Philip R. Muskin, MD

During times of stress and anxiety, it is natural to look for something to “take the edge off.” Fortunately, there is an option that is low cost with relatively no adverse effects that can be used as often you deem it necessary, explains Philip R. Muskin, MD, MA, DLFAPA, LFACLP, Professor of Psychiatry and Senior Consultant in C-L Psychiatry at Columbia University Irving Medical Center in New York City.

In this video, Dr Muskin shares his approach to “chill out” using hypnosis and imagery. Find a comfortable chair, and get ready to take this journey to relaxation.

, MD, is considered one of the first people to use the ideas associated with hypnosis. In late 1700s, he developed a system of therapeutics known as mesmerism, which he practiced first in Germany and later in Paris. Mesmerism was based on the idea that there were fluids in the body that were influenced by “animal magnetism.” Disease, he believed, was caused by obstacles that blocked the fluids. The obstacles, in turn, could be broken via trance states, which would return the harmonious flow of fluids. Although his patients were loyal supporters, the medical profession was critical of his ideas and practices. After a commission appointed by King Louis XVI was unable to find support for his claims, the mesmerist movement declined.

In an ironic twist of fate, a skeptic attempting to discredit the ideals of mesmerism actually became the father of hypnosis after observing a traveling mesmerist. Scottish neurosurgeon 

 conducted trials and experiments on himself and others; he eventually developed a technique of relaxation and eye-fixation that resulted in a trance-like state that could also be achieved by suggestions alone. Braid published “Neurypnology or The Rationale of Nervous Sleep Considered In Relation With Animal Magnetism” in 1842. He coined the terms 

, since he believed the trance-like state was related to sleep. His ideas continued to spread and gain popularity through the late 1800s.

Acceptance for its use often came from odd places. The 

 decreed it was not morally forbidden in 1847. And, in 1956, 

 indicated it was useful in treating pain, including during childbirth.

 issued a report endorsing hypnosis, stating there can be “definite and proper uses of hypnosis in medical and dental practice.” The 

 followed suit, and approved its use in 1958. Last to the party, the American Psychiatric Association issued a position statement in 1961 noting that “hypnosis has definite application in the various fields of medicine.”

, hypnosis is used for relaxation as well as to relieve pain and for psychotherapeutic purposes.

Videos

A simple exercise and tools to "find your Zen." 

A Journey To Relaxation

Good interpersonal communication is at the crux of the patient-physician relationship. Many factors come into play when the relationship breaks down. Understanding various personality types and how certain personalities and relationship archetypes influence physicians will be the focus of an interactive session at APA 2016.

Here are 3 questions that touch on some of the topics from that session.

Which of the following bests fits with a dismissive attachment style?

"I’m OK, you’re not OK" bests fits with a dismissive attachment style.

 provides examples of four attachment styles.

What is another way to describe the manipulative help-rejecting patient?

Patients who are “manipulative help-rejecting”-ie, “passive-aggressive”-tend to be highly susceptible to others’ suggestions and catastrophize situations in their lives. They commonly challenge and violate the clinician’s time and space boundaries.

For example, they may routinely run over scheduled appointment times, initiate frequent “emergency” contact outside of office hours, and make limitless requests (eg, petition elaborate laboratory tests or the request the latest medication for routine ailments). (

The “Hateful Patient” Revisited: A Transactional View of Difficult Physician-Patient Relationships

The “Chairperson’s syndrome” occurs with which of the following patients?

A. A physician admitted for an arthroscopic repair of the knee

B. A hospital vice-president admitted for ACS-3

C. A resident physician admitted with an acute myeloblastic crisis

D. An actress admitted for plastic surgery

“Chairperson’s syndrome” is pressure for the VIP patient to be cared for by the department head. The pressure may come from the patient, family, or attendants, who may assume that the Chairperson is the best doctor for the clinical circumstance.

The pressure may also come from the Chairperson, who feels the need to “take command” in a situation with high visibility. Nevertheless, designation of a Chairperson to care for a VIP patient is appropriate only when the Chairperson is indeed the clinician who has the most expertise in the patient’s clinical issues.

