Current ASAP members can now pay their annual dues securely using a credit card or PayPal account. A regular members dues are $275 national, plus any applicable consituent society dues. Members who do no live in a society area are at-large and pay only national dues.
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From: Lois T. Flaherty, MD
Editor, Adolescent Psychiatry
Journal website: http://benthamscience.com/aps/index.htm
| Adolescent Psychiatry Table of Contents Alert
A new issue of Adolescent Psychiatry is available online: October 2011; Vol. 1, No. 4 The Table of Contents and abstracts are freely available online at http://www.benthamscience.com/contents.php?JCode=APS&Vol=00000001&Iss=00000004
Contents Preface Pp. 264-264 Psychopharmacological Interventions for Adolescents with Eating Disorders Pp. 277-285 Addressing Low Self-Esteem in Adolescents with Eating Disorders Pp. 286-295 Difficulty with Uncertainty: How It Presents in Eating Disorders and What We Can Do About it Pp. 296-306 Eating Disorders in Adolescent Males: An Critical Examination of Five Common Assumptions Pp. 307-312 Bipolar Affective Disorder in Young People: A Review Pp. 313-320 Marijuana and Adolescents: Treatment Strategies for Clinicians Pp. 321-324 Mental Health Services for Minor Detainees at Guantanamo Pp. 325-332 The Promotion of Mental Health: Role of the Family Pp. 333-339 Adolescent Admissions in Psychiatry: Reconsidering Clinical and Institutional Parameters on the Occasion of a Report of a Greek Experience Pp. 340-348 Norwegian Children and Adolescents with ADHD – A Retrospective Clinical Study: Subtypes and Comorbid Conditions and Aspects of Cognitive Performance and Social Skills Pp. 349-354 Non-Suicidal Self-Injury in an Adolescent: A Case Report and Discussion of Treatment Pp. 355-361 Introduction to “Facing and Embracing Spitfires” Pp. 362-368 Substance Abuse Disorders Among Juvenile Offenders Pp. 369-369 Response to Sharer Letter Pp. 370-370 |
As we are entering the 44th year of the American Society for Adolescent Psychiatry, our organization has proven to be a viable, stable and valued member in the world of psychiatric and mental health organizations. Despite challenges ahead, we will continue to grow our organization and, with your participation, make substantial contributions to the field of adolescent mental health and advocacy.
Our recent yearly Annual Meeting in March 2011, was an indication of the continuing success of our organization. The venue, again at Day Top Village in New York City, was professionally handled and catered. Our presenters were among the most respected members in the field of psychiatry. The William Schonfeld Memorial Award and Lecture was given to Dr. Glenn Saxe for his innovations in the study of childhood traumatic stress. Ms. Frances Roton Bell, ASAP’s Executive Director, was awarded the Herman Staples award for her incalculable dedication and contribution to our organization’s welfare. Presented topics included discussion of DSM V proposed changes, disaster psychiatry, cannabis abuse, autism research, childhood trauma and PTSD, high conflict divorce, generational psychiatry, increasing publication skills and panels on eating disorders and dialectical behavioral therapy. We have posted abstracts for some of these presentations on our website, and expect to publish original papers by some of our presenters in our journal, Adolescent Psychiatry.
Our organization has made a number of important developments that serve our goals of education, advocacy, and professional networking. Past President Dr. Joseph Kenan redesigned our website, to make a user-friendly, exciting internet interface, understanding well that our future lies in fostering and improving our web presence which has become the mainstay for contemporary communications and informational resources. In that regard, we have also developed an adolescent pscyhiatry group on LinkedIn, with plans to develop a Facebook page, and further develop our website with forums for discussion, and tabs presenting information to healthcare professionals and community members alike. These pages might serve to provide quick and easy communications between members, discussion regarding various topics, and allow the distribution of important news that affects our field to professionals and the community. Webinars too, are being considered, that will allow members throughout the country to participate in recorded presentations. Dr. Kenan already pioneered our use of videoconferencing for our periodic Board meetings, allowing us more frequent contact as a result of the practical convenience that meeting method provides.
On our publishing front, Dr. Gregory Barclay continues his editorship of our outstanding Newsletter, providing brief updates about our organization, and timely articles. Past President, Dr. Lois Flaherty has negotiated an arrangement with Bentham Science for a new journal on Adolescent Psychiatry, which will serve as the official journal of the American Society for Adolescent Psychiatry. First issue highlights included articles on borderline personality disorder in adolescents, shame in psychotherapy, and overcoming resistance in therapy. An upcoming issue will feature highlights and original papers from our Annual Meeting. Members are afforded special arrangements with the publisher for subscription. Peer reviewers, article submission, and editorial help are always welcomed.
