SOUTHLANDS
The President’s Column
Greetings from Louisville!
By: Rodney A Poling, MD
I am honored to serve as president of the Southern. This group has a long and storied history of service to the psychiatric community through promotion of collegial relationships and wonderful meetings, where extremely interesting and relevant subjects are presented. I was so pleased by the turnout in Chattanooga and want to thank all of our presenters and attendees for making this the highlight of the year. The discussions surrounding, "Inherit the Wind," moderated by Dr. Hershfield, will be remembered for years to come. I look forward to our meeting next year in Biloxi, in cooperation with the Mississippi Psychiatric Association, and I am sure that it will be just as exhilarating for our audience.
Iknowmanyofourmembers;however,youmay notknow much about me. I am originally from Wichita, earned a degree in chemical engineering at Tulane, then attended medical school at the University of Kansas. I then spent 7 years in the Navy, completing my residency in San Diego and then paying back my time during a year as a general medical officer in Amphibious Squadron One –spending 8 months at sea – and then for two years as the chief of inpatient psychiatry at the naval hospital in Orlando. I then spent 31 years in Columbia, Tennessee in private practice – both inpatient and outpatient. During COVID, both our daughters ended up in Louisville and they needed us to be near to help with childcare. The older daughter is a psychiatrist and the younger is a social worker. I must have had some influence in their overall career interests!
We moved to Louisville in 2021, after closing my practice in Tennessee. I am currently at the Robley Rex VA Medical Center, on the inpatient unit. I enjoy working with a wonderful team of psychologists, social workers, and nursing staff. It has been an interesting change from private practice. However, diving back into the governmental bureaucracy has been its own challenge. I am having a greattime, and I do not plan on slowing down anytime soon. I have practiced psychiatry in almost every possible setting from private practice to the military to community mental health centers and academic settings. After all these years, I can honestly say I would not change a single day.
I have been a member of the Southern for many years and have enjoyed the camaraderie developed through meeting physicians from a variety of states and practice settings. Psychiatric associations as well as professional associations in general have suffered in the past few years from decreases in membership and lack of interest in meetings, given the wide availability of CME available online. I believe many physicians doubt the value of memberships in small associations, though I have found the intellectual stimulation and the warmth of friendships
most rewarding. I hope that over the next year we can focus on how to increase our membership and stimulate interest in our annual meetings. We are forming a task force to look at ways we can make our meetings attract more people. I would be happy to hear from anyone who might be interested in participating.
I appreciate your confidence in choosing me as your president. I am so thankful for having a terrific group of veteran members who participate year after year in planning our meetings. I am also grateful for Janet Bryan, and her devotion and professionalism in running this organization. Please feel free to contact me with any questions regarding the association. I look forward to seeing everyone in Biloxi next August!
Executive Director Update
By: Janet Bryan
It is unbelievable that the year is almost at an end. We’ve had a very successful year with the Spring reception this past May in New York, the Annual Meeting in Chattanooga, and 9 new members (and 7 more being processed).
If you were unable to attend the September meeting, see Dr. Hershfield’s article What Went On In Chattanooga for a summary of the presentations.
Mark your calendar for next year’s meeting with the MississippiPsychiatricAssociation,August20 – 23,2025, at the Golden Nugget Biloxi Hotel & Casino. The Program Committee is actively working on the preparations.
Calling for Exhibitors: If you know of people who would be interested in exhibiting, please connect me with them via e-mail or send me their contact information.
We are working on details with PRMS for the Spring Reception at the APA Meeting next May in Los Angeles. Additional details will be sent via e-mail early next year.
Dues notices were mailed to the addresses we have on record at the end of November, for payment by the end of January. If you have not yet paid, you can pay via check or with a credit card at www.sopsych.org
If you know someone who would enjoy being part of the Southern Psychiatric Association family, connect them with me so I can inform them about the application process. Here is a link to the membership application: Join Southern Psychiatric Association (sopsych.org)
I wish everyone a wonderful end- of- year holiday season and a Happy New Year!
Report from the APA Assembly
By: Felix Torres, MD SPA Assembly Rep
The 134th Meeting of the APA Assembly took place in Chantilly, VA, from November 1 to 3. After a 5-year hiatus, I had the honor of returning to the Assembly, where I had represented New York from 2012 to 2019.
