 is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. To create a better world, he is an advocate for treating mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism. He serves on the Editorial Board of

H. Steven Moffic, MD, discusses restorative justice, or the opportunity for perpetrators to talk about their crimes and reasoning in order to help relieve victims, and maybe relieve the perpetrators of guilt as well. Dr Moffic believes it is underappreciated in psychiatry and could be applied more. How can you apply it?

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

Videos

Psychiatric Aspects of Restorative Justice

, we worked with experts from multiple psychiatric areas to bring you thoughtful articles about a wide variety of psychiatric issues, from contingency management treatment for substance use disorders to burnout prevention tips for psychiatrists. Here are some highlights from the issue.

Imagine that you, as a physician, just saw this headline splashed all over the internet: “Depression Probably Not Caused by Excessive Black Bile.” It was followed by a long discourse on how an imbalance in the 4 bodily humors is not responsible for mood disorders. You might scratch your head and wonder why anyone in 2022 would be bothering to refute the Galenic-medieval humoral theory.

As senior academic psychiatrists and psychopharmacologists, we reacted with similar puzzlement to a recent umbrella review and follow-up article by researchers in the United Kingdom. The review, by Moncrieff et al and published in 

 (henceforth, “the review”), argued that there is “no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations” and that “the serotonin theory of depression is not empirically substantiated.” 

Contingency Management is a Powerful Clinical Tool for Treating Substance Use Research Evidence and New Practice Guidelines for Use

Contingency management (CM) is an effective behavior change technique commonly used to treat substance use disorders (SUDs). CM is one of the most effective behavioral interventions for initiating and maintaining abstinence from most types of commonly used drugs and alcohol.

CM-based treatments for SUD originate in basic behavioral science, namely the operant conditioning literature. Operant conditioning is a type of learning in which behavior is modified or maintained through the consequences it produces. In the context of SUD treatment, CM typically modifies substance use by delivering tangible, positive reinforcers (eg, prizes, vouchers, or monetary reinforcement) in exchange for evidence of the performance of the targeted behavior, such as the submission of a drug-negative urine sample. 

Just the Tip of the Iceberg: Psychiatric Implications of Overturning

The US Supreme Court defied the court’s tradition and the expressed intentions of some of its members during their confirmation hearings by overturning the 50-year-old precedent, 

, which had established abortion as a right. Immediately after the 

Dobbs v Jackson Women’s Health Organization

 decision was rendered on June 22, 2022, many states applied or enacted laws either severely limiting or banning abortion.

A week after the decision, a 10-year-old girl, pregnant by rape, was taken to Indiana, having been denied an abortion in her home state of Ohio. She was at high risk, not only for exacerbations of the trauma she had already experienced but for complications of pregnancy and childbirth, not to mention those of motherhood. It is notable, and relevant, that the first responses of Mike DeWine (Ohio’s governor), 

, and other media was to declare that the story was untrue or could not be confirmed. No apologies were offered when the rapist was arrested and confessed. Next, the physician who performed the abortion was accused of not recording the procedure as required by law. 

8 Tips for Psychiatrists to Prevent Burnout

In 2018, the American Psychiatric Association found that burnout among psychiatrists was nearly 50%. This number may be even higher as we persist through a global endemic disease, social and political unrest, and increasing economic stressors. In many states, the collateral impact on health care will only be exacerbated by the recent Supreme Court decision to reverse 

. This has led to increased burden on psychiatrists, our patients, and our colleagues in the medical field who turn to us for assistance.

 in itself can be polarizing and create stigma. It can place blame on the individual and does not take into account systemic or structural barriers that lead to untoward distress. At its core, burnout is an imbalance of empathy and self-compassion. 

. And be sure to stay up-to-date by subscribing to the 

Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at 

Articles

The experts weighed in on a wide variety of psychiatric issues for the September 2022 issue of Psychiatric Times.

From the Pages of Psychiatric Times: September 2022

 (BD) as a condition that is characterized by recurrent and/or cyclical episodes of mania or hypomania and depression.