ASAP has many plans to keep our organization up to date and competitive. Some potential ideas include financial incentives for referring new members, mentoring programs, and action groups to deal with the issues faced by teens in today’s world. We know you will not want to miss these events.
Few fields are as underserved, and in need of public education as ours. A recent news article noted a report by the Substance Abuse and Mental Health Services Administration showing that in excess of 60 percent of adolescents suffering from major depression were not receiving treatment during the study period. This is, of course, only one example of teen mental health needs within our rapidly changing society. Sociopolitical and medical model changes, global unrest, war, substance abuse, economic instability, and globalization of media and communication are just some of the factors that contribute to a unique future landscape. We are the only national academic psychiatric organization dedicated solely to the mental health and well being of adolescents. It is incumbent upon us, as clinicians and leaders in the field to light the torch, dispelling darkness around us. It is my honor to serve this organization, and follow in the footsteps of the leaders who have tread the path before me. I encourage you all to take an active role in this process and join us in these most worthy endeavors. See you on the web, and at next year’s Meeting.
Dean De Crisce, MD, FAAFS
ASAP President Dean De Crisce, MD, FAAFS
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I am happy to present this portrait of an adolescent by Christine Hartunian, also known as Chris Hartunian. It is entitled “Prom Queen.” Christine Hartunian is a world renowned artist living in Los Angeles. Chris Hartunian can be commissioned to paint your portrait. Visit her website.
Do you have an image of an adolescent art? Send to us! Email us on contact page.
Read More...Letters to the Editor
A nice edition of the Newsletter (July, 2010). As an ASAP member going back many, many years, I found it very informative, interesting, and refreshing. I must say that Joe Kenan’s note brought me back to over 20 years ago, when those of us on the Executive Council (I am a Past President) expressed very similar feelings – hemorrhaging funds and members and concern about whether ASAP would last. Many of the past issues appear to have been resolved – non-physician members, less expensive meetings, less frequent publication of the Annals. Hopefully (and likely) membership (in the early 80′s we were over 1000 members) will reverse itself. I say likely because we have managed to get through bad times and we still exist. Thanks also to Lois Flaherty for her continuing work on the Annals.
Alex Weintrob, MD
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Just a brief note to say that I thought the Summer 2010 ASAP Newsletter was the best I’ve seen in a long time. In fact, it was so interesting, I essentially read it from cover-to-cover when I had only planned to skim through it!
Other than the picture of me making me appear to be chubbier than my internal self-image, I enjoyed the contents and the format. Keep up the good work!
Yours,
Perry Bach, M.D.
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Hi and thanks for the published article. Nice work on the newsletter.
However, none of the references are shown in the text.
Dean De Crisce, MD
Editor’s note: We deeply apologize for this oversight. For those interested in a copy of Dr. DeCrisce’s complete article, with foot-noted text references, please contact me directly at gpbmd@aol.com.
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By Joe Kenan, M.D.
State of ASAP
The State of ASAP is excellent. We are financially well off, and we have positioned ourselves to insure a vibrant future. A NEW website is in development; we have gone green (and economical) by having our first Fall Business Meeting by teleconference; and our committees are in full force.
This year’s annual conference in New York City is organized by President-Elect Dean DeCrisce, M.D. The conference promises to be exciting and educational. Start planning now! Rather than step on his punch line, I point you to read his column about the conference.
Major news agencies’ reporting of five suicides within three weeks resulted in a national focus on this issue. Prime time television shows including “Dancing with the Stars”, “360 Anderson Copper”, and “Glee” brought special attention as well.
Two particularly notable cases include:
o Suicide is the leading cause of death among gay and lesbian youth.
o Gay and lesbian youth are 2 to 6 times more likely to attempt suicide than heterosexual youth.
o Over 30% of all reported teen suicides each year are committed by gay and lesbian youth.
Most recent studies echo these results and focus additional causal factors. I bring your attention to one:
The above finding demonstrates that family therapy is an essential intervention for psychiatrists working with LGBT adolescents to identify and correct real or perceived rejection.
ASAP Action
On November 10, Cindy McCain appeared in an anti-bullying public service video where she said, “Our political and religious leaders tell LGBT youth that they have no future”. Ellen DeGeneres said on her TV show “We have an obligation to change this. There are messages everywhere that validate this kind of bullying and taunting and we have to make it stop. We can’t allow this to take another kid’s life.”
