APA 2012

This year’s Annual Meeting in Philadelphia May 5-9 will encompass John Oldham’s presidential theme of Integrated Care by providing the most comprehensive array of presentations ever offered at an APA Annual Meeting. More than 20 presentations on this topic will be offered by top experts in the field including Wayne Katon, M.D., Benjamin Druss, M.D., Jurgen Unutzer, M.D., Roger Kathol, M.D., Joe Parks, M.D., Benjamin Miller, Ph.D., Frank deGruy, M.D. and others.

Integrated care is conceptualized as a range of collaborative efforts with our primary care colleagues in diverse settings to improve overall health. This runs the spectrum from using our expertise in primary care settings to help with the detection and effective treatment of mental illness to engaging primary care to help with the treatment of medical problems in our mental health settings that are contributing to increased mortality. The outcome of these partnerships can result in “improved lives and lifespans” as stated by Steve Sharfstein, M.D., CEO of Sheppard Pratt Health Systems, in a recent AJP editorial. In addition, there is an emerging database showing cost savings in the overall health care system when integrated models of care are implemented.

Integrated care is different from standard consultation in that it encompasses several “core principles” recently established by the Advancing Integrated Mental Health Solutions (AIMS) center at the University of Washington in Seattle. Led by Dr. Unutzer, Director of the AIMS center and Principal Investigator of the “Improving Mood: Promoting Access to Collaborative Treatment” (IMPACT) studies, a Summit was held in May 2011 that resulted in a well thought out inventory of essential values prominent in integration efforts. The core principles of effective integrated care include person-centered care teams providing evidence-based treatment to a defined population of patients using a measurement-based ‘treat to target’ approach.

The idea of psychiatrists assuming responsibility for a population of patients is new for many and a prominent feature of this model in both primary care and mental health settings. This system of team-based care also provides a way to extend limited psychiatric expertise across larger groups, providing one promising solution for the shortage of psychiatrists. It provides a framework for thinking about our role in communities as we position ourselves for healthcare reform and market our value in evolving systems of care.

Integrated Care has a robust evidence base consisting of more than a decade of studies from multiple settings across the country. From the pioneering work spanning Dr. Katon’s, 30-year career, to the repeated success of IMPACT trials extended to other populations, the success Dr. Druss has shown in improving the health status of persons with mental illness in public settings and more, integrated care has demonstrated proven, effective models with psychiatrists prominently featured as essential to the success of such programs. However, psychiatrists in many clinical settings have not had the training opportunities until now to join this healthcare revolution in well-informed and meaningful ways. This year’s annual meeting in Philadelphia will provide a much-needed venue to discover and learn more about this evolving subspecialty area, allowing attendees to sift through the data and experiences of those working in the field.

Some highlights of the meeting include the first course in Integrated Care ever offered at the annual meeting on Saturday, May 5 (Course 4, The Integration of Primary Care and Behavioral Health: Practical Skills for the Consulting Psychiatrist), and a Saturday symposium on financing Integrated Care (Symposium 9, Financing Sustainable Interdisciplinary Care in Psychiatric and General Medical Settings). On Sunday, May 6, a featured highlight of the meeting is an invited forum (Forum 3, The Future is Now: The Evolving Role of Psychiatry in the Integration of Primary Care and Behavioral Health), bringing together top experts in the field in a discussion group format to share ideas and encourage dialogue with attendees. Monday, May 7 offers several top-notch presentations, including a Presidential Symposium (New Approaches to Integration of Mental Health and Medical Services), a symposium with Jeff Brenner, M.D. from Atul Gwande’s New Yorker “hot spotters” article (Symposium 47, Inventing the Neck: Connecting Body, Mind, World from the Top Down and Bottom Up) and a seminar (Seminar 15, Integrating Mental Health Services Within a Primary Care Setting: Effective Strategies and Practical Tips) with Ben Miller, Ph.D., President of the Collaborative Family Healthcare Foundation (CFHA). The selections continue on Tuesday, May 8, with a symposium offered by AADPRT (Symposium 82, Integrated Care and the Future of Psychiatry: Teaching Psychiatry Residents and Fellows to Work at the Interface of Mental Health and Primary Care) and a workshop bringing together the three disciplines on integrated care teams (Workshop 95, Primary Care Behavioral Health Integration: Roles of the Key Team Members). Wednesday, May 9, wraps up with an AACP workshop (Workshop 133, Roles for Psychiatrists in Integrated Care) highlighting key points from the chapter on Integrated Care included in the soon-to-be released Textbook of Community Psychiatry. This full list of presentations is available on the APA website, in the Daily Bulletin at the meeting and as a comprehensive handout with a companion Related Topics list.

