The Department of Psychiatry and Behavioral Neurobiology

2008 - 2009

GRAND ROUNDS

 Sponsored by the UAB School of Medicine, Division of CME  
 The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.  The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Archived Grand Rounds Schedules
If you need to reference past schedules or presentations, the following schedules are archived for your convenience.  
2005-2006 2006-2007 2007-2008

September 2008

The REGARDS Study: How we were seeking the causes of stroke disparities and (also) became a national longitudinal epidemiologic study of cognitive change
George Howard, DrPH
Professor of Biostatistics
School of Public Health
University of Alabama at Birmingham

Virginia J. Howard, PhD
Associate Professor of Epidemiology
School of Public Health
University of Alabama at Birmingham

Objectives: 
1. Describe the magnitude of racial and geographic disparities in stroke mortality
2. Provide an overview of the general study methods of REGARDS (i.e., the “stroke aims”), including available data domains involving depression and stress
3. Provide a history of how cognitive assessment was added to the study, and describe the research protocol.
4. Describe distributions and predictors of selected cognitive measures
5. Discuss opportunities for collaboration

References:
Howard G: Why do we have a stroke belt in the southeastern United States? A review of unlikely and uninvestigated potential causes. Am J Med Sci 1999;317:160-167.

Howard VJ, Cushman M, Pulley L, Gomez C, Go R, Prineas RJ, Graham A, Moy CS, Howard G. The Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study: Objectives and Design. Neuroepidemiology 2005;25:135–143.

Wadley V, McClure LA, Howard VJ, Unverzag FW, Go RC, Moy CS, Crowther, MR, Gomez CR, Howard G. Cognitive status, stroke symptom reports, and modifiable risk factors among individuals with no diagnosis of stroke or TIA in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Stroke 2007;38:1143–47.

Sept. 23
11:00am

Glycogen synthase kinase-3 (GSK3): a potential therapeutic target to treat neuroinflammation
Patrizia De Sarno, Ph.D.
Instructor, Behavioral Neurobiology
Department of Psychiatry and Behavioral Neurobiology
University of Alabama School of Medicine

Objectives: 
1. To investigate the role of GSK3 in neuroinflammation using the mouse model of experimental autoimmune encephalomyelitis.
2. Determine whether inhibiting GSK3 with lithium is a potential target for therapy of multiple sclerosis and other autoimmune inflamatory diseases affecting the CNS.

References:
De Sarno, P., Axtell, R.C., Raman, C., Roth, K.A., Alessi, D.R., and Jope, R.S. Lithium prevents and ameliorates experimental autoimmune encephalomyelitis (EAE). J. Immunol. 2008, 181: 338-345.

Autism: Cortex, Cognition and Connectivity
Dr. Rajesh Kana
Assistant Professor
Department of Psychology
University of Alabama at Birmingham

Objectives:
1. The audience will acquire a basic understanding of the brain structure and functioning in autism.
2. The audience will gain knowledge about the neutral basis of behavioral and cognitive characteristics in people with autism

Due to HIPPA policy, this Grand Rounds is closed to outside professionals.  Only UASOM Department of Psychiatry faculty, staff, residents, and medical students on rotation can attend.

Case Conference
Norman Huggins, M.D. and panel
Assistant Professor
Department of Psychiatry and Behavioral Neurobiology
University of Alabama School of Medicine

Biology of schizophrenia: genes, models, and phenotypes
Akira Sawa, M.D., Ph.D.
Associate Professor of Psychiatry
Director, Program in Molecular Psychiatry
Department of Neuroscience
The Johns Hopkins University

Objectives:
To overview how genetic studies can contribute to understanding of mechanisms for schizophrenia and good clinical practice.

References:
Sawa, A. & Snyder, S. H. Schizophrenia: diverse approaches to a complex disease. Science 296, 692–695 (2002).

A. Kamiya, K. Kubo, T. Tomoda, M. Takaki, R. Youn, Y. Ozeki, N. Sawamura, U. Park, C. Kudo and M. Okawa et al., A schizophrenia-associated mutation of DISC1 perturbs cerebral cortex development, Nat Cell Biol 7 (2005), pp. 1167–1178.