ASAP does not have any official position on the issue, but ASAP’s Legislative and Judicial Affairs Committee is currently drafting a position statement for ultimate vote by the ASAP membership. As your president, I am interested in your views about this emerging mental health issue, either in person at our upcoming annual meeting or by email.
Read More...I am pleased to announce that the inaugural issue of Adolescent Psychiatry in its new quarterly version will be published in January. The following is the Table of Contents.
In Memoriam
Remembering Michael Kalogerakis - Lois T. Flaherty
Michael Kalogerakis, Greek Reminiscences - Nikos Zikilis
Editorial
Adolescent Psychiatry—Past, Present, and Future – Lois T. Flaherty
Special Article
Treatment Outcome of Three Female Adolescents with Borderline Personality Disorder Max Sugar and Irving H. Berkovitz
Commentary—Borderline Personality Disorder in Adolescents Lois T. Flaherty
Perspectives
The Shame Ethic in Adolescent Psychotherapy – John E. Meeks
Keeping it Real: Overcoming Resistance in Adolescent Males Mandated into Treatment – James G. Barrett and Nancy Rappaport
“When Can I See You Again?”: The Immigration Experience, Insecure Attachment and Psychotherapy – Anjana Rajan and Nancy Rappaport
A Psychiatric Perspective on Narratives of Self-Reflection in Resilient Adolescents – Ayelet Barkai and Nancy Rappaport
Reviews and Overviews
A Selective Review of the Research on Juvenile Bipolar Disorder: Implications for Struggling Clinicians – Jennifer Harris
Conflict of Interest as a Possible Factor in the Rise of Pediatric Bipolar Disorder – Edmund C. Levin and Peter I. Parry
Cyber Cruelty: Understanding and Preventing the New Bullying – Ruth Gerson and Nancy Rappaport
Identity and Acculturation in Immigrant and Second Generation Adolescents – Eugenio M. Rothe, Andres J. Pumariega and Diana Sabagh
Albert Ellis’ Rational Emotive Behavioral Therapy – Richard Rosner
Research Article
Identity and Self-image in Turkish Adolescents -Füsun Çuhadaroglu Çetin and Halime Tuna Ulay
The inaugural issue will be free to view and download. The journal will be available both on-line and in a print version. The journal website has been launched. You can view it at www.benthamscience.com/aps
The online manuscript submission system is not ready yet but should be available shortly. In the meantime, manuscripts may be sent to me or to aps@benthamscience.com for manuscript submission
Read More...ADHD and Substance Abuse
Summarized by Dominic Ferro, M.D.
Daniel Pimstone, M.D. and Itai Danovich, M.D. spoke about the dilemma of treating adolescents with both Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders: the most effective treatment for ADHD is with stimulants, which are themselves substances of abuse.
Having both ADHD and substance abuse affects the outcome of both conditions. 30-65% of ADHD patients have impairing symptoms that persist into adulthood, most often symptoms of inattention. These patients have higher rates of divorce, arrest, and speeding. They have higher rates of tobacco dependence as well. In addition, ADHD predicts worse substance abuse outcomes as ADHD patients develop substance abuse disorders at a younger age. They progress more rapidly from experimentation to dependence and quickly move from one drug to others. They are less responsive to treatment and relapse more quickly.
Pertinent to the treatment dilemma is the fact that stimulants are not the most commonly abused substances by adolescents with ADHD. Surveys have shown that 67% used cannabis and 40% used alcohol as their drug of choice. Only 21% abused stimulants. While adolescents with ADHD have similar rates of substance use disorders as other adolescents, they progress to adult chemical dependency disorders at a substantially higher rate.
Looking at populations of adolescent substance abusers, ADHD is an independent risk factor for substance abuse. 10% of adolescent substance users have comorbid ADHD and 25% had ADHD and took medication during earlier childhood. Adolescents with alcohol dependency had the highest rate of comorbid ADHD; those with opiate or cocaine dependence had lower rates.
Dr. Pimstone discussed different theories to explain the correlation between ADHD and substance abuse. One possibility is that children with ADHD have a developmental vulnerability to substance abuse. For instance, there are higher rates of substance abuse disorders among first degree relatives of children with ADHD. Also, children with ADHD have higher rates of social problems and school difficulties, both of which are known risk factors for substance abuse disorders. Similarly, the impulsivity and sensation seeking which are common in ADHD increase the risk of substance abuse.