In starting a new era in APA history as the new CEO and Medical Director, Dr. Marketa M. Wills, MD, MBA, shared her vision in her inaugural address to the Assembly as the first female and first African American to lead the organization. She outlined her strategic approach for the future into three progressive horizons:
• Horizon 1: Lay the Foundation – Establish a culture of trust, transparency, inclusivity, and accountability in an ever-changing landscape
• Horizon 2: Plan, Prime & Define – Establish the vision and strategic direction for the future
• Horizon 3: Execute on Strategic Priorities – Build innovation, strategy and technology within administration; evaluate, refine and prepare the APA for the future
On to the Assembly business…
The APA Assembly is composed of representatives elected from district branches across the U.S.A –including Puerto Rico – and Canada along with representatives of allied groups such as the SPA; and the Assembly Officers.
Its Action Papers advocate for our patients and our profession. These were the 15 approved out of the 20 presented during this Assembly:
• APA Supports Expanding Medicaid Access to Freestanding Psychiatric Facilities – Requests the revision of the current Position Statement on Federal Exemption from the Medicaid Institutions for Mental Diseases(IMD) Exclusion tosupport the expansion of the IMD exclusion rule to include facilities of 36 beds or larger.
• APA Supports Changes to Medicare Lifetime Psychiatric Hospitalization Limit – Requests that the creation of a position statement that supports Medicare coverage for behavioral health and substance use disorder care for 45-60 days per stay, rather than a 190-day lifetime cap.
• A New Educational Experience for Emergency Medicine Resident Physicians – Requests that the APA (1) create a position statement advocating for training in psychiatry for emergency medicine residency programs and (2) advocate for a psychiatry core rotation for them.
• Involuntary Treatment for Substance Use Disorders: From Criminalization to Evidence-Based Treatment –Requests that the APA (1) establish a work group to investigate how to promote data collection across states on outcomes of civil commitments for
substance use disorders and (2) advocate limits on the role of the criminal justice system in these types of commitments.
• Creation of APA Resources Supporting Housing as a Primary Treatment of Severe Mental Illness (SMI) –Requests that APA (1) create a resource document that identifies housing as a critical part of treatment for SMI and (2) craft model legislation for use at the state level to legislate funding for Housing First programs and SMI-specific 1115 waiver slots.
• Access to Stimulant Medications for Treatment of ADHD – Requests that the APA form a work group to study the impact of current scheduling of stimulant medications under the Controlled Substances Act and associated DEA enforcement and manufacturing quotas on access to treatment for individuals with ADHD.
• Social Media Use Issues in Children and Adolescents – Requests that the APA (1) develop guidance for clinicians on how to screen and assess for maladaptive social media use in children and adolescents and suggest appropriate treatment interventions to address such use, (2) compile and publish resources, and (3) issue an updated position statement recognizing recent research findings on associations between social media use and mental health indices, including suicide in youth.
• Mental Health of Expatriates Living in the US Following Disaster Events in their Countries of Origin – Requests that the APA create a resource guide for healthcare professionals to screen, explore, and address disaster-related mental health effects in expatriates living in the US while upholding cultural humility.
• Creating a Position Statement Supporting Mental Healthcare Workers’ Rights in Conflict Zones –Requests that the APA (1) develop a position statement recognizing the rights of mental healthcare workers in conflict zones and (2) release a statement denouncing the military targeting of hospitals, clinics, patients, and mental healthcare workers.
• Prioritize Clinical Diagnosis over Neuropsychological Testing for ASD
• American Psychiatric Association (APA) Position Statement on Vagus Nerve Stimulation (VNS)
• Develop a Resource Document, Continuing Education, and a Position Statement for Ketamine & Esketamine Prescribing in a Psychiatric Practice
• Creation of a Resource Document on Transgender Health in Carceral Settings
• Advocation for the Creation of a Work Group to Assess and Standardize Safety Curricula Across Psychiatry Residencies
• Establishing an Online Submission Portal for Amicus Curiae Brief Requests on the APA Website
All past and current action papers may be found in the APA’s Action Item Tracking System, where their status can also be tracked.