Atsushi Kamiya, Perciliz L. Tan, Ken-ichiro Kubo, Caitlin Engelhard, Koko Ishizuka, Akiharu Kubo, Sachiko Tsukita, Ann E. Pulver, Kazunori Nakajima, Nicola G. Cascella, Nicholas Katsanis, and Akira Sawa, Recruitment of PCM1 to the Centrosome by the Cooperative Action of DISC1 and BBS4: A Candidate for Psychiatric Illnesses Arch Gen Psychiatry, Sep 2008; 65: 996 - 1006. 

The Role of the Pharmaceutical/Device Industry in the Academic Medical Center

A Discussion with:
Thomas Stewart Huddle, M.D., Associate Professor, General Internal Medicine
Stuart James Cohen, M.D., Associate Professor, General Internal Medicine
Rayford W. Thweatt, M.D., Professor, Department of Psychiatry & Behavioral Neurobiology
Meza Kelley, LCSW, Assistant Professor, Department of Psychiatry & Behavioral Neurobiology
Nathan B. Smith, M.D., Professor, Department of Psychiatry & Behavioral Neurobiology

Moderated by Daniel Dahl, M.D., Associate Professor, Department of Psychiatry & Behavioral Neurobiology

Link to discussion format and questions

North American Psychiatric Resident Wellness Survey
Paul O'Leary, M.D. 
Sub-specialty Resident in Child/Adolescent Psychiatry
Department of Psychiatry and Behavioral Neurobiology
University of Alabama School of Medicine

Objectives: 
1.  Discuss differences between the stressed and relaxed residents, including work hours, coping mechanisms, and mental health.
2.  Discuss what coping mechanisms the residents use.
3.  Discuss the main stressors of psychiatric residents

References:
Woodside J, Miller M, Floyd M, McGowen R, Pfortmiller D: Observations on Burnout in Family Medicine and Psychiatry Residents. Academic Psychiatry 2008; 32:13-19.

Keim SM, Mays MZ, Williams JM, Serido J, Harris RB: Measuring wellness among resident physicians. Medical Teacher, Vol. 28, No. 4, 2006, pp. 370-374.

November 2008

Objectives:
1.  To provide a conceptual framework for the study of engagement in HIV care that may be applicable to other chronic diseases.
2.  To describe the prevalence and implications of mental health and substance use disorders in HIV-infected patients, particularly as it pertains to engagement in care.

References:    Journal titles link to abstract and/or full text
Engaging HIV-Infected Patients in Care:  Their Lives Depend on It  Clin Infect Dis. 2007 Jun 1;44(11):1500-2. Epub 2007 Apr 23.

Minorities, the Poor, and Survivors of Abuse:  HIV-Infected Patients in the US Deep South  South Med J. 2007 Nov;100(11):1114-22

Relation of Lifetime Trauma and Depressive Symptoms to Mortality in HIV  Am J Psychiatry 164:1707-1713, November 2007

Barriers to Antiretroviral Adherence: The Importance of Depression, Abuse, and OtherTraumatic    Events  AIDS Patient Care STDS. 2006 Jun;20(6):418-28.

The CATIE Trial: The Data and the Controversy
Marvin S. Swartz, M.D.
Professor and Head, Division of Social and Community Psychiatry
Executive Vice Chair, Department of Psychiatry and Behavioral Sciences
Director, Duke Area Health Education Center Program (AHEC)
Duke University Medical Center

Objectives:
1.  Review the findings from the CATIE trial to date
2.  Discuss implications of the findings for practice
3.  Examine the controversies about the findings

References:
Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA Perkins DO, Keefe RSE, Davis SM, Dadvis CE, Lebowitz BD, Severe J, Hsiao JK. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. The New England Journal of Medicine 2005; 353(12):1209-1223.
 
Swartz MS, Stroup TS, McEvoy JP, Davis SM, Rosenheck RA, Keefe RSE, Hsiao JK, Leiberman JA for the CATIE Investigators.  What CATIE Found: Results from the NIMH Schizophernia Trial.  Psychiatric Services 2008; 59(5):500-506.