Lori Raney, M.D., chairs the APA’s Workgroup on Integrated Care and can be reached at lraney@axishealthsystem.org.

Glen Gabbard, M.D., says that in writing about and teaching psychotherapy to residents, the commonalities between two forms of psychotherapy have often been as obvious as their differences.

Advocates of psychodynamic therapy and cognitive therapy have sometimes been viewed as being at ideological loggerheads. But should they be? At this year’s Annual Meeting in Philadelphia, two of the most admired proponents of these bedrock psychotherapies will bridge the ideological divide in a special Opening Session event that is expected to attract a standing-room-only crowd.

Aaron Beck, M.D., the founder of cognitive therapy, and Glen Gabbard, M.D., well known as an expert in psychodynamic psychotherapy, will explore the similarities and differences in the two approaches.

The Opening Session will be held Sunday, May 6, at 4:30 p.m. in Terrace Ballroom I-III, Level 4, at the Pennsylvania Convention Center.

As in past years, the session will also include the meeting’s opening ceremonies and speeches presented by the APA president and APA presidentelect – this year, John Oldham, M.D., and Dilip Jeste, M.D., respectively. The conversation between Beck and Gabbard will follow.

Dr. Oldham will moderate the conversation. “The topic is important, since there is increasing evidence of the effectiveness of psychotherapy for many different psychiatric disorders, and there is a growing body of evidence that psychotherapy is a biological treatment that can change the brain,” he told Psychiatric News. “It can be confusing to sort out whether a specific type of psychotherapy is uniquely effective for a given patient with a given disorder, or whether a number of different types of psychotherapy can be useful for patients with the same condition.

“In recent discussions, Aaron Beck, a pioneer of cognitive therapy, and Glen Gabbard, a master expert in psychodynamic therapy, became interested in thinking about common elements shared by both treatments,” Dr. Oldham said. “Since many clinicians consider these approaches quite different, it seemed a special opportunity to ask Drs. Beck and Gabbard to informally discuss this question, and the Opening Session seemed the best place to do it. Launching the 2012 meeting by diving right into the clinical world of psychotherapy, led by two larger-than-life experts, seemed an idea that couldn’t be beat.”

Dr. Beck told Psychiatric News that the idea for the conversation originated when an intern working with Dr. Gabbard at the Baylor Psychiatry Clinic came to the Beck Institute for training. “She mentioned that she saw a lot of similarities in Glen’s approach and mine,” Dr. Beck said. “She thought that our therapeutic manner was similar and that Glen’s theory of internal representations was similar to my own theories of cognitive schemas. Having heard that, I wondered whether Glen and I might be making similar observations but using a different language to describe them. I thought such a conversation would be interesting not only from the standpoint of similarities, but also from the standpoint of what the real differences are in our approaches and what the bases for these differences are,” he said.

Dr. Gabbard had a similar reaction. “I wasn’t surprised to hear [the intern’s remarks],” he added. “When Judith Beck [Aaron Beck’s daughter] and I edited the Oxford Textbook of Psychotherapy, we noted that therapists from different backgrounds and training often conceptualized the therapeutic approach similarly. Many sophisticated observers have stressed that so-called common factors, such as empathy, therapeutic alliance, active listening, and others, are at the core of good therapy no matter what the therapist calls his or her approach.”

Dr. Gabbard said psychiatrists who attend this event will learn how the two approaches have evolved over time and will become acquainted with the theory and technique of each and of the therapeutic action involved in both approaches. And they will also come to understand the nature of the fundamental differences between the two treatments.

