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...THE HERMAN D. STAPLES AWARD
The Staples Award was begun to honor Past President, Herman D. Staples, M.D., the fourth President and a founding member of the American Society for Adolescent Psychiatry. This award is given to the individual who embodies the spirit, integrity and dedication to the treatment of adolescents.
RECIPIENTS OF THE
HERMAN D. STAPLES AWARD
1997 Sherman Feinstein, M.D. *
1998 Leonard P. Henschel, M.D.
1999 Virgil Cox, M.D.
2000 Daniel Offer, M.D.
2001 Richard A. Ratner, M.D.
2002 Mark Chenven, M.D.
2003 Mark A. Wellek, M.D.
2004 Richard Rosner, M.D.
2005 Perry B. Bach, M.D.
2006 Stephen B. Billick, M.D.
2007 Robert Weinstock, M.D.
2008 Lois Flaherty, M.D. and Glen T. Pearson, M.D.
2009 Bertram Slaff, M.D.
2010 Frank S. Williams, M.D.
2011 Frances Roton Bell
* Deceased
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.
Read More...
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.
Read More...BY Lois T. Flaherty
As Secretary of The International Society for Adolescent Psychiatry and Psychotherapy (ISAPP), I have the pleasure of announcing that ISAPP will meet September 14-18, 2011 in Berlin, Germany. Berlin is an exciting city which, since the fall of the Berlin Wall, has regained its status as one of the leading cultural capitals of the world.
President-elect Annette Streeck-Fischer, who spoke at our Annual Meeting in 2006, is hard at work organizing the program together with Fritz Resch, program co-chair. The deadline for abstract submission is February 1, 2011 and the deadline for early registration for the meeting is March 2011. The official language of the meeting is English. The following is their announcement of the meeting.
As president elect I want to invite you together with Franz Resch, chair of the scientific committee, to the conference of the International Society of Adolescent Psychiatry and Psychology (ISAPP) taking place in Berlin 2011 from September 14 to 18. September 2011.
As the topic of the conference ‘Adolescence – a second chance: Development – Attachment – Neurobiology – Trauma – Psychodynamics – Treatment’ indicates, a broad spectrum of actual scientific findings and issues concerning the care for adolescents will be presented.
Adolescence with its specific challenges has been neglected in research as well as in diagnostics and therapy for a long time. In the lights of data that half of the psychiatric disorders of adults have their onset in youth the question if adolescence may be a second chance is not only important from a developmental perspective but has implications also for therapists, supporting systems, society and policy. The conference dealing with themes between normality and pathology shall bring together well-known experts in the field and professionals working with adolescents in health care.
We would be delighted to welcome you to discuss these important topics in Berlin, a fascinating city with its history, social tensions and cultural highlights.
Annette Streeck-Fischer
President Elect
Franz Resch
Chair of Scientific Committee
The ISAPP meetings always have a number of cultural and social events both for attendees and accompanying persons, and this one is no exception. There are several tours planned, including a walking tour, visits to museums, a tour called “Controversial Berlin” and a special tour of Jewish Berlin. ASAP members who attended the previous meetings in Province, Rome, and Montreal can testify that they are enjoyable and stimulating.
Further information about the meeting, including a list of invited speakers and topics, as well as information about the meeting venue and social program, may be found at the meeting website, www.isapp2011.org.
Read More...By James Gilfoil, M.D.
I know, I know, it’s tough going back to the Big Apple so soon. Well, Wall Street has bounced back a bit thanks to all your tax dollars, so you ought to feel real good about that. Try to put your bitterness aside, though, lest it spoil your eating, for Gotham is still the restaurant capital of the world. And here are some suggestions about where to drown your sorrows and appreciate the bounty.
What’s the word—Thunderbird, oops, wrong jingle. The word in New York this year is Italian or maybe it’s “Eatalyan.” It seems like every good restaurant that’s opened in the last two years is Italian, and, on top of that, this great new Italian food court and high end market has opened across from Madison Square Park. Eataly is a bit like the Ferry Building in San Francisco. With four restaurants and all the gelato and espresso you can handle, it’s a must. Warning! The crowds can be overwhelming.
