UPDATES IN C-L PSYCHIATRY

Updates in C-L Psychiatry is a popular, half-day, deep-dive review course featuring multiple experts in the field. Presenters address topics like neuropsychiatry, psycho-oncology, and pediatric C-L psychiatry which serves as an excellent preparation for certification or re-certification exams. ACLP members registered for the full conference receive complimentary registration to this course.

Speakers:

• Sarah Andrews MD - Assistant Professor in Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine   
• Robert Weinrieb MD, FACLP - Chief Psychiatric Consultant, Program Director Consultation-Liaison Fellowship, Penn Transplant Institute
• Sanjeev Sockalingam MD, MHPE, FACLP - Vice-President, Education and Professor, Centre for Addiction and Mental Health, University of Toronto
• Durga Roy MD - Assistant Professor of Psychiatry and Behavioral Sciences, John Hopkins University School of Medicine
• Xavier Jimenez MD, FACLP - Director, Consultation-Liaison Psychiatry, Long Island Jewish Medical Center/Northwell
• Mark Oldham MD - Assistant Professor of Psychiatry, University of Rochester Medical Center
• Margo Funk MD, MA - Director of Cardiovascular Psychiatry, Program Director Adult Psychiatry Residency, Brigham and Women's Hospital
• Priya Gopalan MD, FACLP - Associate Professor of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital
• Damir Huremovic, MD, FACLP - Assistant Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

FUNDAMENTALS OF C-L PSYCHIATRY

The Fundamentals of C-L Psychiatry course is designed to introduce new practitioners to the field of C-L Psychiatry. The course has a revolving list of topics, covering about five topics per year, with the goal of covering most of the basics over a 3-year cycle.

This year's topics include:

• How to do a Consult - Stephen Nicolson, MD, FACLP, Director, Psychiatry Consultation Service, Beth Israel Deaconess Hospital - Plymouth
• Psychopharmacology in the Medically Ill - J.J. Rasimas, MD, PhD, FACLP, FACMT, FACPsych, Medical Director, C-L Psychiatry Service & Fellowship, Hennepin County Medical Center
• Transplant Psychiatry - Jose Maldonado, MD, FACLP, FACFE, Professor - Associate Division Chief Adult Psychiatry, Consultation Psychiatry, Stanford University
• Pediatric C-L Psychiatry - Laura Markley, MD FACLP, FAAP, FAPA, Medical Director of C-L Psychiatry, Akron Children's Hospital
• Suicide Risk Assessment - Scott Simpson, MD, MPH, Medical Director, Psychiatric Emergency Services, Denver Health Medical Center

SKILLS COURSES

The Skills Course Package bundles seven deep-dive sessions on current C-L Psychiatry issues (does not include the two sessions listed above) for a single fee:

• Advanced Collaborative Care Skills: Practical Strategies for the Implementation and Sustainability of the Collaborative Care Model
• Advancing Autism Knowledge and Care in the C-L Setting: Skills for the C-L Psychiatrist: A Pediatrics SIG-sponsored Skills Course
• AIM to Learn: Actioning on Implicit (Biases) and Microaggressions in the Learning Environment
• Brief Action Planning (BAP) and Motivational Interviewing (MI) for C-L Psychiatry: A Stepped-care Approach to Health Behavior Change
• ECT for C-L Psychiatrists: An Effective Intervention That Might Save a Life
• Getting Real About C-L Psychiatrists Treating Addiction
• QTc Prolongation and Psychotropic Medications: An In-depth Guide for the C-L Psychiatrist

More details on each follow below:

Advanced Collaborative Care Skills: Practical Strategies for the Implementation and Sustainability of the Collaborative Care Model

Collaborative care (CoCM) is an evidence-based, integrated model for the treatment of common mental health conditions in medical settings. Efficacy of CoCM has been demonstrated by more than 80 RCTs. However, significant practice change is required to implement and sustain CoCM. This advanced skills course will draw on the presenters from the University of Washington’s (UW) Advancing Integrated Mental Health Solutions (AIMS) Center and Integrated Care Training Program. The presenters have significant expertise in CoCM clinical practice, team building, implementation and financing. Each section will have both a didactic and self-directed learning component.