“We live in an era of multiple psychotherapies,” Dr. Gabbard said. “It is of great interest to psychiatrists to know which ones work with which disorders and with which patients. Are there unique features of specific psychotherapeutic approaches? Or do they all draw from the same toolbox? Cognitive therapy and psychodynamic psychotherapy have appeared to converge in recent years. This Annual Meeting event will examine those areas of convergence and divergence in a spontaneous dialogue between two experienced practitioners of cognitive therapy and psychodynamic therapy.”

Dr. Beck is University Professor Emeritus of Psychiatry at the University of Pennsylvania, Perelman School of Medicine, and Dr. Gabbard is a clinical professor of psychiatry at Baylor College of Medicine and training and supervising analyst at the Center for Psychoanalytic Studies in Houston.

Edward “Ted” Kennedy Jr., son of the late Massachusetts senator and brother of former Rep. Patrick Kennedy, will deliver the William C. Menninger Memorial Convocation Lecture at this year’s annual meeting in Philadelphia.

Kennedy is the president and co-founder of Marwood Group and Co., a health care–focused financial services firm headquartered in New York with offices in Washington, D.C., London, and Kuwait. According to its website, the firm provides services to institutional investors, health care corporations, and trade associations. His wife, Katherine Gershman Kennedy, M.D., an APA member, is a psychiatrist in New Haven, Conn., and is on the voluntary faculty at Yale University School of Medicine.

The lecture will be presented at the Convocation of Distinguished Fellows, which will be held Monday, May 7, from 5:30 p.m. to 6:30 p.m. in the Pennsylvania Convention Center.

Kennedy brings to the APA meeting his family’s longstanding interest in and support of issues related to mental health. His father served 47 years as senator from Massachusetts and was a staunch supporter of parity coverage for treatment of mental illness and of funding for research on mental illness. Sen. Kennedy delivered the Convocation lecture at APA’s annual meeting in Washington, D.C., in 1992.

Brother Patrick Kennedy was a member of the U.S. House of Representatives from Rhode Island from 1995 to 2011. He was instrumental in the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, signed into law on October 3, 2008. He also is the founder of “The Next Frontier: One Mind for the Brain,” a campaign to promote brain research, according to the May 6, 2011 Psychiatric News.

Ted Kennedy Jr. also has a long history of involvement in health care issues. Prior to founding the Marwood Group, Kennedy served as an associate and later as counsel to the law firm of Wiggin and Dana, a health law practice focused primarily on state and federal regulatory and reimbursement issues affecting hospitals, home-care agencies, long-termcare providers, physicians, and mental health professionals.

In addition, Kennedy served as director of legal and regulatory affairs at the Connecticut Hospital Association, educating acute care providers and policymakers on a wide variety of emerging health care issues.

Kennedy has been a leader in the civil rights movement for persons with disabilities. In his law practice, he advised companies about how best to expand opportunities for persons with disabilities and how to avoid liability under the Americans With Disabilities Act. He serves on the corporate and advisory boards of numerous disability organizations, including the American Association of People With Disabilities, and lectures nationwide on topics relating to health and disability law.

Kennedy’s experience with the health care system is more than professional, however. In 1973, at the age of 12, he was diagnosed with osteosarcoma in his right leg, requiring surgical amputation.

Civilian mental health professionals are finding it increasingly important to have a knowledge and comfort level in treating military and former military personnel.

About half of recent veterans are treated in VA hospitals, which means that the other half use non-VA physicians or no physicians at all, according to Elspeth Cameron Ritchie, M.D., M.P.H., who is chief clinical officer in the District of Columbia’s Department of Mental Health.

To fill this need for educating civilian psychiatrists in the needs of military veterans and their families, and to update military professionals with the latest information, the APA Annual Meeting will feature a number of sessions in its Military Track. APA has featured sessions dealing with military mental health issues for years. Last year, for the first time, the sessions were organized into a specific track of sessions.

This year’s offerings will focus on what the healthcare professional should know in caring for soldiers, their families, and veterans as they move out of the military and into the civilian community.

Captain Paul Hammer, M.D., director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, agrees that preparing yourself to treat the various effects of combat service, such as posttraumatic stress disorder (PTSD) and depression, is vitally important for the civilian physician.

“I don’t think people realize that in the different conflicts we have been in over the past few years, that 40 percent of the people who have fought in these are from the National Guard and Reserves,” he said. “They have been heavily used by the military. They are not the kind of people who will end up going back into a military treatment environment, they’ll be seen in the civilian environment.”