NO GRAND ROUNDS SCHEDULED
THANKSGIVING HOLIDAY

December 2008 

 Dangerousness Decisions: Does Possible Violence Justify Involuntary Confinement?
Douglas Mossman, M.D.
Director, Glenn M. Weaver Institute of Law and Psychiatry
University of Cincinnati College of Law
Volunteer Professor and Associate Program Director, Institute of Psychiatry and Law
University of Cincinnati College of Medicine

Objectives:
At the conclusion of this presentation, attendees will
1.  summarize the events leading to the Tarasoff decision,
2.  summarize the requirements Tarasoff imposed,
3.  describe current limitations of violence assessment,
4.  describe ethical problems posed by preventive detention.

References:
Mossman D: Assessing predictions of violence: being accurate about accuracy. J Consulting Clin Psychology 1994;62:783-792
 
Mossman D: Critique of pure risk assessment, or Kant meets Tarasoff. U Cincinnati L Rev 2006;75:523-609

Objectives:  
1.  Familiarize participants with the clinical challenges associated with opioid analgesic abuse among patients with chronic non-cancer pain; 
2.  Provide an overview of findings of a treatment trial for patients with pain and opioid use disorders.

References:
Heit HA. The truth about pain management: the difference between a pain patient and an addicted patient. Eur J Pain, 2001, 5(Suppl A), 27-9.
 
Savage SR. Long-term opioid therapy: Assessment of consequences and risks. J Pain and Symptom Management 1996, 11, 274-86.
 
Weaver M, Schnoll S. Abuse liability in opioid therapy for pain treatment in patients with an addiction history. Clin J Pain 2002, 18(4 Suppl):S61-9.
 

Objectives:
1. To examine the need for substance abuse tx particularly opiate dependence
2. To examine the pharmacology of buprenorphine
3. To examine the literature concerning the use of buprenorphine

References:
To review power point presentation select this link

2008/2009 GRAND ROUNDS
"The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.  The University of Alabama School of Medicine designates this educational activity for a maximum of 1 hour in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the activity."

January 2009     February 2009     March 2009     April 2009      May 2009

January 2009

The Eyes Have it
Dr. Fred J. Biasini
Research Associate Professor of Psychology
Associate Director, Sparks Clinics and
Director, Interdisciplinary Training at the Civitan International Research Center
Director, UAB Early Head Start Program
Department of Psychology
University of Alabama at Birmingham

Objectives:
1.  Overview of the face recognition capabilities of individuals with Autism Spectrum Disorders (ASD)
2.  Presentation of a new computer technology to teach face recognition skills to children with ASD

 

Objectives:
1. List the benefits of advanced directives for patients with dementia and list 2 strategies to put this in place.
2. Appreciate that Alzheimer’s disease is a terminal illness.
3. Acknowledge the lack of evidence of any benefit of tube feeding for patients with advanced dementia.

 References: 
Hurley AC, Volicer L: Alzheimer Disease: “It’s okay, Mama, if you want
to go, it’s okay”. JAMA 2002; 288:2324–2331

Shega JW, Hougham GW, Stocking CB, Cox-Hayley D, Sachs GA: Barriers to limiting the practice of feeding tube placement in advanced dementia. J Palliat Med 2003;6:885–893.

Magnetic Resonance Spectroscopy in Schizophrenia
Rebecca Jones, M.D.
PGY-IV Resident in Psychiatry
Department of Psychiatry and Behavioral Sciences
University of Alabama School of Medicine

Objectives:
1.  Explain the role of N-acetylaspartate in neuropsychiatric disease
2.  Explain the role of Magnetic resonance spectroscopy in  Schizophrenia
3.  Discuss current literature
4.  Discuss future research directions

 February 2009

Objectives:
1.  To establish the importance of functional change to diagnostic understanding of MCI and dementia
2.  To identify financial capacity as a paradigmatic IADL for studying functional change in MCI and dementia
3.  To describe recent empirical research on financial capacity in MCI and AD patient populations
4.  To provide videotape illustrations of financial capacity impairments in MCI and AD patients

References:
Marson, D., Sawrie, S., McInturff, B., Snyder, S., Chatterjee, A., Stalvey, T., Boothe, A. & Harrell, L. (2000).  Assessing financial capacity in patients with Alzheimer’s disease: A conceptual model and prototype instrument.  Archives of Neurology, 57: 877-884.