My first choice in dining this year would be Del Posto, from Joe and Lidia Bastianich and Mario Batali, the same people behind Eataly, Babbo, Lupa, and Casa Mono. Maybe it’s shorter if I list what they’re not behind. Anyway, Del Posto—their high end Italian—hit the big time this year when it earned its fourth star from the New York Times. So what, you say. It’s the first Italian restaurant to be so honored in 36 years. That’s a very big deal. Italian food is basically a peasant cuisine, and it’s wonderful, but, as opposed to French cuisine, the high end is very difficult to do well. Eat a high end Italian meal with some wonderful eggplant dish and you can’t help but compare it to the great eggplant parm you get from your local Mama Mia’s. You’ll be thinking that wild nettle sformato was good and all, but was it worth $16? Or I can do much better risotto at home. Here’s the place to try high end Italian again. Del Posto is warm, inviting, and elegant at the same time. There’s a great staircase and good music from the piano. A five course meal is $95 and the seven course extravaganza is $125, and there’s an exhaustive Italian wine list. You’ll need to enlist the sommelier’s help with that one, especially to ferret out some bargains. Since this is necessary for you to attend the convention, at least the beleaguered taxpayer picking up part of your tab this time won’t be you. Take that, Master of the Universe!
Next I would venture over to Central Park South to Michael White’s Marea. If you read my article last time, and I know you did, but you just forgot what I recommended, you’ll remember that Michael was doing some great pastas at the reasonably priced Convivio, which is great with a group. His Alto is very good, too, but much more formal than Convivio. Marea is high end seafood, and, boy, it’s some good seafood, featuring turbot and an outstanding salt-baked branzino. There’s nothing quite like a salt-baked whole fish. Well, there may be some things that are better, but we’re not going into that now. There’s some competition between White and Batali as to who is the more authentic Italian chef, especially with both of them having spent time at some very good restaurants in Italy. You know how to resolve that issue.
Perhaps the most appealing of all these new glam spots in New York is Danny Meyer’s Maialino—Italian for “little pig”—a nickname Mr. Meyer earned when he was in Rome. Anything Meyer touches turns to gold—Union Square Café, Eleven Madison Park, the Modern, Grammercy Tavern, Shake Shack, and his homage to barbeque Blue Smoke. Go to the website and you’ll see how appealing Maialino is. You’ll want to eat every meal there. It’s supposed to be a Roman trattoria, and it’s a bit like Pizzeria Mozza in LA, except there’s no pizza. It has all the great roman pasta dishes—amatriciana, carbonara, con sal e pepe. And then there’s the roasted suckling pig. Oh, it’s wonderful! It’s $72, yes, but it’ll feed three, and there’ll be some left over for sandwiches the next day, and, with the typical Meyer touch, the restaurant will give you the bread to take home with you for those sandwiches. He did write a book on hospitality and helping diners have a memorable experience. Be seduced!
Another good Italian newcomer is Locanda Verde, which you might keep in mind in case you can’t get into any of the above. Scott Conant’s Scarpetta in the meatpacking district is also excellent—I love his goat. Don’t forget Drew Nieporent’s terrific Corton, in the old Montrachet space. I hear I had a wonderful meal there at the last ASAP meeting. I do know I drank an awful, and I do mean awful, lot of very good wine that evening and what dishes I do remember were very, very good. That attractive blonde young thing kept bringing me more wine to taste, then she put the gun to my head and told me to drink it all. And you know what, I did. Corton had just opened before our last meeting, and it’s garnered nothing but much deserved stellar reviews since. This needs to be high on your list, as does one of my all time faves, Terrance Brennan’s Picholine. My last meal there remains one of the highlights of my gastronomic life. The food was fantastic, and I do remember it. The cheeses blew my mind. Brennan almost single handedly started the cheese craze in this country, because he loves the stuff and didn’t care if he lost money on it. You’ll taste some cheeses you can’t get elsewhere—I still remember an English Berkswell—described as “what Manchego—the great Spanish cheese—wishes it could be.” And Picholine is much more reasonable than the other four star restaurants in New York.