 In the DSM-5, there are 2 subtypes of BD: bipolar I disorder (BD-I) and bipolar II disorder (BD-II). A diagnosis of BD-I is established if an individual experiences at least 1 manic episode with additional major depressive and/or hypomanic episodes. Individuals are diagnosed with BD-II if they experience at least 1 hypomanic episode and at least 1 major depressive episode without any manic episodes. Although BD is not as common among older adults as it is among younger adults, available evidence indicates that the total number of 

 with BD is expected to increase significantly over the next few decades.

 It has been observed that between 1980 and 1998, the relative frequency of late-onset bipolar disorder increased from 1% to 11%.

According to the International Society for Bipolar Disorders (ISBD) Task Force, “older age bipolar disorder” (OABD) is defined as BD occurring in individuals ≥ 50 years of age.5One quarter of all cases of BD occur among individuals ≥ 60 years of age and > 10% of the cases occurred among individuals ≥ 70 years of age.

OABD has a point prevalence of 0.1% to 0.5% and a lifetime prevalence of 0.5% to 1.0%.

 Among older adults who are diagnosed with a 

 New-onset mania later in life occurs in approximately 10% of individuals with OABD, and it is often associated with neurovascular disease.

 Among older adults who go to the emergency room for a psychiatric evaluation, BD has been noted in 17% of cases.

 Approximately 8% to 10% of geriatric inpatient admissions and 6% of geriatric psychiatry outpatient visits include individuals with OABD. Among individuals who live in residential psychiatric program for older adults, the prevalence of bipolar disorder is approximately 17.4%.

 A diagnosis of BD is noted in approximately 3% of older nursing home residents and 9.7% of older chronically institutionalized individuals. Approximately 70% of individuals with OABD are women.

Comparison Between OABD and Early-Onset Bipolar Disorder

Individuals with OABD often present with depression rather than hypomania or mania as the presenting symptom.

 They also tend have more frequent recurrences of 

 and present with symptoms that are severe.

 In contrast to individuals with early-onset bipolar disorder (EOBD), individuals with OABD present with greater latency periods between the initial and subsequent mood episodes.

 There is also significantly less family history of mood disorders noted among individuals with OABD when compared to individuals with EOBD.

 These individuals also have a history of more stressful life events when compared to age-matched controls.

Individuals with OABD also present with more 

 including cardiovascular, respiratory, endocrine, and metabolic disorders.

 These individuals often present with an average of 3 to 4 comorbid medical conditions.

 These comorbid conditions also worsen outcomes for individuals with OAD, including the risk for suicide.

When compared to individuals with EOBD, individuals with OABD often present with greater association with cerebrovascular disease and other neurological disorders.

 They often present with increased white-matter hyperintensities in frontal, parietal, and putaminal brain areas.

 Individuals with OABD may have greater cortical sulcal widening and lateral ventricle-brain ratio scores when compared to individuals with EOBD.

 On neuroimaging studies, these individuals present with greater morphological abnormalities of the brain when compared to individuals with EOBD.

 It has also been noted that among individuals with OABD, depressive symptoms are often associated with left cerebral hemisphere vascular lesions, whereas manic symptoms are often associated with right cerebral hemisphere vascular changes.

Available evidence indicates that when compared to age-matched controls, psychiatric comorbidities are more common among individuals with OABD, but the rates of these comorbidities are lower than what is seen among individuals with EOAD.

 is the most common comorbid psychiatric disorder among individuals with OABD, with a 12-month and a lifetime prevalence of 38.1% and 38.1%, respectively.

 The other common psychiatric comorbidities are (12-month and lifetime prevalence rates): panic disorder (11.9% and 19.0%), 

 (9.5% and 20.5%), and dysthymia (7.1% and 15.5%). It has been noted that older women with OABD have a greater prevalence of panic disorder when compared to age-matched controls, whereas older men have a greater prevalence of alcoholism.

 Available evidence indicates that the prevalence rates for psychotic symptoms among individuals with OABD are similar to those of individuals with EOBD.

 When compared to individuals with EOBD, the risk for suicide among individuals with OABD appears to be lower.

