed inthis article possible, and we thank these donorsfor their vision and commitment to improvingoutcomes for people with mood disorders.Additional funding opportunities are available forthis and other programs. Contact information forour development team is included on page 16.3
PROGRAM UPDATEPrecision HealthEnhancing Mental Health Care ThroughGenomics and Mobile TechnologyPDetermining the mental health treatment most likely tobe effective for each patient can be challenging. Clinicians,including those at U-M, rely heavily on evidence-basedpractice to maximize patient recovery and try to meet thegrowing need for care. However, mental health treatmentremains largely subjective and typically involves a trial anderror approach.recision Health is one of the biggest trends inhealth care right now. It is an emerging fieldthat aims to tailor treatment to each uniqueindividual, rather than the average patient. Throughmeasuring genetics, environment, and lifestyle, thegoal is to determine optimal treatment and preventionstrategies for various health conditions. PrecisionHealth has enormous potential to advance treatment,accelerate recovery, and improve patient outcomes —especially in the mental health field. The Department ofPsychiatry has a number of Precision Health Initiativesunderway, a few of which are mentioned below.Precision Prevention of New PersistentOpioid Use Following SurgeryNew persistent opioid use (defined as opioid use morethan 90 days after surgery) is the most common surgicalcomplication, occurring in 6% of surgical patients.Efforts are underway at the policy level to reduce opioidprescribing after surgery; however, these efforts do notaddress the underlying patient risk factors that also drivethe opioid epidemic. Fortunately, there are promisingintervention options that could change a patient’s opioidrelated risk trajectory if delivered at the right time, butsuccess hinges upon the effective and timely identificationof those at risk.Research has shown a small number of factors (manydocumented in the electronic health record) can predictwhich patients may go on to develop new persistent opioiduse after surgery. Advanced and innovative approaches areneeded to extract this information and analyze this rich,but complex data resource.A multi-disciplinary study team within the Departmentof Psychiatry is utilizing several machine-learning basedmethods to classify health record data and build analgorithm to predict risk for opioid problems before theystart. The team, consisting of Anne Fernandez, Ph.D., G.Scott Winder, M.D., Amy Bohnert, Ph.D., and other U-Mcollaborators, will then identify patients at risk and invitethem to participate in an intervention to prevent newpersistent opioid use and subsequent opioid addiction.This work will advance precision health in the areas ofaddiction and mental health, and utilizes a diverse set ofprecision health resources at U-M.4The Providing Mental Health Precision Treatment(PROMPT) study, led by principle investigators AmyBohnert, Ph.D. and Srijan Sen, M.D., Ph.D., of theDepartment of Psychiatry, joins collaborators fromdepartments across U-M, including engineering, LSA,pharmacy, and public health. The project aims to reducethe burden of depression and other mental healthconditions by two means.First, patients waiting for their first appointment inoutpatient psychiatry and University Health Service(UHS) will be provided access to mobile technologyinterventions. These include wearable technology, mentalhealth smartphone applications, and daily, individualizedapp-based feedback on behavioral and health data such assleep and physical activity.Second, The study will gather both subjective andobjective patient data (i.e., self-report surveys, wearabletechnology and smartphone data, data from the medicalrecord, and DNA samples) before, during, and afteroutpatient care to better understand the factors thatinfluence patient recovery. The project is innovative inits collection and analysis of combined objective andsubjective data, and hopes to advance knowledge abouthow to accelerate recovery from mental health conditionsby better matching pharmacological, psychological, andmobile-based treatments to patients. The PROMPT studywill begin recruiting at the Rachel Upjohn Building andUHS in fall 2019.