The ‘Hateful Patient’ Revisited: A Transactional View of Difficult Physician-Patient Relationships

,” by Greg Sazima, MD, on which Dr Muskin’s session and this article is based.


• Groves JE. Taking care of the hateful patient. 

1978;298:883-887.
• Smith MS, Shesser RF. The emergency care of the VIP patient. 

Dr Muskin is Professor of Psychiatry at Columbia University Medical Center, and Chief of Service: Consultation-Liaison Psychiatry, at New York-Presbyterian Hospital/Columbia University Medical Center in New York. He is an editorial board member of 

Articles

What factors lie at the heart of the patient/physician relationship? 

Challenging Patients

First, for those attending this year’s American Psychiatric Association meeting, I encourage everybody to download the APA Meeting app. You can download it here: 

. You can put in your personal schedule and if there are any changes (date, time, venue) it updates automatically. Spend 20 minutes customizing it so you can quickly look at what you want to do and be ready. You can also publish your profile if you want to let people know that you are there.

There is something for everybody at this year’s APA Meeting, but if you’re interested in major depressive disorder (MDD), keep in mind that within a particular session there may be quite a bit about MDD together with other topics-you just need to dig a little deeper to find it. A quick look at the conference program resulted in at least 30 sessions on MDD and bipolar disorder, and there are many more.

Here are a few that stand out. On the 17th, Carlos Zarate is giving the Simon Bolivar award lecture, “An Update on the Treatment and Research of Treatment-Resistant Depression and Bipolar Disorder.” One of the things he’ll talk about is the use of ketamine as a possible tool to identify biomarkers for treatment response.

In addition, there are two other talks on the 17th that should be fantastic. Alan Schatzberg will present “An Update on Antidepressant Treatment: Pharmacogenetics, Rapidly Acting Agents, and Brain Stimulation.” As you can see by the title, it’s not just an update. Alan is going to talk about pharmcokinetics, brain stimulation, and the new field of rapidly acting agents such as ketamine or ketamine analogs.

Helen Mayberg has several presentations. She’ll be joining the conversation on science, advocacy, and mental health during the Opening Session on Sunday the 17th. Later that day she’s chairing an interactive session, “Reflections on a Decade of Research Investigating Deep Brain Stimulation for Depression.” On the 19th, she and her colleagues will talk about neurocognitive predictors of response in treatment-resistant depression.

On the 18th, Jerry Rosenbaum who is the Chair at the Massachusetts General Hospital , will be giving a talk that’s targeted at what we all struggle with clinically: “What to Do While Waiting for Better Antidepressant Treatments.”

On the 19th, Sarah “Holly” Lisanby, who is the Chair at Duke, and is really an ECT radio-imaging guru, is going to talk about seizure therapy for depression. She’s going to be talking about translational development of magnetic seizure therapy and how it can improve safety and focality of seizure therapy-but what she calls it is, "Teaching an Old Dog Some New Tricks."

As you’ll see for yourself at the meeting, we’re really trying to stay on the cutting edge of science and provide a glimpse into the future. And at the same time, as we always do at APA, we try to provide clinicians with practical material that they can use in their practice.

Also on the 18th, Julio Licinio, who’s a former Program Chair and the editor of 

, will be presenting “Depression and Obesity: The Clinical and Research Interface of Two Modern Diseases.” The talk is on the clinical interrelationship between obesity and depression, how one can cause the other-I really expect this to be fantastic.

For many years, there’s been an interest about the connection between inflammatory disease and depression. We now have a better sense that the two are connected in some way-we’re not there yet, but we are getting closer. Bernhard Baune and Roger McIntyre are going to be talking about “Beyond Inflammation. Diverse Immune and Metabolic Dysfunctions in Clinical Depression.”

Here is just some of what they will cover: dynamic phase-specific model of immune dysfunction in depression, the neurobiology of chemokines in depression, and immune inflammatory mechanisms relevant to the treatment and prevention of brain disorders. Helen Lavretsky of the David Geffen School of Medicine at UCLA will join the conversation with a talk on the effects of antidepressants and anti-inflammatory agents on older adults with stress and mood disorders. And, on the other side of the age spectrum, Benjamin Goldstein will be talking about inflammation as a putative biomarker for mood and cognition in adolescents with bipolar disorder.