When compared to age-matched controls, varying degrees of cognitive impairment have been identified among a majority of individuals with OABD.

 These include lower Mattis Dementia Rating Scale (DRS) scores (P=0.0003) and Mini-Mental State Examination (MMSE) scores (P=0.0007). When compared to individuals with EOBD, about half of individuals with OABD score ≥ 1 standard deviation (SD) below the mean on the DRS and MMSE total scores.

 However, no correlation has been noted between the Young Mania Rating Scale (YMRS) scores and the cognitive functioning among these individuals.

 Available evidence indicates that individuals with OABD also present with worse psychomotor functioning and mental flexibility when compared to individuals with EOBD.

 Greater cognitive impairment has been noted among individuals with OABD who have more vascular risk factors and a greater number of hospitalizations.

When compared to age-matched individuals with unipolar depression, individuals with OABD have an earlier age at onset of illness.

 They are also noted to have higher total symptom severity, to have higher positive symptom scores, and to be more impaired in community living skills.

 When compared to aged-matched controls, these individuals are also 4 times more likely to use mental health services and 4 times more likely to have psychiatric hospitalizations. The 

 describes the difference between EOBD and OABD.

It is imperative to obtain a detailed history when assessing individuals with OABD.

 This history will also help identify individuals who develop mood symptoms due to secondary medical and/or neurological disorders. Additionally, individuals who develop mood swings due to the effects of prescribed drugs or drugs of abuse can be identified by obtaining a thorough history. Comorbid medical and/or neurological disorders can be identified by a focused physical examination. Laboratory workup can also identify common conditions that cause mood symptoms, including hyperthyroidism.

 Laboratory workup that is commonly ordered as a screening tool among individuals with OABD include a complete blood count, a complete metabolic panel, a thyroid panel, urine-analysis and culture, and drug screen. Additional tests that can be ordered include vitamin B12 and folate levels, rapid plasma regain/Venereal Disease Research Laboratory test, and human immunodeficiency virus (HIV) testing if nutritional deficiency, neurosyphilis, or HIV infections are suspected as possible comorbid conditions. If cerebrovascular disease is suspected as a possible etiology for mood symptoms or there is evidence of cognitive dysfunction among individuals with OABD, computerized tomography or magnetic resonance imaging scans can be obtained.

Although there are no specific screening tools for the diagnosis of OABD, some available instruments can assist with quantifying and qualifying the symptoms of OABD and in monitoring their progress. The Mood Disorder Questionnaire is a common screening tool that has been identified as having good sensitivity and specificity for detecting a lifetime history of mania or hypomania, although the potential for over-diagnosis of BD is a known limitation for this screening instrument.

 Other screening instruments include the Bipolar Spectrum Diagnostic Scale, the Hypomanic Personality Scale, the Bipolar Depression Rating Scale, and the YMRS.

 The most widely used clinical assessment tool for the diagnosis of bipolar disorder is the structured clinical interview from the DSM-IV.

 After the screening process, the DSM-5 criteria can assist with confirming the diagnosis of BD.

 describes the process for diagnosing OABD.

Available evidence indicates that OABD is not an uncommon condition. Individuals with OABD present with less family history of psychiatric disorders but greater burden of medical comorbidities when compared to individuals with EOBD. When compared to age-matched controls, these individuals have higher rates of health care service utilization and worse outcomes. It is imperative to rule out underlying medical disorders, adverse effects of prescribed medications, and/or the adverse effects of drugs of abuse as possible etiologies for OABD.

is professor and chairman of the Department of Psychiatry at Creighton University School of Medicine and Catholic Health Initiatives (CHI) Health Behavioral Health Services in Omaha, Nebraska. He is also an adjunct professor of psychiatry at Yale School of Medicine.

is cofounder and managing principal of Behavioral Health Advisory Group in Princeton, New Jersey.

Desk Reference to the Diagnostic Criteria From DSM-5

. American Psychiatric Publishing; 2013:65-92.

2. Montes JM, Alegria A, Garcia-Lopez A, et al. 

Understanding bipolar disorder in late life. 