Griffith, H.R., Belue, K., Sicola, A., Krzywanski, S., Zamrini, E., Harrell, L, and Marson, D.  (2003). Impaired financial abilities in mild cognitive impairment: A direct assessment approach.  Neurology.  60: 449-457.

Martin, R., Griffith, R., Belue, K., Harrell, L., Zamrini, E., Anderson, B., Bartolucci, A. Marson, D.  (2008).  Declining financial capacity in patients with mild Alzheimer’s disease: A one-year longitudinal study.   American Journal of Geriatric Psychiatry.  16 (3): 209-219.  On line publication­ February 8, 2008.  

Supervising Psychodynamic Psychotherapy: A Unique Experience and A Unique Skill
Emily Lazenby, M.D., Alicia Austin, M.D. & Jennie Mahaffey, M.D.
PGY-IV Residents in Psychiatry
Department of Psychiatry and Behavioral Sciences
University of Alabama School of Medicine

Objectives:
1.  Recognize educational needs of supervisee 
2.  Knowledge of psychodynamic supervisory process 
3.  Maximize growth and development of supervisee 
4.  Discuss various technical approaches to psychotherapy supervision

March 2009

Objectives:
1.  Review the effects of parents, peers, and puberty on aggressive and delinquent behavior in adolescence
2.  Discuss recent research on combined influences of parents, peers, and puberty

References:
Mrug, S., Elliott, M.N., Gilliland, M.J., Grunbaum, J., Tortolero, S., Cuccaro, P., & Schuster, M.A. (2008). Positive parenting and early puberty in girls: Protective effects against aggressive behavior. Archives of Pediatrics and Adolescent Medicine, 162, 781-786.

Mar. 17
11:00am

Objectives:
To familiarize the audience on different schizophrenia endophenotypes, their refinement, and findings of associated genes. 

References:
Wonodi I, Hong LE, Stine OC, Mitchell BD, Elliott A, Roberts RC, Conley RR, McMahon RP, Thaker GK. Dopamine transporter polymorphism modulates oculomotor function and DAT1 mRNA expression in schizophrenia. Am J Med Genet B Neuropsychiatr Genet. 2008 Jun 13.

Schizophrenia endophenotypes as treatment targets. Stephen I. Deutsch, Barbara L. Schwartz, Richard B. Rosse, John Mastropaolo, Ayman H. Fanous, Abraham Weizman, Jessica A. Burket, Brooke L. Gaskins

Objectives:
1. To acquire a basic understanding of brain structure abnormalities in the basal ganglia in schizophrenia.
2. To gain knowledge about how these abnormalities vary depending on diagnosis, treatment response and treatment with antipsychotic medications.

References:
Roberts, R.C., J.K. Roche, and R.R. Conley (2005) Synaptic differences in the patch matrix compartments of subjects with schizophrenia: a postmortem ultrastructural study of the striatum. Neurobiol. Dis., 20:324-335.

Roberts RC, Roche JK, Conley RR (2008) Differential synaptic changes in the striatum of subjects with undifferentiated versus paranoid schizophrenia. Synapse, Aug 62(8):616-27.

Roberts, R.C., J.K. Roche, R.R. Conley and A. Lahti. Dopaminergic synapses in the caudate nucleus of subjects with schizophrenia: relationship to treatment response. Synapse, in press 

Objectives:
1.  CNS neural circuitry of feeding behavior
2.  Potential mechanisms of action (AAPD induced weight gain)

References:

 April 2009

Objectives:
At the end of this presentation, attendees will: 
1.  understand the definition, prevalence and impact of treatment-resistant depression (TRD) 
2.  become more familiar with emerging treatment strategies for TRD with a specific emphasis on brain stimulation therapies
3.  become familiar with the background of and preliminary data for subcallosal cingulate deep brain stimulation (DBS) for TRD

References:
Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, Schwalb JM, Kennedy SH. Deep brain stimulation for treatment-resistant depression. Neuron 45:651– 660, 2005. 

Lozano AM, Mayberg HS, Giacobbe P, et al.: Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol Psychiatry 2008, 64:461–467.