In addition, there were 20 position statements presented for Assembly consideration prior to moving to the Board of Trustees for approval; 12 were up for revision, 6 were newly proposed, 1 was up for retention, and 1 was recommended for retirement. These are presented to the Assembly for an up-or-down vote and cannot be revised on the Assembly floor. Those that are not approved return to the Joint Reference Committee, which serves as a clearinghouse for items between the Board and the Assembly and the councils. These were the approved position statements:
• Revised Position Statement on Assuring the Appropriate Care of Pregnant and Newly-Delivered Women with Substance Use Disorders
• Revised Position Statement on Solitary Confinement (Restrictive Housing) of Adolescents
• Revised Position Statement on a “Dangerous Patient” Exception to Psychotherapist-Patient Privilege in Criminal Court Proceedings
• Revised Position Statement on the Social, Structural, and Political Determinants of Mental Health and Health Equity
• Revised Position Statement on Residency Training Recommendations in Substance-Related and Addictive Disorders for the General Psychiatrist
• Revised Position Statement on Transitional Aged Youth
• Revised Position Statement on Supporting Implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA or Parity Law)
• Revised Position Statement on the Need to Maintain Immediate- and Long-Term Inpatient Care Access for Persons with Serious Mental Illness
• Revised Position Statement on Diverse Representation in Medicine
• Revised Position Statement on Discrimination Against Transgender and Gender Non-Conforming Individuals
• Revised Position Statement on Religious Persecution and Genocide
• Proposed Position Statement on Bias in Law Enforcement
• Proposed Position Statement on Non-Physician Practitioner Training Interference with Psychiatry Resident Training
• Proposed Position Statement on Comprehensive Sexual Education for Children, Adolescents, and Young Adults
• Proposed Position Statement on The Mental Health Impact on People Displaced by Climate Change
• Proposed Position Statement on Federal Exemption from the Medicaid Institutions for Mental Diseases (IMD) Exclusion
• Proposed Position Statement on The Impact of Ageism on the Mental Health of Older Adults
• Retention of the 2019 Position Statement on Joint Resolution Against Torture of the American Psychiatric Association and the American Psychological Association
• Retirement of the 2019 Position Statement on Discrimination Against Persons with Previous Psychiatric Treatment
The revision of one on Capital Punishment was not approved.
All current APA position statements may be found online in the APA Policy Finder
The next Assembly meeting will take place in Los Angeles from May 16 to 18. The deadline for action papers is March 20. Please reach out to me if you are interested in collaborating on one.
The APA Seniors
By: Steve Sharfstein, MD
This year I became President of the APA Seniors, my final presidency after many others. This one is especially gratifying because attaining “senior” status is a goal all of us aspire to achieve. I have been a psychiatrist for over 50 years, spanning at least 5 different careers –community psychiatrist, public health leader, consultation/liaison/psychosomatics, hospital/health system administrator/CEO, private practice – and to have reached this final milestone is truly gratifying.
Who are the APA Seniors? Well, if you are at least 65 years old and an APA member, you qualify. As 40% of APA members are over 65, at least 15,000 of us are eligible to join. Over 400 have done so. We have a voice in the APA Assembly, where our Action Papers can represent our interests. Dr. Jenny Boyer, our Representative, recently authored one on Ageism, which passed.
Recently, we approached the Editor of Psychiatric News on writing a regular column for and about Seniors, since many of us continue to practice and to contribute to the profession. The first one, which I wrote, appeared in the December issue.
We consider ourselves the most welcoming group in the APA. When we gather in person at the APA Annual Meeting,andonZoomsthroughouttheyear,weshareour personal histories and narratives. We reach out to younger APA members, serve as mentors and impart what we have to give best – our wisdom. We share retirement experiences and what we go through as we embark on our post-retirement adventures. Psychiatry has been good to us, and we celebrate the decision we made many years ago to pick it as our medical specialty the most humanistic of all of them.
There are zero dues, although we appreciate donations. So, (if you are 65+) join us!
INTERVIEW: Rodney Poling, MD
SPA President
Chattanooga, TN September 12, 2024
By: Bruce Hershfield, MD
Q: Please tell us about your current work and about the other things you have done
Dr. P: “I was in Tennessee for 31 years, in solo private practice with both outpatient and inpatient work the-old fashioned way. Both our daughters ended up in Louisville during COVID. Our older daughter is a psychiatrist and our younger one is now a social worker. During COVID our older daughter was pregnant and needed help with her older son. She and her husband asked us to come help, and it felt like the time to make a change, so I ended up closing my practice. We moved to Louisville, and I took a job with the VA there. We have been in Louisville for 3 years, and it has been quite a transition. I’ve seen a lot of aspects of psychiatric practice from private practice to working in the Navy and even to briefly working in a mental health center, years ago. I just do inpatient work for the VA now. They are building a new hospital, scheduled to be completed in 2026. We have 16-18 beds. Another psychiatrist and I staff the unit, and we have a great team, which is very different than being in solo private practice. It’s been a lot of fun!”