A few other sessions that people may not want to miss-and remember, I’m looking at 30 sessions, but only pointing a few out-quite frankly, there are so many. At 1 pm on the 16th, there’s a session on melatonin and light treatment for seasonal affective disorder by Alfred Lewy. And, there’s “A Psychodynamic Approach to Treatment-Resistant Mood Disorders” that Eric Plakun is presenting on the 19th.

Two other sessions that I think are worth mentioning are: first, Florian Holsboer’s presentation on the 17th. He’s one of our international speakers, and he is going to be talking about something that everybody wants to hear about, the future of antidepressant drug discovery. And, at 9 am on the 16th Charles Nemeroff will be chairing a session on personalized medicine in mood and anxiety disorders. He’ll be joined by Alan Schatzberg, Kerry Ressler, Phil Harvey, Helen Mayberg, and Ned Kalen. This, I think, is a really very hot topic.

I should mention one of my own sessions. On Sunday the 17th, my colleagues and I are presenting (we try to do this every year) “Pearls of Psychosomatic Medicine.” We’re going to be talking about several different “hot” topics. We’ll start with a discussion of our role in bringing addiction treatment into medical settings by providing models of care. Then we’ll review QTc prolongation-one of the hottest topics this year-and its corrolation with Torsades de Pointes as well as how to manage a delirious patient with prolonged QTc. Then we’ll review the treatment of mood and anxiety disorders in pregnant and nursing women-there are many other sessions on this topic but this one is short and to the point. It’s always a good session and we really try to make it brief, to the point, take-home pearls; get there early, because the room is always packed!

And, last but not least, is Richard Kogan, professor of psychiatrist and concert pianist-he’s one of the top draws of every APA meeting. This year he’s talking about and playing Chopin. Chopin is not known to have had psychiatric illness, but based on his story it’s likely that he had a panic disorder as well as depression; although he probably died of tuberculosis. It’s a fascinating tale, with lots of tawdry parts in it, of one of the really the great composers of all times. The session will be a little different this year-it’s on Saturday evening at 5:30 and it will be in the theatre of the convention center, which holds approximately 2000 people; but, once again, get there early if you want to get a seat.

Of course the main purpose of our meeting is to learn, but it’s also to meet people from all over the world. You know, if you’re sitting in a meeting, while everything is getting going, why not say hello to the person who’s sitting next to you. Exchange cards. The next thing you know, that person’s from London and you’re emailing her, “how do I get a patient therapy who’s doing a semester at Oxford?” That’s what’s fantastic about the meeting. That you really have an opportunity to meet people, to share experiences with people.

Dr Muskin is Professor of Psychiatry at Columbia University Medical Center and Chief of Service: Consultation-Liaison Psychiatry at New York-Presbyterean Hospital/Columbia University Medical Center in New York. He is an editorial board member of Psychiatric Times.

With topics such as antidepressant treatments, brain stimulation, pharmacogenetics, and rapidly acting agents, there is something for everybody wanting to learn the latest on MDD at this year’s APA meeting.

Highlights of the 168th American Psychiatric Association Annual Meeting: A Focus on MDD



At first glance, it may not look like there’s much happening with bipolar disorder at this year’s American Psychiatric Association meeting, but there is actually so much. Within a particular session, there may be quite a bit about bipolar disorder-you just need to dig a little deeper to find it.

Here are a few that stand out. On the 17th, Carlos Zarate is giving the Simon Bolivar award lecture, “An Update on the Treatment and Research of Treatment-Resistant Depression and Bipolar Disorder.” One of the things he’ll talk about is the use of ketamine as a possible tool to identify biomarkers for treatment response.

In addition, there are two other talks on the 17th that should be fantastic. Alan Schatzberg will present “An Update on Antidepressant Treatment: Pharmacogenetics, Rapidly Acting Agents, and Brain Stimulation.” As you can see by the title, it’s not just an update. Alan is going to talk about pharmcokinetics, brain stimulation, and the new field of rapidly acting agents such as ketamine or ketamine analogs.