Bipolar disorder: similarities and differences between patients with illness onset before and after 65 years of age.

5. Sajatovic M, Strejilevich SA, Gildengers AG, et al. 

A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force.

6. Sajatovic M, Blow FC, Ignacio RV, Kales HC. 

Age-related modifiers of clinical presentation and health service use among veterans with bipolar disorder. 

Bipolar disorder in middle-aged and elderly adults: is age of onset important?

Prevalence of bipolar disorder in a psychogeriatric population.

11. Shulman KI, Tohen M, Satlin A, et al. 

Mania compared with unipolar depression in old age.

13. García-López A, Ezquiaga E, De Dios C, Agud JL. 

Depressive symptoms in early- and late-onset older bipolar patients compared with younger ones.

14. Hays JC, Krishnan KR, George LK, Blazer DG. 

Age of first onset of bipolar disorder: demographic, family history, and psychosocial correlates.

15. Beyer JL, Kuchibhatla M, Cassidy F, Krishnan KR. 

Stressful life events in older bipolar patients.

16. Gildengers AG, Whyte EM, Drayer RA, et al. 

Medical burden in late-life bipolar and major depressive disorders.

17. Kilbourne AM, Post EP, Nossek A, et al. 

Improving medical and psychiatric outcomes among individuals with bipolar disorder: a randomized controlled trial.

18. McIntyre RS, Konarski JZ, Soczynska JK, et al. 

Medical comorbidity in bipolar disorder: implications for functional outcomes and health service utilization.

19. Juurlink DN, Herrmann N, Szalai JP, et al. 

Medical illness and the risk of suicide in the elderly.

Medical and psychiatric comorbidities among elderly individuals with bipolar disorder: a literature review.

The role of vascular risk factors in late onset bipolar disorder.

22. Lloyd AJ, Moore PB, Cousins DA, et al. 

White matter lesions in euthymic patients with bipolar disorder.

23. Tamashiro JH, Zung S, Zanetti MV, et al. 

Increased rates of white matter hyperintensities in late-onset bipolar disorder.

24. Sarnicola A, Kempton M, Germanà C, et al. 

No differential effect of age on brain matter volume and cognition in bipolar patients and healthy individuals.

25. Young RC, Nambudiri DE, Jain H, et al. 

Brain computed tomography in geriatric manic disorder.

Structural neuroimaging and mood disorders: recent findings, implications for classification, and future directions.

Current research in affective disorders following stroke.

28. Goldstein BI, Herrmann N, Shulman KI. 

Comorbidity in bipolar disorder among the elderly: results from an epidemiological community sample.

Cognitive impairment in bipolar disorder in old age: literature review and findings in manic patients.

30. Gildengers AG, Butters MA, Seligman K, et al. 

Cognitive functioning in late-life bipolar disorder.

31. Schouws SN, Comijs HC, Dekker J, et al. 

Cognitive impairment in early and late bipolar disorder.

32. Schouws SN, Stek ML, Comijs HC, et al. 

Risk factors for cognitive impairment in elderly bipolar patients.

33. Bartels SJ, Forester B, Miles KM, et al. 

Mental health service use by elderly patients with bipolar disorder and unipolar major depression.

34. Tampi RR, Joshi P, Bhattacharya G, Gupta S. 

Evaluation and treatment of older-age bipolar disorder: a narrative review.

35. Hirschfeld RM, Williams JB, Spitzer RL, et al. 

Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire.

36. Zimmerman M, Ruggero CJ, Galione JN, et al. 

Detecting differences in diagnostic assessment of bipolar disorder.

Assessment tools for screening and monitoring bipolar disorder.

The Bipolar Depression Rating Scale (BDRS): its development, validation and utility.

40. Young RC, Biggs JT, Ziegler VE, et al. 

A rating scale for mania: reliability, validity and sensitivity.

Between 1980 and 1998, the relative frequency of late-onset bipolar disorder increased from 1% to 11%. How can you best assess for this condition? 

Assessment of Individuals With Older Age Bipolar Disorder

“We tend to think of self-care as a luxury, but it really isn’t—because taking care of ourselves is taking care of the instrument that we use in our work, and that is incredibly important.” 