Q: “What has surprised you the most about the transition?”
Dr. P: “The tempo of treatment is a bit slower-paced than in private practice where every moment you are not seeing someone is a time when are not generating income. When you have employees, and you have rent to pay, it’s very important to keep busy. The VA is a large organization, with lots of patients to see and to provide care to. There is the inherent bureaucracy that with goes along with a large organization, with a lot more paperwork. (Although in private practice, if you bill insurance, there is also a lot of paperwork.) Nevertheless, in the VA, there is a lot of time to devote to the Veterans.”
Q: “What was the most difficult part of moving from Tennessee to Kentucky?”
Dr. P: “It went pretty smoothly. It was right in the middle of COVID. It’s hard to remember what it was like in that year before the vaccines came. We shut down my office for a month or more we didn’t see any patients before we got going on zoom-type visits. A lot of my practice was geriatric and getting a lot of them on-line so we could see them took quite an effort. Things just turned upside-down during that year. I had decided I would cut down over a period of several months. I had a small geriatric unit and that was changing, as the company that owned it was transitioning to providing things through nurse practitioners. I was also the Medical Director of a new psychiatric hospital that had opened in our town, which turned out differently than I had expected. It was my “entree” into the for-profit world. Of course, my own practice was for-profit, but I had never worked for one of the big companies psychiatric hospitals all over the
place. The involvement of the financial people in the clinical decisions I don’t know that I was naïve, but it was more than I expected, so I tendered my resignation. So, in the end it turned out to be a smoother transition than Ihadanticipated. The VA was wonderful togiving me time to get acclimated.”
Q: “Where are your from originally and how did you become a psychiatrist?”
Dr. P: “I grew up in Wichita, Kansas. My father was psychiatrist. He had grown up in Oklahoma one of 5 children and the only boy. All of his sisters were teachers. When he finished high school, his mother was determined he was going to go to college. They drove part-way to Oklahoma City, and they ran out of money to buy gas. His mother told him to get out of the car and get to college. He hitchhiked to Oklahoma Baptist University in Shawnee. Then he went to medical school in Oklahoma, then did his internship in Iowa. He was interested in Neurology, but then World War II broke out and he was in the Army Air Corps. Many of the injuries had psychiatric components,andhewas givenacourseinPsychiatry and he went to a hospital in Arizona and then was in the Philippines and ultimately in Tokyo. He came back to central Kansas and started practicing Psychiatry. He practiced till the early ‘60’s, when he was killed in a car accident by a drunk driver. I was just 5 years old the youngest of four. It always stuck in my mind what he had done.
I went to Tulane, where I did pre-med in engineering (one of only two places you could do that at the time). Then came back to Kansas City for med school. I was planning on being a family practitioner, but, as I did my psychiatric rotation, I became enamored with that. I was in a Navy program for medical school, so I ended up doing my internship in San Diego in what was called “diversified Psychiatry”. I only did 3 months of psychiatry; the rest was all Medicine, Surgery, etc. Then I spent a year as a General Medical officer on a ship. I came back to San Diego and finished my Residency in Psychiatry. Then I was in Orlando for two years as the Chief of Inpatient Psychiatry on a 25-bed unit. I ran that with a wonderful psychologist who was a great help. Then I got out of the Navy, and we moved to Tennessee.”
Q: “Which part did you like the most and the least?”
Dr. P: “We have enjoyed all aspects. My wife and I have been married 45 years. We met the first day of our freshman year in college. We sat next to each other in calculus class; my last name began with a P and hers with an R. Each time had its wonderful aspects, so we have enjoyed every part. When we were in San Diego, it was wonderful, but it was changing. Whatever you decided to do, it seemed like 10,000 others had decided to do it at the same time. We also enjoyed Orlando. But our years in Tennessee raising the kids and being part of a smaller community in Columbia about 40 miles south of Nashville. It’s a rural community, with the city having 60-70,000, but then we served a community of 8 counties, totaling 250.000.”
Q: “What did you like about the South?”