Holtzheimer PE, Nemeroff CB: Novel targets for antidepressant therapies. Current Psychiatry Reports 2008, 10(6):465-473.

Third Annual Research Symposium
Grand Rounds Series

The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.  The University of Alabama School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Apr. 21   11:00am

Objectives:
1.  To describe the evidence for Motivational Interviewing to promote behavior change  
2.  To demonstrate what MI is and is not, and how it could be used in brief interviewing situations  
3.  To describe novel developments in the applications and methods of MI

Due to HIPPA policy, this Grand Rounds is closed to outside professionals.  Only UASOM Department of Psychiatry faculty, staff, residents, and medical students on rotation can attend.

Case Conference
Evan Grant, M.D.
PGY-IV Resident in Psychiatry
Department of Psychiatry and Behavioral Sciences
University of Alabama School of Medicine

Objectives:
To present a case of a psychotherapy patient I have treated during residency.

May 2009

Presenters:
Cheryl McCullumsmith, M.D., Ph.D.
Assistant Professor

Daniel Dahl, M.D.
Associate Professor
 
Panel Members:
Lindsay Levine, M.D. 
Assistant Professor

Rob McCullumsmith, M.D.
Assistant Professor

Department of Psychiatry and Behavioral Neurobiology
University of Alabama School of Medicine

Objectives:
1. To inform the audience of the different psychotherapies that current have an evidence base for effectiveness in the treatment of borderline personality disorder (BPD).
2. To review some of the actual data to support the effectiveness.

References:
Silk KR: Augmenting psychotherapy for borderline personality disorder: the STEPPS program. Am J Psychiatry 2008; 165 (4): 413-415

Giesen-Bloo J, van Dyck R, Spinhoven P, van Tilburg W, Dirksen C, van Asselt T, Kremers I, Nadort M, Arntz A: Outpatient psychotherapy for borderline personality disorder. Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006; 63:649-658.

Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF: Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry 2007; 164:922-928.

Linehan MM, Armstrong H, Suarez A, Allmon D, Heard HL: Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry 1991; 48:1060-1064

May 19
11:00am

Objectives:
At the conclusion of this presentation, attendees will be able to:
1.  Describe national trends in the clinical diagnosis and treatment of bipolar disorder in children and adolescents.
2.  Define clinical characteristics that distinguish children with severe mood dysregulation from bipolar disorder.
3.  Characterize common mental health treatments that precede a clinical diagnosis of children with bipolar disorder. 

References:
Moreno C, Laje G, Blanco C, Jiang H, Schmidt A, Olfson M: National trends in the outpatient treatment of bipolar disorder in youth. Archives of General Psychiatry 2007;64:1032-1039.  

Blader JC, Carlson GA : Increased rates of bipolar disorder diagnoses among U.S. child, adolescent, and adult inpatients, 1996-2004.  Biological Psychiatry 2007;62;107-114, 2007.  

Olfson M, Crystal SC, Gerhard T, Huang C, Carlson GA : Mental health treatment surrounding new clinical bipolar diagnoses in youths.  Psychiatric Services (In Press). 

1.  Risk of untreated mental illness in pregnancy

2.  Risk of medication use in pregnancy and post-partum

3.  How to effectively weigh the risks and benefits of treatment in pregnancy/post partum

4.  Goal is to maximize a healthy mental state while maintaining fetal medication exposure

Fourteenth Annual Scholar's Bowl  
Moderated by Daniel C. Dahl, M.D.
Associate Professor, Vice Chairman for Education and Training & Clinical Affairs  
Residency Training Director 
Department of Psychiatry and Behavioral Neurobiology
University of Alabama School of Medicine

A rapid-pace, information-packed hour of questions in which a two teams of our residents and faculty will compete against each other for the title of Scholar's Bowl Champions of 2008.  Dr. Dahl will serve as moderator and will provide a series of challenging psychiatric as well as general knowledge questions.   You won't want to miss it! 

Objectives: 
To stimulate review of the Psychiatric literature and the Psychiatry Resident In-Training Examination (PRITE) material.

"The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.  The University of Alabama School of Medicine designates this educational activity for a maximum of 1 hour in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the activity."

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