New Brain Imaging Methods May Improveour Understanding of DementiaThe rate of Alzheimer’s disease and associated dementiasis expected to increase dramatically in the coming decadesdue to the aging of the baby boomer generation. A formof brain imaging, magnetic resonance imaging (MRI), iscommonly used in the diagnosis of dementia; however,these images usually focus on the size of specific brainstructures and overlook the problems that result fromdisrupted blood flow to the brain.A new study led by Scott Peltier, Ph.D. (Department ofBiomedical Engineering) and Benjamin Hampstead, Ph.D.(Department of Psychiatry), is directly examining theeffects of disrupted blood flow in the brains of older adults,including those with Alzheimer’s disease. A series of newMRI methods will allow the team to better understand if,how much, and where in the brain blood flow is reducedas well as what effect this has on the white matter, orthe “wiring”, of the brain. The team also plans to use newmethods to analyze these data with the goal of predictingwho is likely to show cognitive decline and progressto dementia.The goal is to develop mathematical models that will helpresearchers and, possibly clinicians, identify those whocould benefit from early interventions. This study buildson Drs. Hampstead and Peltier’s roles in the MichiganAlzheimer’s Disease Research Center, which is one of themajor research centers funded by the National Institute onAging (NIA), as well as their work with non-pharmacologicinterventions that may improve cognitive impairment inolder adults, which is also funded by the NIA.Those interested in learning more about these studies cancontact either Dr. Peltier or Dr. Hampstead at 734-763-9259.Benjamin Hampstead, Ph.D.5
PROGRAM UPDATEThe Sleep and Circadian Research LaboratoryThe Sleep and Circadian Research Laboratory within theDepartment of Psychiatry researches sleep and circadianrhythms in human clinical disorders and treats patients withsleep and circadian disorders. The lab, which is co-directed byHelen J. Burgess, Ph.D. and J. Todd Arnedt, Ph.D., is a state-of-theart facility that has been specifically designed to conduct highlysophisticated sleep and circadian research studies. Additionalfaculty members within the sleep lab include Leslie Swanson, Ph.D.,and Deirdre Conroy, Ph.D.Sleep is an integral, but often underappreciated, pillar of health andwell-being. Increasing evidence links poor sleep and circadian healthto increased risk for developing mental health disorders, such asdepression and anxiety. Faculty members in the lab know that ifsleep health is improved, symptom burden is reduced and qualityof life is improved — but sleep is often forgotten in the treatmentof these disorders. Perhaps even less recognized is the circadiansystem, which affects the timing and quality of sleep, mood andmany other aspects of physical health.“Sleep and circadian health play a big role in the development ofmental health disorders. But one of the advantages of addressingsleep and circadian dysfunction is that we have well-establishednon-pharmacological treatments, such as cognitive behavioraltherapy for insomnia (CBT-I) and bright light therapy, that canrapidly improve sleep and daytime functioning,” he added.“Our program is unique because of the breadth and depth of ourresearch and clinical care program,” said Helen Burgess, Ph.D.,professor of psychiatry. “We have leading expertise in researchingand treating both sleep and circadian disorders, which we leverageto conduct research in patients with all kinds of debilitating clinicaldisorders, such as substance use, depression, traumatic stress,chronic pain, and others.”Sleep and Circadian Research Laboratory:Facility and ResourcesThe Sleep and Circadian Research Laboratory, housed within theRachel Upjohn Building on the East Medical Campus, includesthree bedrooms wired with state-of-the-art digital sleep recordingequipment and a central control room with ensuite bathroomand shower. The central section of the lab also includes a roomcontaining a dim light photostimulator, a highly sophisticatedpiece of equipment that allows for precise measurement of anindividual’s sensitivity to light, and which has the potential to helpus understand a critical mechanism of circadian disruption.Adjacent to the main laboratory are two temperature and lightcontrolled time isolation suites, each with its own wired bedroomfor sleep recordings, living room (see photo), and a bathroom witha shower. These suites are uniquely designed to allow for precisemeasurement of intrinsic circadian timing and for long-term studiesto study the impact of environmental changes, such as changes inday length, on the circadian system.Research Focus: Sleep and Circadian Healthin Clinical Disorders“We know that roughly 10% of the general population has chronicinsomnia, which is defined as difficulties falling and/or stayingasleep lasting at least three months with adverse impacts ondaytime functioning,” said J. Todd Arnedt, Ph.D., associate professorof psychiatry. “We also know that about 30% of the generalpopulation suffers from circadian disruption, in the form of shiftwork, early school start times or just irregular sleep patterns duringthe week.”6The central aims of the research conducted in the Sleep andCircadian Research Lab are to advance the understanding of therole of sleep and circadian rhythms in clinical disorders and totranslate these findings into more effective and efficient treatmentsfor patients. The team is committed to improving not only sleepand circadian health for patients, but also improving quality of lifefor people and reducing the burden of clinical disorders like chronicpain, addiction, and mood disorders.
The sleep research lab currently has several studiesunderway. A few of the active studies in the lab arehighlighted below:The FibroLight Research Study is examining the effects of awearable light treatment on fibromyalgia symptoms. Morning lighttherapy is well recognized to improve mood and sleep — two factorsknown to impact pain. This study is testing a commercially availablelight treatment device, the “Re-timer,” which permits people to beambulatory during the light treatment.“This makes light treatment much more feasible formany people — gone are the days where people haveto sit in front of a li
2019 DEPARTMENT OF PSYCHIATRY ANNUAL NEWSLETTER Sincerely, Gregory W. Dalack, MD Associate Professor Interim Chair and Associate Chair for Education and Academic Affairs Michigan Medicine Department of Psychiatry F6327, University Hospital South 1500 E. Medical Center Dr, SPC 5295
section five: speciality psychiatry 29. child and adolescent psychiatry 159 30. women and mental health 169 31. geriatric psychiatry 173 32. emergency psychiatry 177 33. psychotherapy 181 34. forensic psychiatry 189 35. community psychiatry 193 36. mental health legislations in india 195 37. neuroimaging, eeg and evoked potentials 197 38.
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DEPARTMENT OF PSYCHIATRY DIVISION OF CHILD & ADOLESCENT PSYCHIATRY UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES PSYCHIATRIC RESEARCH INSTITUTE Psychosis in Children and Adolescents Written by: Jody L. Brown, M.D. Assistant Professor D. Alan Bagley, M.D. Chief Resident Department of Psychiatry Division of Child & Adolescent Psychiatry
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