Dr. P: “Certainly, the weather. When I was growing up on the plains, you had the winter and then 100 degrees in the summer. When we first moved to Tennessee, in the fall, after 5 years in San Diego and two in Florida we first thought the trees were dying. We had forgotten that it’s what happens in the fall! But it was nice to have the seasons. For many years, we had mild summers and winters, though now everything seems more extreme.”
Q: “Tell us about your participation in the Southern.”
Dr. P: “I had been a member of the APA since residency and had attended meetings of the Tennessee Psychiatric Association in the ‘90’s, then it kind of died out for a few years. One of the members, Dr. DiGaetano, had been active in the Southern and she invited me to the meeting in Chattanooga in 2015. I met you there. I also knew Dr. Jennings. I decided to join and have been to a number of meetings. I joined the Board of Regents and then was Treasurer, then VP and now president-elect. Meeting such wonderful people reinforces your confidence in the idea that there are many wonderful people practicing Psychiatry around the country. I have enjoyed the socializing and have enjoyed the get-togethers. Also, the subjects that we cover in the meetings you just don’t get them anywhere else. For example, so many of Dr. Komrad’s presentations stand out. I remember the first time I heard him, in Chattanooga, when he talked about movies, then the one he did about the eugenics movement in the United States and how that spilled over to the Nazi regime things that you don’t hear about anywhere else. I’m also looking forward to the movie presentation at this meeting. I watched Inherit the Wind again a week or two ago. A fascinating film that reinforces that things never change. Maybe there is a veneer of technology that covers it over, but human beings stay the same very vulnerableto persuasionandbeliefandfaith all these elements that that sometimes come into conflict with science and understanding the physical world. How do we come together on that? Many people who are in Medicine understand the science, but as psychiatrists, we have to understand that other aspect about how people can believe so deeply and have such unswerving faith – how that plays into their lives.”
Q: “What are your thoughts about becoming president of the Southern?”
Dr. P: “It’s a little daunting. In our Council meeting today, there were so many wonderful ideas, but the important part is moving forward with them. I think the main thing is increasing our membership and getting younger psychiatrists involved providing something of value for them. Having mentoring and an opportunity to discuss what is a psychiatrist’s role in today’s world? Where do we fit in? Our role used to be pretty specific, but in today’s world there are so many other professionals and the everchanging scope of practice. What can we offer to people that others don’t? How do we keep our value? We all know what we do and find reward in working with our patients and their families and each other, but there are so many other factors. I have dealt with this when I was
president of the Tennessee Psychiatric Association and now in the VA structure. There are so many other professionals who want to do what we do, without the full experience. Many are very good very bright but their training sometimes may not keep up with their authority.”
Q: “How can the members of the Southern help you?”
Dr. P: “There seems to be a core group of folks who continue to participate and provide ideas and develop the programs. How do we improve on the numbers of people who attend our meetings? We need to survey the members to find out what they get from the Southern and what we can do to improve that.
Sometimes the practice of Psychiatry can be a very singular pursuit just you and your patient. When I was in private practice, I found support in the medical community because there weren’t that many psychiatrists around. The friendships and the relationships you have with the medical community and our professional associations, such as the Southern and the APA and our state district branches, are so important. I would just like to get younger psychiatrists to participate and have a voice in making political decisions.
When I started my internship in 1983 in San Diego, the Admiral who was in charge of the hospital (they were still physicians at that time) said, “’Right now, 10% of physicians are employed and the other 90% are in some sort of private practice setting. But by the end of your careers, it’s going to be exactly the opposite.’ It was true. So many psychiatrists are now employed either by big organizations like the VA or by hospital chains or medical groups. So, the value of being a member of a professional organization is not apparent to them.
I remember the Tennessee Medical Association had a presentation from the Executive Director, who put it in the starkest terms. ‘You may think your years of education and training and experience give you the right to practice Medicine. In Tennessee, it’s 49 votes in the House and 19 votes in the Senate. That’s what gives you the privilege to practice. If you don’t have a voice with that political group, you all are at risk of that privilege being changed.”
Two SPA Members in 3-Way Race for APA President-Elect Editor’s Note
SPA members Rahn K. Bailey, MD and Harsh V. Trivedi MD, along with Mark Rapaport, MD are this year’s candidates for APA President-Elect. In accordance with how we have handled this kind of situation in the past, I have asked Drs. Bailey and Trivedi to submit articles about their candidacies, but this does not mean the SPA or Southlands is endorsing any of the three.
