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Beth Israel Medical Center: Psychiatry Residency and Fellowship Programs

Research: Overview

Mount Sinai Beth Israel Research Divisions:

Biological Psychiatry

Igor Galynker MD PhD, Lisa Cohen PhD, Zimri Yaseen MD

 

Bipolar Center

Igor Galynker MD, Zimri Yaseen MD

 

 

 

Personality and Trauma

Lisa Cohen PhD

 

 

 

Suicide Prevention Research Program

Igor Galynker MD PhD, Zimri Yaseen MD

 

 

 

 

 

 

Division of Addiction Psychiatry

Charles Perkel MD, Yasmin Hurd PhD, Melanie Israelovitch MD

Several risk factors have been recorded for the development and severity of a substance use disorder and they are divided into biological risk factors, such as family history; psychological risk factors, such as childhood trauma; and social risk factors, such as peer influence. Most studies have looked at many different risk factors; however, to our knowledge, only few of them have looked at the effect of the combination of risk factors simultaneously. The purpose of the study is to gain insight in the simultaneous role of family history and childhood adversities in the development and severity of substance use disorders.

Knowledge about the effects of synthetic cannabinoids is limited. There are several case reports and case series in the literature reporting psychotic symptoms, irritability, agitation, anxiety, depression, and suicidality, in addition to medical emergencies such as acute renal failure, cardiac arrest, and sudden death.

In this research study, we review psychiatric presentations of patients admitted to MSBI with Synthetic Cannabinoid use.

The association between cannabis use and psychosis is well known. However, the biological effect of cannabis on brain is controversial and there is a debate over the direction of causality between psychosis and cannabis use. This Research project investigates the relationship between psychosis and BDNF level in cannabis users.

With mandatory E-prescribing coming down the line in the next year or so we decided as a clinic that it would be useful to get a better idea of our benzo prescribing practices. We hope to implement a new clinic policy regarding benzo use and prescription. The details of this policy have yet to be worked out but will target trying to decrease long term benzo use. We will collect data of prescribing practices at a point in time after implementing the new clinic policy and see if prescribing has changed and particularly look at if we mitigated any risk in the high risk group.

 

Geriatric psychiatry

Melinda Lantz MD, Evelyn Wong MD

The dangers of benzodiazepine use, especially in geriatric patients include an increased risk of falls, hip fractures, and cognitive impairment as well as a significant increased risk of dementia. However, reducing and eliminating use of these agents in patients with a history of chronic benzodiazepine use poses many clinical challenges, including patient preference, fear of inducing withdrawal, and the lack of a well-recognized clinical guideline for the reduction or elimination of benzodiazepines in the geriatric population. There is a need for clinical pathways to guide both the clinician and patient in a path of safe and effective treatment.

We have formulated an action plan and clinical pathway for the reduction of benzodiazepine usage in outpatient geriatric psychiatry patients. The pathway has been implemented with a number of patients with successful reductions and/or elimination of benzodiazepines from their medications regimen. There have also been some patients that could not successfully reduce their benzodiazepine use despite repeat attempts and the addition of other agents with psychotherapy.  In this research project, patient factors that may correlate with successful reductions in benzodiazepines will be explored.

Over the past thirty years, much needed attention has been given to the reduction in use of seclusion and restraints in mental health settings. Although much emphasis has been given to the negative aspects of restraint and seclusion use including ethical considerations, potential harms to patients and staff, poor financial outcomes to the facility, and the perpetuation of negative stereotypes towards inpatient hospitalization, seclusion and restraints continues to be a utilized in hospitals. The use of these interventions is particularly troublesome in geriatric patients, both due to their cognitive and medical frailties, as well as the number of patients hospitalized due to dementia-related symptoms. Review of the literature reveals many risks to older psychiatric patients placed in seclusion or restraints with essentially no identifiable benefit outside of short-term containment.

As the use of restraints and seclusion is inherently an unplanned, emergency event, the development of protocols to reduce the use of such physically restrictive measures to deal with agitated patients has been difficult. New guidelines for care must emphasize prevention, promotion of environmental modifications, staff communication and patient comfort. The use of comfort rooms rather than a seclusion room is a concept ideally suited for the older adult.

 

Psychosomatic Medicine and Consultation-Liaison Psychiatry

Joe Wallack MD, Safin Daniel MD, Ashley Ken MD,

There is much discussion about cardiac risk factors, QTc prolongation and Torsades de Pointes in patients being given psychotropic medications.  Various projects and research presentations, completed by the Division, have focused on use of these medications in hospitalized, acutely-ill medical patients.  Currently the group is exploring data from a large sample of hospitalized patients, with a goal of further defining the clinical factors that should be explored when prescribing psychiatric medications to the medically ill.

Patients with Bipolar Disorder have higher rates of obesity, cardiovascular and pulmonary disease and die younger when compared with the general population.  Health Behaviors such as sleep, exercise, diet, medical follow up are components which may ameliorate some of these medical co-morbidities.  The Division has an ongoing project exploring these behaviors as noted by the patient themselves.  This work has led to findings that even severely ill patients feel healthy behaviors and lifestyle can affect psychiatric as well as medical illness.  The goal of the research is to better define these behaviors, allowing physicians to target behaviors that will assist in maintaining overall health of patients with Bipolar Disorder.

As efforts across the country focus on enhanced safety for patients, staff and visitors in the Medical/Surgical setting, the division has been working on projects related to preventative and acute response approaches to these issues.  From exploration of the documentation by Psychiatric Consultants for behavioral risk factors, to acute response teams and their integration into the various medical and surgical services, the division is collecting data and presenting the research to foster the dialogue nationally related to patient safety.

The Division is frequently consulted on unique case presentations that are turned into poster presentations and written up as case reports.  Topics covered recently include the management of potentially lethal Skin-Picking Disorder in the acute medical setting, the psychiatric and neurologic presentation of Idiopathic Basal Ganglia Calcification, and how to use psychiatric medications for patients with Brugada pattern on electrocardiogram which is a risk for sudden cardiac death.

 

Child and Adolescent Psychiatry

Dr Zisu, Dr Portnoy

 

Neurobehavioral Psychiatry

Dr Todd Feinberg

 

General Psychiatry

This study will be the first study to address whether the staff is aware of the patients’ side effects and how that may affect adherence. It will also look at the relationship between perceived side effects and insight and adherence.

David Klahr MD

This study is in coordination with a service grant from the United Jewish Council and involves collaboration with the Educational Alliance and the New School.  We are currently evaluating and treating seniors with DSM-5 diagnosed Hoarding Disorder who are referred to us from the Educational Alliance, a community based organization in lower Manhattan.  The treatment includes a 15-session course of CBT conducted by residents and fellows in supervision with a clinical psychologist.  The research involves a battery of tests at baseline and measures of improvement at 3 subsequent time intervals.  There is a control group of seniors referred to us from Educational Alliance for issues other than hoarding.  Preliminary data of our baseline data have been presented at an OCD conference in Boston.  Psychiatry residents have been actively involved in all aspects of treatment and research.

David Roane, MD 

The Department of Psychiatry, in association with Employee Health, has been educating residents throughout the hospital on the critical issues of physician depression and suicide.  We are now collecting date at educational presentations, via smartphones, to investigate resident attitudes about physician depression. This includes items related to obstacles and opportunities in our efforts to provide residents with appropriate treatment.  This is in conjunction with hospital support of a new mental health program for house staff.  Residents are actively involved in all aspects of this important project and the New School is assisting us in data collection and analysis.  We are expanding our data collection to include residents at UCSD.

David Roane, MD

 
 

©2017 Mount Sinai Beth Israel Medical Center


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