Pandemic Doesn’t Stop the APA: Virtual Meeting Highlights

CONFERENCE REPORTER

Although not a replacement for the 173rd American Psychiatric Annual Meeting, the Spring Highlights Meeting, a free live event with more than 3000 attendees, touched on several important areas in psychiatry on April 25 and 26, 2020. The APA seemingly moved mountains to put together an impressive roster of 15 virtual sessions with key leaders in their respective areas in psychiatry.

APA leadership decided to cancel the 2020 Annual Meeting on March 15th. Scheduled to take place in Philadelphia from April 25 through April 28, the meeting was expected to draw thousands of psychiatrists from across the globe to engage with their colleagues, take in the sessions, and partake in CME activities. Then the COVID-19 pandemic swooped down, bringing hundreds of live events in medicine and beyond to an abrupt end. This year is only one of a handful of APA meetings that did not hold its annual event in person, most notably one that didn’t happen at the end of World War II.

Instead of the live annual meeting, a virtual meeting, the APA Spring Highlights Live Virtual Meeting was created. A running theme throughout this meeting was the COVID-19 pandemic and the need for mental health treatment now and after the immediate crisis subsides, both for the public and health professionals.

Drs Saul Levin, Bruce Schwartz, and Jeffery Geller kicked off the meeting that took place on Saturday, April 25 and Sunday, April 26. They were followed by 13 psychiatric experts who provided their insights on a number of topics. Presented by Dr Schwartz an additional session, The Annual Business Meeting, took place on Sunday, for APA voting members only.

Saul Levin, MD, CEO and Medical Director of the APA, who oversees programs in prevention and health care disparities, kicked off the opening session by stating the decade is off to a difficult start that presents both challenges and opportunities. He called out the New York State Psychiatric Association as “a shining example of how we should respond in a crisis,” a living example that psychiatrists are physicians first. Calling the COVID-19 pandemic “the most extraordinary crisis of our lifetime,” he thanked all psychiatrists for the extraordinary job they are doing.

The APA is working across party lines to improve mental health care at the state and government level, Dr Levin said. Working closely with departing APA President, Bruce Schwartz, MD, they worked to advance psychiatry, and he congratulated Dr Jeffrey Geller as he takes over the role of APA President: “I know that he will rise to meet the challenges of this coming year and provide the membership with his experience and vision for his presidential year,” he said.

More than ever before, psychiatry will be called to advance care over the course of the decade. Psychiatrists and colleagues “from all over the world will come together with the hard work necessary to meet the challenges of COVID-19 and the issues affecting our patients and the profession.” He also spoke to mental health disparities and the higher mortality rate among African Americans, Native Americans, and other minorities across the US. Incarcerated persons and those in treatment are also suffering, and there is a need for more research funding for the opioid crisis and substance use disorders.

Outgoing 2020 APA President, Bruce Schwartz, MD, Professor, Deputy Chair, and Clinical Director of Psychiatry & Behavioral Sciences at Montefiore and the Albert Einstein College of Medicine in New York City, noted that the true heroes are the workers who sacrifice their health and well-being and that of their family, as well as residents and fellows, many of whom interrupted their training to provide acute medical care in hospitals and ICUs. “COVID-19 is a visual reminder that we are physicians first . . . This epidemic has made it imperative that mental and health care are to be a priority.”

The trauma of what health care providers have witnessed will have lasting effects, reverberating for years to come: “The entire mental health workforce had to be mobilized and interdisciplinary collaboration is all that allowed us to cope with this emergency. We will need this full workforce to cope with the psychiatric effects after this passes,” he said.

APA President-Elect Jeffrey Geller, MD, MPH, Professor of Psychiatry at the University of Massachusetts Medical School and Medical Director at a 200-bed psychiatric hospital serving adults and adolescents, also shared his insights. While acknowledging the devastation of COVID-19, he took a sobering glance at psychiatry’s past when patients in the 19th century were deprived of basic human needs.

In 1848, only 5000 of 22,000 patients with mental illness in the US were in hospital. The majority were in jail or worse-many were kept in captivity, “in cages, pens, cellars, and warehouses, and cells, and sold at auction. where they were bound with chains . . . lacerated with ropes, surged with rods, put in severe constraints and strapped upon beds with course hard straps of leather.” At that time Dorethea Dix called on Congress to provide appropriate care for persons with mental illness.

When it comes to psychiatric beds, the situation for people with serious mental illness (SMI) is not that much different today. Dr Gellar noted that the bed shortage continues. In 1955, there was one psychiatric bed for every 300 Americans; today there is one bed for 3000. Consequently, the majority of patients with SMI find themselves incarcerated.

Below are some highlights from the meeting.

Physician Leadership During Times of Crisis

Patrice A. Harris, MD, MA, President of the American Medical Association (AMA) and chair of the AMA's Opioid Task Force, discussed the AMA's multi-faceted response to the COVID-19 pandemic. She discussed efforts to secure resources for physicians; an appeal for science and data to protect public health; and a call to prioritize equity during the pandemic to prevent the widening of existing health gaps between populations.

The NIMH: Programs, Priorities and Plans
The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. Joshua A. Gordon, MD, PhD, Director of the National Institute of Mental Health discussed what NIMH learned so far and outlined research priorities with short-, medium- and long-term timeframes. He also touched on issues of importance to the mental health research community, touching on NIMH priorities in computational psychiatry, neural circuits, and suicide prevention.