Dr. Rahn Bailey is Candidate for APA President-Elect
Rahn K. Bailey, M.D., is a boardcertified psychiatrist, medical educator, and researcher who is committed to advancing mental health care and promoting health equity. He envisions a future where psychiatric care is innovative, compassionate, and patient-centered. He has been a strong advocate for addressing health disparities, equity, and improved access to clinical care. In New Orleans, his work has been instrumental in developing strategies to improve community health, including research and education on structural barriers to gun violence.
Dr. Bailey is also dedicated to mentoring the next generation of psychiatrists. He serves as Chair of the Department of Psychiatry at Louisiana State University, where he also is the Assistant Dean for Community Engagement. He has already made significant contributions to the APA, including as Membership Committee Chair, Board of Trustees member, President of the APA Global Mental Health Caucus, and President of the Tennessee Psychiatric Association. In 2024, the APA awarded him the Solomon Carter Fuller Award for his work on Black adolescent violence prevention.
He is a member of the SPA’s Board of Regents and has lectured at our annual meetings.
Under Dr. Bailey’s leadership, the Department of Psychiatry at LSU Health New Orleans is implementing a transformative mental health care initiative at Orleans Parish Prison. He has written over 86 peer-reviewed articles in more than 20 reputable journals, about psychotic disorders, depression, forensic psychiatry, competency, confidentiality, and risk management. He has also publishedthree books:HealthDisparities(2013), Gun Violence (2018), and Intimate Partner Violence (2020), offeringa physician's perspective oncrucialtopics in psychiatric care delivery.
Dr. Bailey earned his medical degree from the University of Texas Medical Branch. He completed his Psychiatry residency at the University of Texas at Houston in 1994, serving as chief resident, and completed a fellowship in Forensic Psychiatry at Yale in 1995. Throughout his career, he has been dedicated to advancing psychiatric care. He brings a breadth of experience, leadership, and vision that could improve the future delivery of mental health services. He would like a chance to show what he could do to help as APA President.
Dr. Harsh Trivedi is Candidate for APA President-Elect
Dear SPA colleagues: I am honored to be nominated for APA President-Elect.
I serve as President and CEO of Sheppard Pratt, the nation’s largest private nonprofit psychiatric provider – and a steadfast partner of the Southern, including sharing our own Janet Bryan. I am grateful to have been involved with the Southern for far longer than Janet has, extending nearly 15 years back to when I came to Vanderbilt as executive medical director.
Through my breadth of experiences – from my time at Sheppard Pratt, to Vanderbilt, to Brown Medical School/Bradley Hospital, to Harvard Medical School/Children’s Hospital Boston – I understand how difficult it is to build a sustainable medical practice, with insufficient reimbursement rates and growing administrative burdens. I see how inadequate access to care and health disparities are impacting communities across our country.
The APA has been a formative influence throughout my career. From being the resident member of many committees, to my time as a Spurlock Congressional Fellow, to serving as chair of the Council on Healthcare Systems and Financing – I would not be where I am today without the opportunities APA has afforded me over the past 20 years.
I have long championed making evidence-based best practices readily accessible. I have served as the editor of the APA Textbook of Hospital Psychiatry, the Psychiatric Clinics of North America, and the Child and Adolescent Psychiatric Clinics ofNorth America. We need to provide members and district branches the tools to succeed.
I am uniquely positioned to give back and lead: from representing psychiatry in the AMA house of delegates, to serving as the voice of psychiatry on the board of the American Hospital Association, to serving on the APA Presidential Taskforce for the Future.
In addition, I have deep experience with the media – I am well prepared to represent the APA publicly. From national TV appearances on channels like CBS and ABC, to interviews with mainstream outlets like the Wall Street Journal, to podcasts, I am adept at connecting with clinicians, politicians, and the general public.
As a leader, I roll up my sleeves, understand challenges, collaborate, and build consensus to deliver transformative solutions.
I humbly ask for your vote so I may serve our APA. Harsh K. Trivedi, MD, MBA, DFAPA, DFAACAP
Our New Assembly Rep Felix Torres, MD
By: Bruce Hershfield, MD
AfterhavingservedontheSPABoard of Regents for the past three years, Dr. Felix Torres is now representing us in the APA Assembly.