Speakers:

• Anna Ratzliff MD, PhD - Professor, University of Washington   
• Jurgen Unutzer MD MPH - Professor and Chair of Psychiatry, University of Washington
• Andrew D. Carlo MD MPH - Assistant Professor, Northwestern Feinberg School of Medicine
• Jessica Whitfield MD, MPH - Acting Assistant Professor, University of Washington School of Medicine
• Ramanpreet Toor MD - Assistant Professor, University of Washington
• Denise Chang MD - Clinical Associate Professor, University of Washington

Advancing Autism Knowledge and Care in the C-L Setting: Skills for the C-L Psychiatrist: A Pediatrics SIG-sponsored Skills Course

Autism spectrum disorder (ASD) is a common diagnosis and prevalence rates continue to rise; recent studies show that one in 40 children in the US carry this diagnosis. Patients with ASD often have significant challenges in medical settings due to limited communication abilities, sensory processing difficulties, resistance to change in routine, and difficulty regulating behavior when stressed, which can worsen autism related behaviors and aggression, delay diagnosis and treatment, and limit their participation in their care. This patient population additionally has significant medical comorbidities, more symptoms of chronic medical problems and mortality rates that are 2.4 times higher than the general population; these rates are even higher in patients with severe intellectual disabilities. Providers may be unfamiliar with how to effectively complete a diagnostic assessment, manage their behaviors and provide treatment, leading to poorer patient outcomes and increased distress in both providers and patients. C-L psychiatrists can improve the care of patients with ASD through staff education, patient and family involvement, and coordinated care using best practices. This skills course will help attendees gain a better understanding of unique challenges in the care of patients with autism and provide skills and strategies to better support these patients and improve their medical care experience.

Speakers:

• Shelly Kucherer MD - Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Hospital   
• Alex Israel MD - Assistant Professor of Psychiatry, UPMC Western Psychiatric Hospital
• Serena Fernandes MD - Child and Adolescent Psychiatrist, Boston Children's Hospital
• Laura A. Markley MD FACLP, FAAP, FAPA - Medical Director of C-L Psychiatry, Akron Children's Hospital
• Julienne Jacobson MD - Clinical Associate Professor Keck School of Medicine of USC, Direct C/L Psychiatry, Children's Hospital Los Angeles

AIM to Learn: Actioning on Implicit (Biases) and Microaggressions in the Learning Environment

This course seeks to guide attendees in identifying ways that implicit bias and microaggressions can impact our perceptions and behaviors in patient care and the clinical learning environment. Attendees will be able to describe how identity (including both personal and professional identities) and intersectionality impact team dynamics, and then practice communication strategies to use when faced with unexpected bias.

Speakers:

• Asale Hubbard PhD - Acting Director, Diversity, Equity, and Inclusion, San Francisco VA Health Care System   
• William Hua PhD - Psychologist, San Francisco VA Health Care System
• Caitlin Hasser MD - Staff Psychiatrist, Portland VA Health Care System

Brief Action Planning (BAP) and Motivational Interviewing (MI) for C-L Psychiatry: A Stepped-Care Approach to Health Behavior Change

Persistent unhealthy patient behaviors, including non-adherence, unhealthy use of alcohol, tobacco, prescription and other drugs, poor nutrition/over-eating, and sedentary lifestyle account for 70-80%, or more, of the overall burden of chronic illness, disability, and death in the U.S. C-L psychiatrists grapple with these complex behavioral issues in their clinical, consultative, and educational work, but rarely receive sufficient training in targeted evidence-based medical interviewing strategies. This 4-hour course aims to provide C-L psychiatrists with conceptual models and pragmatic skills to systemically address health behavior change complexities in their roles as clinicians and teachers. Specifically, the course will present an integrative stepped-care approach, starting with the eight core competencies of Brief Action Planning (BAP) and supplementing these skills, as needed, with focused applications of concepts and skills from the field of Motivational Interviewing (MI). From MI, the course will highlight: Spirit of MI; recognizing and responding to change and sustain talk/ambivalence; and using the Four Process Model of MI for patients not ready for action planning.

Speakers:

• Yuri Jadotte MD, PhD, MPH - Assistant Professor and Associate Director of Preventive Medicine Residency Program, Renaissance School of Medicine at Stony Brook University   
• Taranjeet Ahuja DO - Communication Skills, Co-Leader; Assistant Professor of Science Education & Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
• Roy Stein MD - Clinical Professor, University of North Carolina School of Medicine
• Deepa Sannidhi MD - Associate Clinical Professor, UC San Diego School of Medicine
• Camila Romero MD MPH - Assistant Clinical Professor, University of California San Diego, Preventive Medicine
• Richard Frankel PhD - Dr. Frankel is Professor of Medicine and Geriatrics, Indiana University School of Medicine
• Igor Koutsenok MD - Professor of Psychiatry, University of California San Diego
• Steven Cole MD, FAPA, FACLP - Professor of Psychiatry, Emeritus, Stony Brook University School of Medicine

ECT for C-L Psychiatrists: An Effective Intervention That Might Save a Life

Electroconvulsive Therapy (ECT) is an effective, rapidly acting treatment for many psychiatric conditions including depression, mania, and catatonia. It is a key component of modern psychiatric care, providing relief of sometimes life-threatening symptoms for which no other therapies are effective. ACLP recognizes the need for ECT training: “The C-L psychiatrist must be knowledgeable about electroconvulsive therapy (ECT) and recognize when to introduce it in depressed, catatonic, or critically ill patients” (Bronheim, Fulop, Kunkel, et al; 1998). Because many patients seen by C-L psychiatrists have comorbid medical conditions that may be disabling and that can be made worse by one or more psychiatric conditions, rapid treatment and resolution of these conditions is essential to optimal patient care. This course will introduce C-L clinicians to ECT or serve as a refresher course for C-L clinicians familiar with its use and will show how it may be used in medical and surgical patients while addressing the legal, ethical, and physiological parameters that must be considered when providing a course of ECT for complex patients. We will also discuss the challenges faced by ECT recipients and providers during the COVID-19 pandemic. Several cases that illustrate the many ways ECT can be used successfully by C-L Psychiatrists will be presented.