My favorite of those four stars remains Le Bernardin. Though I like Jean George, I prefer his more casual places—JoJo, the one that started it all, and Spice Market. Another Danny Meyer spot, in case you haven’t tried it, is Eleven Madison Park, which much like Del Posto, recently earned its fourth star. The setting is spectacular, and the food has improved dramatically over the years. And, if you’ve hit it big in the recent stock market runup, give L’Atelier de Joel Robuchon a try. Afterwards, hopefully you’ll be chastened and look back on it as wonderful and decadent, but most of all a “real learning experience.” Hopefully you’ll have lots of them as I plan to this March.
Read More...Perfectionism can be Deadly
Summarized by Lois T. Flaherty, M.D.
College students who experience severe shame if they fail to live up to their own and their families’ expectations for academic success, and who see depression as a sign of failure and weakness, are at particular risk for depression and suicide. In a workshop at last spring’s APA meeting, Kristine Girard, a psychiatrist at MIT, termed this syndrome “maladaptive perfectionism”.
Dr. Girard discussed the high profile case of Elizabeth Shin, who died in 2000 after a fire in her dorm room, which occurred after she took an overdose of medication. She had a history of depression with a suicide attempt, and had received mental health services from MIT. Her parents brought suit against MIT and a number of individuals, claiming that MIT had failed to prevent her death. MIT eventually settled the case out of court, which means that this cannot serve as a legal precedent and the details of the findings of investigations are not public. In its aftermath MIT undertook a major self study and implemented changes designed to improve the monitoring of students’ well-being on campus.
Dr. Aradhana Sood was involved in the State of Virginia’s investigation in the aftermath of the Virginia Tech case, in which Seung-Hui Cho massacred 32 students and faculty before killing himself. Cho had a long history of psychiatric illness and was essentially untreated despite progressive deterioration that was obvious to faculty and students. That case highlighted significant gaps in mental health care to college students and the pitfalls of privacy laws.
The cases raised important questions about the limits of confidentiality and the in loco parentis role of educational institutions, which diminished as young adults were deemed progressively more independent. That both cases involved Asian-American students highlighted the pressures facing these students. Mental illness is strongly stigmatized among this group, leading to denial and reluctance to seek help.
The presenters emphasized that combating stigma, advertising mental health services and publicizing warning signs of depression and suicide are key to colleges’ efforts to prevent suicide. Supportive groups such as Asian-American societies and “Active Minds” (www.activeminds.org ) are also positioned to help. According to its website, the latter organization supports student-run mental health awareness, education, and advocacy groups on campuses throughout North America.
Jack Yen, MD. MPH, (Ohio State University) discussed his institution’s attempts at screening to identify students at high risk. Part of the prevention efforts involve educating staff at all levels – the janitor in a dorm, for example, may be the first to be aware that a student is isolating himself in his room. OSU students may take an on-line survey for assistance. Psychotherapy including CBT and medication management are available through student health services. Ohio State, one of the largest universities in the US, has developed a federally-funded Suicide Prevention Resource Center with online resources (http://suicideprevention.osu.edu ). The emphasis is on culturally sensitive approaches, so the Center has developed and distributed brochures for each of the main ethnic groups on campus.
In another session, Doris Iarovici, MD of Duke University listed the major challenges facing universities include the high rates of students currently taking psychotropic medication, Internet addiction, and substance abuse. Students often present asking for stimulants after having taken a friend’s prescribed medication and finding it helps the study and retain information, yet have never required treatment for ADD and may be sufficiently sleep deprived to appear as though they have ADD. She advised college health services to use a harm reduction strategy, as it is unlikely most students will abstain totally from potentially harmful behaviors. The phenomenon of “effortless perfectionism,” in which mainly female students present the appearance of academic success without working, is an emerging and significant source of additional stress on college campuses.
In recent years the APA has increased its focus on college mental health, beginning with Michele Reba’s appointment of a task force on this topic when she was President. This year’s meeting featured several presentations on this topic. “The Deadly Years: Preventing Suicide in Asian American College Students.” was the title of a workshop presented by Aradhana Sood, Kristine A. Girard, and Jack Yen, all members of the Caucus of Asian American Psychiatrists. Dr. Iarovici’s presentation was part of a presentation on generational issues and mental health sponsored by the Association of Women Psychiatrists
Read More...