He is a clinical, forensic, and administrative psychiatrist double-boarded in Psychiatry and Forensic Psychiatry by the ABPN. In addition to his bachelor’s degree from Yale and MD from the Universidad Central del Caribe he is a Fellow of the American College of Healthcare Executives.
A Distinguished Fellow of the APA, he sat on its Board of Trustees as the Minority/Underrepresented Representative and was its Co-Chair of its Structural Racism Accountability Committee from 2021 to 2023. He has also served as a Special Advisor to the United Nations, ensuring the inclusion of mental health in its development goals and agendas.
Dr. Torres is the Chief of Forensic Medicine for the Texas Health and Human Services. He has consulted and testified in hundreds of cases on mental health issues. He is committed to the fight against stigma towards mental illness and to the education of underserved populations. He has extensive experience serving as a mental health contributor to local, national, and international media outlets. From 2021 to 2023, he hosted the YouTube/Facebook Live show, “Sin Salud Mental No Hay Salud” (No Health Without Mental Health).
An SPA member since 2020, Dr. Torres has been active on our Program, Resident Research Award, and Long Range Planning Committees. He is the proud father of 4year-old twins and speaks Spanish, French, and Italian.
We are very fortunate indeed to have Dr. Torres representing us.
Day 1
What Went on in
Chattanooga
The SPA Annual Meeting
September 12-14, 2024
Some Notes on the Presentations
By: Bruce Hershfield, MD
The first presenter, Dr. David Casey, pointed out in Psychotherapy with Older Adults that only a small percentage of older adults are even offered psychotherapy. Some of them feel “bad” instead of “sad” and may benefit from psychosocial treatments. Despite “ageism”, most older people report a high satisfaction level and mood. It’s important in treating them to address negative reinforcement, and it may be advisable to
include family or a caregiver. Increasing the quality of life, instead of a cure, may be the best goal.
Then Timothy Jennings, MD, addressed issues of Alzheimer’s Dementia Prevention & Risk Reduction. He spoke about plaques and tangles, describing tau proteins as scaffolding pins in the microtubules; the brain makes its own insulin, which inhibits tau hyper-phosphorylation that could lead to calcium influx. The problem is that there is a high rate of insulin resistance as the brain ages. As neurons die, the brain releases amyloid, which also increases insulin resistance. Increases in CNS inflammation increase insulin resistance and contribute to Alzheimer’s. Even peripheral inflammation can increase insulin resistance by 6 different mechanisms. He went on to describe multiple ways of preventing Alzheimer’s including exercise, diet (including pomegranate juice), and perhaps coffee and green tea. New learning and sleep can help, and infrared light may also prove to be useful.
This was followed by a Wellness Panel. First came Dr. Tarak Vasavada, who spoke about Discover the Secrets to Happiness with 5 Basic Principles. Happiness is the current state of positive emotion. Happier people tend to live longer. He estimated that happiness is determined ½ by genes and 10% by outside factors, with the remaining 40% being “intentional”. It takes two years to overcome a loss, but only one year to come back to one’s usual state after a dramatic positive event. Losing income does tend to bring more misery, but giving to others can make people feel happy. People tend to be more unhappy in their child-bearing years. He pointed out how little time we spend preparing for retirement.
Next up was Gary Weinstein, MD, who talked about Incorporating Integrative Wellness Techniques in Clinical Practice. He described Hans Selye’s theory of emotional strain and then talked about what traditional meditation entails. It’s training to focus on a single object, leading to a relaxation response. He then led the audience in a demonstration of alternate-nostril breathing.
This was followed by Diana Partington. LCP-MHSP, who spoke about Satisfy Your Curiosity & Toss a Few ‘DBT Skills’ to Your Toolbox. She showed a film by DBT’s founder, Marsha Linehan, then said that once-per-week DBT is very present-focused, with a concentration on any life-threatening behaviors. It involves developing a toolbox of skills, managing relationships, and setting boundaries. She emphasizes doing what is effective, setting agreements about observing limits and empathizing, and admitting fallibility. Phone-coaching, along with therapy for the therapists are features of DBT that appear to help.
To close out the day’s program, Dilip Jeste, MD, who addressed us by zoom from California on the subject of Positive Psychiatry: Promoting Wisdom & Well-being in Individuals & Communities. He criticized electronic health records for making us treat diseases instead of patients,
so that our primary goals appear to be limited to decreasing symptoms and signs. He mentioned ‘Mans’ Search for Meaning’ and ‘A Beautiful Mind’ and pointed out that wisdom is more than intelligence. He mentioned “The Silent Pandemic of Loneliness” and pointed out that is more of a problem with people who have schizophrenia than for others. He said that Costa Rica, though poor, is a relatively happy place that has a good primary healthcare system.