Substance Use Disorders in Perinatal Women
With more than 7 million people who have a substance use disorder, pregnant women are not immune. In this session Kimberly Yonkers, MD, Director of the Psychological Medicine and Center for Wellbeing of Women and Mothers at the Yale School of Medicine, reviewed the epidemiology of substance use in pregnancy. She also discussed the longitudinal course of substance use in pregnancy and consequences of substance use in pregnancy to the mother and infant.

The Substance Abuse and Mental Health Services Administration (SAMHSA): Current and Future Directions
Elinore McCance-Katz, MD, Assistant Secretary, Mental Health and Substance Use, SAMHSA, presented a discussion about SAMHSA’s mission, which is to reduce the effects of substance misuse and mental illness on US communities. In the past few years SAMHSA has focused on best practices in the diagnosis and treatment of mental illnesses and substance misuse. An overview of current SAMHSA initiatives, priorities and opportunities were reviewed and the audience reminded that psychiatry has a voice in our federal government and SAMHSA is an avenue through which that voice is heard.

Crisis Hotlines are Key to Transforming Care Delivery
Kimberly Williams, President and CEO of Vibrant Emotional Health discussed the potential for a national 3-digit number for mental health and suicide prevention, which will more effectively integrate crisis hotlines into the US care delivery system. Vibrant, a leader in the administration of crisis hotlines, provides 24/7 crisis line services to millions throughout the country in partnership with local and federal governments and corporations including managed care and technology companies. It includes New York City’s leading edge, multi-lingual, multi-modal contact center program that responds around the clock to the mental health needs of tens of thousands of New Yorkers.

Global pandemics, such as COVID-19, create profound social, economic, and psychological disruption. Certain populations experience unique adversities and vulnerabilities, resulting from the infectious disease itself as well as society's response to managing it. The scope and magnitude of the COVID-19 pandemic necessitates the use of evidence-based population mental health interventions to augment clinical care. Customized and actionable resources aid psychiatrists, other health care professionals, and organizational leaders to best support patients and communities.

Psychiatry and the Coronavirus Pandemic
In this session, Joshua C. Morganstein, MD, Chair, APA Committee on the Psychiatric Dimension of Disaster, provided a brief review of global pandemics and their profound social, economic, and psychological disruption especially in populations at increased risk for adversities and vulnerabilities. In addition, he suggested interventions and customized and actionable resources for use by mental health professionals to help patient through the crisis.

Expansion of Psychiatric Practice Through Telepsychiatry During the COVID-19 Era
In this session Avrim Fishkind, MD, CEO/Consultant, emergency Psychiatry and Psychiatric Emergency Design, Empathis Soul Health, provided an overview of how to use telepsychiatry in the changing landscape of COVID-19 pandemic. He also reviewed the legal, clinical, cultural, and practical aspects of using technology to deliver patient care.

NIAAA 50th Anniversary-Alcohol Use Disorder: The Brain, the Pain, and Alleviating the Shame
In his presentation, George F. Koob, PhD, Director, National Institute on Alcohol Abuse and Alcoholism (NIAAA) reminded the audience how far the NIAAA has come in its 50 years of existence. The organization is using a heuristic framework for its research efforts that include neurocircuitry and neurofunctional domains, and he discussed highlights of research findings and how they have translated to diagnosis, prevention, and treatment.

The Role of Synaptic Autoantibodies in Psychiatric Disease
The discovery of diseases in which autoantibodies against neurotransmitter receptors produce psychiatric symptoms has changed the diagnostic and treatment approach to many neurologic and psychiatric disorders previously considered idiopathic. In this presentation, Joseph Damlau, MD, PhD, Professor, Catalan Institute for Research and Advanced Studies, University of Barcelona, and Adjunct Professor of Neurology at the University of Pennsylvania, used anti-NMDA receptor (NMDAR) encephalitis to exemplify this category of diseases, of which 11 may present with psychiatric symptoms.

Narcissistic Pathology of Love Relations
In this presentation Otto Kernberg, MD, FAPA, examines narcissistic patients’ incapacity to establish satisfactory love relations. The diagnostic exploration of patients' erotic, emotional, and evaluating aspects of love relations help us understand typical narcissistic failures in these areas. Clinical material illustrates phases, vicissitudes, and prognostic implications of these therapeutic processes.

Black and Gay: A Historical Perspective of Black Gay Men
In today's more open American society being black and gay carries a double stigma that threatens to deny equal opportunities, status, and standing. Billy Jones, MD, Clinical Professor, Department of Psychiatry, NYU Langone Health, present a historical picture of ongoing, intertwined, natural human conditions the impact they have had on major social changes.

Opportunities and Challenges in Addiction Research
Scientific advances have increased our understanding of the biological, developmental, and environmental factors involved in drug abuse and addiction and are stimulating further explorations into increasingly targeted strategies for their prevention and treatment. Nora D. Volkow, MD, Director, National Institute on Drug Abuse (NIDA) discussed the better understanding of the brain's neurodevelopmental trajectories we now have, ie, the interaction with social environments and genetics as they relate to vulnerability and resilience to drug use and addiction.

For more information about the meeting as well as continuing education, go to https://www.psychiatry.org/psychiatrists/meetings/spring-highlights.