Capt. Hammer’s symposium “Treatment of PTSD and Depression in DoD: Taking Lessons Learned from the Trenches Into Your Practice and Community” will focus specifically on the treatment of PTSD and depression in the returning military. The panel will discuss the unique and complex aspects of PTSD in service members and veterans, the co-occurring conditions, and ways to treat those with combat service.

“Understanding what the combat experience is and understanding the patient’s perceptions are important, said Capt. Hammer. “I think the military culture is a little different and I think if you aren’t familiar with the military and military culture, you may approach it differently; I think treatment might not be as successful if you don’t have that understanding.”

Dr. Ritchie is also involved in a number of symposia and workshops aimed at educating the provider on unique aspects of treating service members.

“Many are often seeking care through health plans through their business or school, or they are not seeking care at all. They get brought to the emergency rooms when they are in trouble,” said Dr. Ritchie. “There is a lot of focus in this military track on what the civilian doctor needs to know.”

“Updates on Screening and Treatment of the Psychological Effects of the Wars in Iraq and Afghanistan” includes six speakers shedding light on various aspects of the mental health issues tied to the Long War. “Most civilians have heard of PTSD, but their understanding of it is usually related to Vietnam veterans, sexual assault victims, or natural disaster survivors,” said Dr. Ritchie. “What we are seeing in the soldiers as they come back today is a slightly different collection of symptoms. It’s much fresher. And, many people have been back and forth into the war zone a number of times, so they may have layers of acute stress disorder or PTSD.”

Among the topics being discussed in the symposium are screening and intervention strategies, providing treatment in war zones, pharmacotherapy, and building community delivery of services.

Another compelling topic in the military track is the workshop “Joining the Ranks of Military Psychiatry as a Civilian Contractor.” Dr. Ritchie has gathered several psychiatrists who got their start in private practice, but have moved into military psychiatry. The workshop will provide perspective from both those who are working as contractors and those in the military who work with contractors.

Dr. Ritchie is also excited about the “Army Psychiatrists in the Combat Zone; Personal Experiences and Reflections” workshop. “I think it’s going to be fascinating,” she said. “One of my colleagues decided to join the Army midway through his career and came in as an Army major. He deployed to both Afghanistan and Iraq. He got back from Afghanistan recently, where he had a very interesting and difficult experience. He’ll have the perspective of being there recently.”

The other important aspect of treating those with military service is the role their families play. Physicians may be tasked with treating family members of veterans, or those who were wounded or died in service. While most press is focused on families of the deployed, it is often the families of the fallen warrior, who have moved out of military housing and feel their connection to the military is lost, that find their way into the civilian doctor’s practice.

“In all of our discussions, we bring in the families, because it is not just about treating the veteran or the service member,” said Dr. Ritchie. “It is absolutely about the stresses of the family. It is important for civilian doctors to ask about connection to the military, and it’s not just children and the nuclear family, but brothers and sisters as well. Many of our young men and women who have died in combat left behind younger brothers and sisters, and they don’t get talked about in the public discourse.”

For the first time, the National Institute on Drug Abuse (NIDA) offers its Addiction Performance Project as part of the Annual Meeting. Award-winning actors will perform the third act of Eugene O’Neill’s Long Day’s Journey Into Night. The project is a CME program to stop stigma associated with addiction and promote a healthy dialogue that fosters compassion, cooperation, and understanding for patients living with this disease. The Addiction Performance Project is part of NIDA’s outreach to practicing health professionals and those in training. Each performance begins with a dramatic reading followed by a facilitated audience discussion chaired by Nora Volkow, NIDA’s director. Discussion topics may include challenges and opportunities in caring for drug-addicted patients, provider biases, and how best to incorporate screening, brief intervention, and referral to treatment.

NIDA’s Addiction Performance Project will be held on Tuesday, May 8, from 11:00 a.m. to 12:30 p.m. at the Pennsylvania Convention Center, Terrace Ballroom 4.

Winner of two Academy Awards, two Emmy Awards, and a Golden Globe, actress Dianne Wiest will perform the third act of Eugene O’Neill’s Long Day’s Journey Into Night for NIDA’s Addiction Performance Project.