Helen Mayberg has several presentations. She’ll be joining the conversation on science, advocacy, and mental health during the Opening Session on Sunday the 17th. Later that day she’s chairing an interactive session, “Reflections on a Decade of Research Investigating Deep Brain Stimulation for Depression.” On the 19th, she and her colleagues will talk about neurocognitive predictors of response in treatment-resistant depression.

On the 18th, Jerry Rosenbaum who is the Chair at the Massachusetts General Hospital , will be giving a talk that’s targeted at what we all struggle with clinically: “What to Do While Waiting for Better Antidepressant Treatments.”

On the 19th, Sarah “Holly” Lisanby, who is the Chair at Duke, and is really an ECT radio-imaging guru, is going to talk about seizure therapy for depression. She’s going to be talking about translational development of magnetic seizure therapy and how it can improve safety and focality of seizure therapy-but what she calls it is, Teaching an Old Dog Some New Tricks.

As you’ll see for yourself at the meeting, we’re really trying to stay on the cutting edge of science and provide a glimpse into the future. And at the same time, as we always do at APA, we try to provide clinicians with practical material that they can use in their practice.

There’s a bit more science on the 18th with Roger McIntyre’s symposium with the catchy title of “From Neuron to Neighborhood: An Update on Contemproary Models for Disease Pathogenesis, Clinical Characterization, and Treatment of Bipolar Disorder,” which will provide a clinically relevant understanding of contemporary pathogenic models of bipolar disorder.

Also on the 18th, Julio Licinio, who’s a former Program Chair and the editor of Molecular Psychiatry, will be presenting “Depression and Obesity: The Clinical and Research Interface of Two Modern Diseases.” The talk is on the clinical interrelationship between obesity and depression, how one can cause the other-I really expect this to be fantastic.

For many years, there’s been an interest about the connection between inflammatory disease and depression. We now have a better sense that the two are connected in some way-we’re not there yet, but we are getting closer. Bernhard Baune and Roger McIntyre are going to be talking about “Beyond Inflammation. Diverse Immune and Metabolic Dysfunctions in Clinical Depression.” Here is just some of what they will cover: dynamic phase-specific model of immune dysfunction in depression, the neurobiology of chemokines in depression, and immune inflammatory mechanisms relevant to the treatment and prevention of brain disorders. Helen Lavretsky of the David Geffen School of Medicine at UCLA will join the conversation with a talk on the effects of antidepressants and anti-inflammatory agents on older adults with stress and mood disorders. And, on the other side of the age spectrum, Benjamin Goldstein will be talking about inflammation as a putative biomarker for mood and cognition in adolescents with bipolar disorder.

A few other sessions that people may not want to miss-and remember, I’m looking at 30 sessions, but only pointing a few out-quite frankly, there are so many. At 1 pm on the 16th, there’s a session on melatonin and light treatment for seasonal affective disorder by Alfred Lewy. And, there’s “A Psychodynamic Approach to Treatment-Resistant Mood Disorders” that Eric Plakun is presenting on the 19th.

Two other sessions that I think are worth mentioning are: first, Florian Holsboer’s presentation on the 17th. He’s one of our international speakers, and he is going to be talking about something that everybody wants to hear about, the future of antidepressant drug discovery. And, at 9 am on the 16th Charles Nemeroff will be chairing a session on personalized medicine in mood and anxiety disorders. He’ll be joined by Alan Schatzberg, Kerry Ressler, Phil Harvey, Helen Mayberg, and Ned Kalen. This, I think, is a really very hot topic.

I should mention one of my own sessions. On Sunday the 17th, my colleagues and I are presenting (we try to do this every year) “Pearls of Psychosomatic Medicine.” We’re going to be talking about several different “hot” topics. We’ll start with a discussion of our role in bringing addiction treatment into medical settings by providing models of care. Then we’ll review QTc prolongation-one of the hottest topics this year-and its corrolation with Torsades de Pointes as well as how to manage a delirious patient with prolonged QTc. Then we’ll review the treatment of mood and anxiety disorders in pregnant and nursing women-there are many other sessions on this topic but this one is short and to the point. It’s always a good session and we really try to make it brief, to the point, take-home pearls; get there early, because the room is always packed!