Another possible explanation is that substance abuse and ADHD share common endophenotypes, genetic predispositions to both disorders. The best evidence for such endophenotypes is found in the dopamine system that results in a theorized hypodopaminergic state. Other possible shared endophenotypes include cognitive processing deficits and selective attention, excessive arousal with consequent aggression and impulsivity, impaired behavioral disinhibition, and impaired affective regulation that results in insensitivity to aversive conditioning and rewards.
A third possible explanation is that adolescents with ADHD use substances to modulate psychiatric symptoms, in other words the “self medication” theory. Surveys of patients indicate that they believe that this is the best explanation for their experience. Attentional dysfunction is a predictor of initiation and maintenance of tobacco use, which patients describe as helpful with focus. Alcohol and cannabis may ameliorate the commonly reported subjective symptoms of anxiety and dysphoria or they may help with disordered sleep. Adolescents with ADHD more often reported using substances to alter mood instead of trying to get high. Illicit substance use also reportedly improved the self image of ADHD adolescents.
A final explanation is that early exposure to stimulants results in substance abuse, the so-called “priming phenomenon”. Dr. Danovich described some of the factors that support this theory, in particular the cases of later stimulant abuse. The pharmacokinetics of stimulants, especially their rapid rate of onset, does seem to play a role. For instance, the subjective effect is less evident when stimulants are taken orally vs. intravenously, the latter of which had linear dose response of “liking” the drug. Compared to extended release preparations, short acting stimulants have a greater likelihood of developing a reinforced pattern of use was in animal models. Animal models also demonstrate patterns of sensitizing and dependence on stimulants.
However, in humans, early stimulant initiation has not led to measurable negative outcomes. In fact, the rate of substance use disorders was decreased among ADHD adolescents taking prescribed stimulants than those who do not. On further analysis, a comorbid conduct disorder was more predictive of the observed substance abuse into adulthood. However, Dr. Danovich concluded that there is no good evidence that substance abusing teens could be safely treated with stimulants, and it is known that some patients will divert or abuse prescribed medication.
Dr. Pimstone opined that neuropsychological evaluation is not helpful when an adolescent is actively using, and that the best tool is a thorough clinical assessment with an eye toward the timing of symptoms. He recommended establishing separate timelines for the symptoms of ADHD and of the substance abuse disorder. He also recommended performing the neuropsychological assessment after several weeks of abstinence.
With regard to treatment, these adolescents should be engaged with enhanced psychosocial interventions in integrated and structured care with frequent re-evaluation. Dr. Danovich recommended minimizing the use of reinforcing medications, for instance starting with long acting stimulant preparations, or considering Strattera and other non-stimulant medications. He also recommended involving the adolescent’s support network to assist in close monitoring. Since there are separate treatment systems and funding sources for mental health, substance use, and medical care, treatment is even more challenging since contact between providers in different systems is needed to effectively manage these cases.
Read More...Lois Flaherty, M.D.
I am delighted to report that the inaugural issue of Adolescent Psychiatry will debut in January 2011. This issue (and only this issue) will be freely available on-line. A special reduced subscription rate will be available for ASAP members. This on-line journal replaces our biannual printed Annals which was no longer affordable or practical for our membership.
The contents of the January issue will include articles on borderline personality disorder and bipolar disorder in adolescents, cybercruelty, immigrant adolescents, research on identity and self-esteem, and several articles on psychotherapy. The journal will have a website at Bentham Science Publishers, <www.Bentham.org>, for accessing it on-line, ordering print copies and subscriptions, and submitting manuscripts. The submission, review and editing process will all be electronic. The publisher is offering 2 free journal subscriptions for anyone who requests a library subscription.
As I have previously reported, the new version of Adolescent Psychiatry will be published quarterly. The anticipated dates of publication are January, April, July and October. The deadline for receipt of articles by the publisher is 2 months prior to publication date. The usual time for peer review is 4 weeks, and it is also necessary to allow time for revision and editing, usually another 4-8 weeks. So the minimum time from receipt of articles to publication is about 4 months. So far I have plans for two special issues, one on substance abuse in adolescents and one on early manifestations of psychotic disorders. In addition, I would like to begin a tradition of having a special issue that would include the presentations at the Annual Meeting, titled, The Proceedings of the Annual Meeting of the American Society for Adolescent Psychiatry.
The journal will have a section for letters to the editor as well as commentaries on the published articles. I am hoping that the initial issue will spark some.
Prospective authors who are interested in submitting articles may contact me to discuss their submissions, or send abstracts or outlines of their articles to me directly at AnnalsEditor@aol.com.
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