In this Mental Health Minute, M. Katherine Shear, MD, of Columbia University discusses the importance of self-care and how self-care is actually an ethical responsibility for clinicians. She also shares some her favorite forms of self-care, from walking and biking to maintaining a positive mood to reading murder mysteries.

is Marion E. Kenworthy Professor of Psychiatry at Columbia University and director of the Center for Prolonged Grief at the Columbia University School of Social Work. Her work includes more than 330 peer-reviewed publications and the development of several widely used assessment instruments and instructional materials for prolonged grief disorder therapy. Dr Shear has served on review committees of the National Institute of Mental Health and on the advisory council for its National Center for Complementary and Alternative Medicine. She has also served as an advisor to the DSM-5 workgroup on complicated grief and adult separation anxiety, a member of the World Health Organization’s ICD11 Working Group on Mood and Anxiety Disorders, a member of the scientific advisory board of the American Foundation for Suicide Prevention, and an elected member of the board of the Association for Death Education and Counseling.

When we take care of ourselves, we can take better care of our patients.

The Ethical Responsibility of Self-Care

Is organized medicine really on the decline? As more nursing and other allied organizations are growing and becoming more politically active, what is happening to membership in physician organizations? Given the increasing stressors of the COVID-19 pandemic, gun violence, physician wellbeing, rising health care costs, the scope of practice issues, and government intrusion on medical decision making, this is a time when physicians, the field, and our patients need help more than ever. Is there still strength in numbers?

According to the 2018 Survey of America’s Physicians: Practice Patterns and Perspectives, 80% of physicians were at full capacity or overextended, and 78% sometimes or always experienced burnout.

 The COVID-19 pandemic has only worsened these statistics. One 2021 study reported that rates of US physician burnout during the first year of the pandemic increased over time among 4 of 5 frontline specialties, with the greatest increases among hospitalist and primary care respondents.

 Organized medicine and specialty organizations are key pillars of support for individual physicians that provide opportunities to advocate for more funding and resources for our medical system and education.

In the 1950s, about 75% of all practicing physicians in the United States were members of the American Medical Association (AMA).

 According to a December 2016 article by 

 online, AMA membership was representative of about one-sixth of the nation’s physicians.

 Subsequently, the AMA has intentionally worked on representing its members and patients through strategic work on 3 core pillars of advocacy, innovation, and equity, which has helped fuel 10 consecutive years of membership growth with a 35% cumulative increase in members from 2011 to 2021.

Each year when the American Psychiatric Association (APA) membership dues come into members’ inboxes, there are always complaints about the ever-increasing price of membership. With practice expenses and conference fees, along with membership dues, we again ask ourselves, 

“Why are we APA members? What are we paying for?” 

The question comes up year after year. APA membership showed a 14% growth from 2013 to 2018,

 but most recently membership count through year-end 2020 declined 3.6% from the previous year, from 38,799 to 37,420 (

Of note, involvement of members has been an additional issue, as only 19.39% of eligible APA members voted in the 2021 APA election.

APA’s recent decrease in membership is thought to be primarily due to the impact of the COVID-19 pandemic. In the busy world of psychiatric practice, especially with increased patient and staffing demands due to the pandemic-induced mental health crisis, psychiatrists can feel isolated and may find it hard to recognize how organized medicine and the APA can be helpful to the average psychiatrist. With the rise of other mental health disciplines, some psychiatrists additionally feel that organized psychiatry is not helping psychiatric physicians and the field. They instead just want to get their paperwork completed, patients seen, and research statistics completed.

It is important to remember that the APA contributes to education and growth of not only individual psychiatrists, but also the profession as a whole. It provides individual psychiatrists robust educational opportunities through free and discounted subscriptions, journals, and online newsletters, free online CME learning modules, and discounted registration to the APA Annual Meeting and Mental Health Services Conference, among others. Additionally, the APA provides practice tools such as free participation in PsychPRO, the APA’s national mental health registry, access to practice management tools, along with networking and professional development, leadership opportunities, and career search databases. There are additional member benefits for resident-fellow members including discounted membership, online forums, and specific educational opportunities.