And, last but not least, is Richard Kogan, professor of psychiatrist and concert pianist-he’s one of the top draws of every APA meeting. This year he’s talking about and playing Chopin. Chopin is not known to have had psychiatric illness, but based on his story it’s likely that he had a panic disorder as well as depression; although he probably died of tuberculosis. It’s a fascinating tale, with lots of tawdry parts in it, of one of the really the great composers of all times. The session will be a little different this year-it’s on Saturday evening at 5:30 and it will be in the theatre of the convention center, which holds approximately 2000 people; but, once again, get there early if you want to get a seat.

So this is as overview of an overview as I can possibly give you, and if I left someone or something out, it wasn’t on purpose. I really want everyone to have a great time and learn. I don’t think you should go to every single session from morning till night because you’ll go crazy. But I do think this is a great opportunity to meet friends and colleagues that you may not have seen for a while; to talk with new colleagues and perhaps make some unexpected new friends.

Of course the main purpose of our meeting is to learn, but it’s also to meet people from all over the world. You know, if you’re sitting in a meeting, while everything is getting going, why not say hello to the person who’s sitting next to you. Exchange cards. The next thing you know, that person’s from London and you’re emailing her, “how do I get a patient therapy who’s doing a semester at Oxford?” That’s what’s fantastic about the meeting. That you really have an opportunity to meet people, to share experiences with people.

Finally, I encourage everybody to download the APA Meeting app before they come to Toronto, so they don’t have to pay the extra charges. If you’re not in the hotel and getting free WiFi or you’re not in the convention center you might have to pay for it. Or if you have a United States phone and you don’t have an international plan, it’ll cost you. You can download it here: 

. You can put in your personal schedule and if there are any changes (date, time, venue) it updates automatically. Spend 20 minutes customizing it so you can quickly look at what you want to do and be ready. You can also publish your profile if you want to let people know that you are there.
 

From the treatment of mood and anxiety disorders in pregnant and nursing women to the effects of antidepressants and anti-inflammatory agents on older adults with stress and mood disorders, APA is a great opportunity to learn state-of-the-art information on bipolar disorder. 

Highlights of the 168th American Psychiatric Association Annual Meeting: A Focus on Bipolar Disorder 

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American Psychiatric Association Annual Meeting

 in the Big Apple this year . . . so much, in fact, that we’ve invited the Chair of Scientific Program Committee, Dr Philip R. Muskin, to provide you with a road map-and to tell you about some of highlights you won’t want to miss.

Be sure to note that the Menninger Convocation Lecture is at 2 PM on Monday May 5th, given by Vice-President Joseph Biden at the 

. Remote viewing sites will be available at the Hilton Hotel, The Marriott Marquis, and at various places at the Javits Center.

Podcasts

There’s a lot going on at the American Psychiatric Association Annual Meeting in the Big Apple this year . . . so much, in fact, that we’ve invited the Chair of Scientific Program Committee, Dr Philip R. Muskin, to provide you with a road map. More in this podcast.

State of the Art-and Science-of Psychiatry: Highlights of the APA 2014 Annual Meeting

 new Editorial Board member, Philip Muskin, MD, what he believes are the biggest challenges that psychiatry will face in the next few years.

In this brief video, he talks about what DSM-5, the medical home, and the search for money to fund novel approaches to new psychiatric treatments may mean to the practice of psychiatry.

Dr Muskin is Professor of Psychiatry at Columbia University Medical Center; Chief of Service: Consultation-Liaison Psychiatry at New York-Presbyterian Hospital/Columbia University Medical Center; and Chair of the Scientific Program Committee for the APA’s Annual Meeting. He is the author of 

DSM-5™ Self-Exam Questions: Test Questions for the Diagnostic Criteria

, which will be published early next year.
 

In this brief video, Psychiatric Times’ new Editoral Board member talks about what DSM-5, the medical home, and the search for money to fund novel approaches to new psychiatric treatments may mean to the practice of psychiatry.