Speakers:

• Terry Rabinowitz MD, DDS, FACLP, FAPA, FATA - Professor of Psychiatry and Family Medicine. Medical Director, Psychiatry Consultation Service, Larner College of Medicine at the University of Vermont   
• Amy Odefey MD - Assistant Professor of Anesthesiology, Larner College of Medicine at University of Vermont
• Evan Eyler MD, MPH, FAAFP, DFAPA - Professor of Psychiatry, Robert Larner, MD, College of Medicine at the University of Vermont, University of Vermont Medical Center
• Karen Lewicki MD, JD - Medical Director, Inpatient Psychiatry, VAMC White River Junction
• Julia Knight MD, PhD - Director, Interventional Psychiatry, Dartmouth Hitchcock Medical Center

Getting Real About C-L Psychiatrists Treating Addiction

As of June 2020, 13% of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19. This has been accompanied by increases in overdoses and other opioid-related mortality and adds to the millions of American adults and adolescents already suffering from comorbid substance use and mental health issues pre-pandemic. Many of these patients are seen in acute care settings such as emergency departments or hospitals, often making consultation-liaison (C-L) psychiatrists the de facto addiction specialists. The pre-recorded portion of this workshop will cover a variety of complex addiction-related issues relevant to C-L psychiatrists, including: Substance use in pregnancy; substance use disorders in end-stage medical disease; cannabis for the C-L psychiatrist; opioid use disorder in the general hospital; and psychedelics. 

Speakers will present clinical scenarios often faced by C-L psychiatrists and work with the audience on reviewing the latest data and treatment modalities through case presentations and didactics for group discussion. The interactive portion of this workshop will engage the audience through complex case discussions highlighting each of the above topics followed by a question-and-answer session. Facilitators will guide audience members through high yield learning points, practical tips and updates of evolving science related to evaluation and treatment of substance use with the goal of improving participants’ knowledge base and clinical skills.

Speakers:

• Gerald Scott Winder MD MSc - Clinical Associate Professor of Psychiatry and Surgery, University of Michigan   
• Joji Susuki MD - Director, Division of Addiction Psychiatry, Brigham and Women's Hospital, Assistant Professor of Psychiatry, Harvard Medical School
• Thida Thant MD - Director of the University of Colorado Consultation-Liaison Psychiatry Service, University of Colorado, Aurora
• Simon Sidelnik M.D. - Director Addiction Consultation-Liaison Psychiatry, NYU Grossman School of Medicine

QTc Prolongation and Psychotropic Medications: An In-depth Guide for the C-L Psychiatrist

Psychiatrists routinely prescribe psychotropic drugs that may prolong cardiac repolarization, thereby increasing the risk for Torsades de Pointes (TdP), a potentially fatal cardiac arrythmia. The corrected QT interval (QTc) on the 12-lead electrocardiogram (ECG) is the most widely accepted benchmark of TdP risk and has drawn significant attention amongst prescribers of psychotropic medications. Over the past decade, psychiatrists have witnessed the swinging-pendulum-effect of approaches to QTc prolongation and psychopharmacology, from unwitting disregard to marked hypervigilance.

In this experiential preconference course, we will provide all of the tools necessary to empower the C-L psychiatrist to confidently use the ECG to guide clinical decision-making. The first half of the course will guide members through an in-depth evidence-based understanding of QTc prolongation, basic and advanced ECG interpretation, psychotropic medications, risk assessment and monitoring. This will include updates in the literature from the past year, including evidence for newly approved medications. In the second half of the course, participants will get hands-on practice with brand new cases involving measurement of the QTc, appropriate applications for different QTc correction formulae, and an approach to more complex patients including those with pacemakers, implantable cardioverter defibrillators and wide QRS complexes. We will also highlight some advanced topics that have not been covered in this course previously, including QT dispersion and T wave morphology.

Speakers:

• Christopher M. Celano MD, FACLP - Associate Director, Cardiac Psychiatry Research Program, Massachusetts General Hospital   
• Scott R. Beach MD, FACLP - Program Director, Massachusetts General Hospital
• Margo Funk MD, MA - Director of Cardiovascular Psychiatry, Program Director Adult Psychiatry Residency, Brigham and Women's Hospital