Like any organization, the APA is not perfect; it is working on improving diversity and health equity, but we need to be part of the change we want to see. The board of trustees has hired independent consultants to continue to address these issues.

Elie Aoun, MD, MRO, current APA early career psychiatrist trustee at large, describes the organization as his professional home and a place that has provided support and growth as he has moved through his career.

“I consider myself a child of the APA. I joined the organization soon after I moved to the United States and was fascinated by its structure. I joined the assembly as the representative for residents and fellows, then applied and got selected for the APA Leadership Fellowship.That afforded me the most exciting professional opportunity of my career. I got a seat on the Council on Addiction Psychiatry… a seat at the table with the most brilliant minds in addiction psychiatry—leaders whose books I had learned from.”

Even more important is the APA’s role to advocate and lobby on behalf of the psychiatric profession and national mental health issues. Some may say that the APA is not doing enough and has been slow on specific practice issues, but there is no other organization advocating on behalf of general psychiatry. The APA is built on its members and needs our support to direct its efforts. The APA continues to lead the fight for mental health parity, telehealth, collaborative care, GME funding, and fighting against nonphysician scope of practice legislation. APA dues may seem expensive compared to the fees of other organizations, but the annual fee includes not only national and local district branch dues, but also support for local and national lobbying efforts.

Now as an attending, Aoun constantly encourages trainees to not only join the organization, but also participate as actively as they can in the opportunities the APA has to offer, stating that, “what a missed opportunity it is to not take part of the incredible action the APA leads.”

The American Academy of Psychiatry and the Law

Specialty organizations have also been struggling to keep members active during these changing times. The American Academy of Psychiatry and the Law (AAPL) is an organization of psychiatrists dedicated to excellence in practice, teaching, and research in forensic psychiatry. Although AAPL membership peaked in 2019 at 1890 members, membership dropped by 20% to a nadir of 1505 by May 2021 before increasing just slightly to 1519 members by January 2022. Most concerningly, the drop in membership over the pandemic has been primarily due to the loss of resident and fellow members.

AAPL members are required to be members of either the APA, the American Academy of Child and Adolescent Psychiatry, or the Canadian Psychiatric Association. Therefore, the challenges the APA faces in getting psychiatrists to recognize the benefits of joining their organization are even more pronounced for forensic subspecialists who are considering joining 2 separate organizations, each with their own membership dues. However, there are a number of benefits to AAPL membership (

Ten Reasons to Join the American Academy of Psychiatry and the Law

One of the benefits most frequently cited by AAPL members is the opportunity that AAPL provides to connect and collaborate with forensic colleagues worldwide. Give that it is a small subspecialty field, forensic psychiatrists benefit from networking for academic and job opportunities. Networking is especially valuable for rural and private practice forensic psychiatrists, whose daily work of solo forensic evaluations, followed by seemingly endless report writing, can be especially isolating yet paradoxically reliant on strong networks for case referrals. Networking opportunities within AAPL include not only informal ones, but also formal mentoring programs including the Rappeport Fellowship for third-year psychiatry residents interested in forensic psychiatry and the Women’s Committee’s newly developed small group mentoring program.

Like the APA, AAPL also provides members with educational opportunities including a MOC self-assessment, free virtual AAPL CME presentations, mailed copies of 

The Journal of the American Academy of Psychiatry and

, and discounted registration rates for the annual AAPL meeting and forensic psychiatry board review course. Reduced membership rates are also available for trainees and students.

AAPL members have opportunities to seek leadership positions by joining AAPL committees and pursuing positions on AAPL’s executive council. Members are also able to apply for a members-only educational or research grant from the AAPL Institute for Education and Research.

Finally, and perhaps most importantly, both academic journals and the popular press have focused on the intersection of mental health and the criminal justice system as structural inequities are increasingly exposed. Forensic psychiatry is not only a practice of independent court evaluators, but a field of public and correctional psychiatrists addressing mental health treatment and disparities in care in the criminal justice system. As the national organization of forensic psychiatrists, AAPL is situated at the heart of these issues and AAPL membership provides forensic psychiatrists with an opportunity to shape and influence the field of forensic psychiatry.

According to Susan Hatters-Friedman, MD, AAPL president (2021 to 2022):

“AAPL is a professional home for many forensic psychiatrists. Though we are so much looking forward to the in-person meeting in New Orleans in October, AAPL has remained vital to members during the pandemic, shifting to online annual meetings but also to online live programming—including workshops, lectures by senior leaders, committee meetings, and town hall meetings… AAPL is a leader in the world within forensic psychiatry… AAPL’s ethical guidelines and AAPL’s practice resources ranging from conducting the forensic assessment to correctional prescribing are invaluable to the practice of forensic psychiatry. This is not just within ourselves, but has importance within the justice system and outside of North America, too. As AAPL members, we have the opportunity to comment on and help contribute to these guidelines. At AAPL, we can have a voice in the future of our field.”

Early-career psychiatrists and psychiatrists-in-training should not underestimate the opportunities that organized psychiatry can provide as they develop their career trajectory. For psychiatrists in mid-career and beyond, becoming more involved in local and national organizations provides opportunities to look beyond day-to-day practice and challenge themselves to continue to learn and give back to the field.

Other medical fields are growing and uniting to advocate for their professions. Psychiatrists need to wake up and work together to support each other and the field. Specifically, we need to advocate for our patients and our profession and to protect our scope of practice. The time is now!

is senior psychiatrist and director of psychiatric education at NYC/Health + Hospitals Correctional Health Services and clinical assistant professor in the Department of Psychiatry at the NYU Grossman School of Medicine in New York, NY. 

 is the deputy chief medical officer of Central Regional Hospital and an adjunct assistant professor in the Department of Psychiatry at the University of North Carolina at Chapel Hill. 

 is an adult and forensic psychiatrist in private practice in Draper, Utah. He is an adjunct assistant professor of psychiatry in the University of Utah Department of Psychiatry and medical director of Strive Psychiatry in Draper, Utah. 

 is professor and chairman, the Paul and Ruth Jonas Chair in Mental Health, and chief of psychiatry for OU Health at the University of Oklahoma College of Medicine.

The American Academy of Psychiatry and the Law 53rd Annual Meeting will take place in New Orleans, Louisiana, from October 27 to 30, 2022. To register or to learn more, visit 

1. 2018 survey of America’s physicians: practice patterns and perspectives. The Physicians Foundation. 2018. Accessed September 5, 2022. 

https://physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf

Frontline physician burnout during the COVID-19 pandemic: national survey findings

3. Quiller LM. Organized medicine: why physician membership is more important now than ever before. Medical Association of the State of Alabama. December 11, 2017. Accessed September 5, 2022. 

https://alabamamedicine.org/organized-medicine-physician-membership-important-now-ever/

4. Drum K. The AMA represents only about one-sixth of all doctors. 

. December 27, 2016. Accessed September 5, 2022. 

https://www.motherjones.com/kevin-drum/2016/12/ama-represents-only-about-one-sixth-all-doctors/

5. AMA fact sheet on its decade of membership growth. American Medical Association. 2021. Accessed September 5, 2022. 

https://www.ama-assn.org/system/files/2021-06/ama-10-years-2021-fact-sheet.pdf

8. American Academy of Psychiatry and the Law. 10 reasons to join AAPL. American Academy of Psychiatry and the Law. 2022. Accessed September 5, 2022. 

https://aapl.org/docs/pdf/AAPL%20Member%20Benefits.pdf

Here’s how the American Psychiatric Association and the American Academy of Psychiatry and the Law provide valuable opportunities for psychiatrists and the psychiatric field.

Psychiatric Aspects of Restorative Justice

From the Pages of Psychiatric Times: September 2022

Assessment of Individuals With Older Age Bipolar Disorder

The Ethical Responsibility of Self-Care

The Strength and Value of Organized Psychiatry

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Mental Health Stigma for Providers: A Hidden Challenge Among Us