Day 2
Anoop Karippot, MD, began the second day by talking about How WillI Sleep WhenMy World Is Raging He told us that decreased sleep duration leads to an increase in C-V deaths, while sleeping too long can lead to an increase in all other kinds. Two days’ inadequate sleep affects driving as much as a blood-alcohol level of at least 0.08. He reviewed some recent medications for insomnia and described how caffeine works by decreasing adenosine.
This was followed by Dr. Manoharan, who lectured about Coca-Cola in Veins: Restless Leg Syndrome. It affects 510% of people in North America and Europe and is twice as common in women as in men. The primary type is probably genetic, though a host of other factors can worsen the risk. It can be painful especially deep in the calves and increases the risk of depression 2-4 times. Antidepressants, lithium, and caffeine can worsen it. Calcium-channel ligands like gabapentin help; so do benzos and opioids, but they are to be avoided because of side effects. Iron sulfate can also help. Frequently misunderstood and misdiagnosed, it is nevertheless treatable.
Next, Dr. Mark Komrad talked about Vulnerable Ethics the Tuskegee Syphilis Study. He first told us about the disease, pointing out that it was the first one to be determined to actually cause a psychiatric disorder. The experiment, located in Macon County, Alabama (where there was a 35% positive rate) lasted from 1932-73 the longest non-therapeutic study in history. It involved 425 men in all. In 1969 the CDC recommended against discontinuing the study, but a 1974 class action suit led to $10 million for the 72 survivors and 40 affected survivors and 19 affected children. It was a very dramatic example of a violation of the ethical principle that one should serve the “greatest good for the greatest number”.
This was followed by Dr. Debra Barnett’s Digital Therapeutics in Psychiatry. Software is currently being used to track sleep, activities, mood, and medication compliance. The first effective use was for substance use disorder. Now, many other disorders are being addressed, especially PTSD. Use of this software may serve as a bridge between therapy sessions. Questions arise about which ones to trust, how effective they are, and about how the information will be kept private.
Next,Richard Shelton, MD, taughtusabout WhatDoNew Treatments Tell Us About Depression. He talked about
the Star-D trial, which initially used citalopram. He spoke about a triple-reuptake inhibitor called liafensine and about a molecular marker for antidepressant response called Ankyrin-3. He talked about how reproductive hormones affect mood, pointing out that progesterone levels increase during pregnancy, then collapse. Starting a progesterone contraceptive increases the risk of depression. It looks like the next generation of antidepressants will be based on a better understanding of the disorder(s).
Neethu Nandan, MD, gave the SPA Resident Research Award lecture to finish off the day’s academic activities: Retinal Abnormalities & Neurocognitive Tests As Potential Biomarkers for Psychosis. The retina is a “window to the brain” and it does do some informationprocessing. It has become clear that people who are having their first episode of psychosis have less macular volume and thickness. Retinal dysfunction does increase “noise” in the brain, and it is possible that retinal markers can serve as predictors of psychosis.
Day 3
Dr. Rahn Bailey began the Saturday session with Firearm Use in Intimate Partner Violence. He told us that 1 in 5 women and 1 in 7 men in the USA is the victim of severe physical violence. Owning a gun and having it in the house increase the risk of violence. Of the people killed by guns in high-income countries in 2015, 92% were in the USA. Guns cause more suicides than homicides. He suggested we could help the situation by getting guns say from those who have a history of intimate partner violence. It would help if dealers had to notify authorities when someone who should not have a weapon tries to buy one.
This was followed by Daniel Sharfstein, JD, who told us about Education for Self-Determination: Cherokee & Chickasaw Students at Vanderbilt 1885-89. There were 12 such students. Their parents and grandparents had experienced the “Trail of Tears”. Many eventually got involved with tribal affairs, before that kind of government was dissolved in 1906. (Some tribal government was restored during the New Deal.) Many went on to have positions of authority, having benefited from the lack of segregation that had been true during their student days.
The final presentation was “Inherit the Wind”: AScreening oftheFilm &a PanelDiscussion. We watched a summary of the first half of the movie, then the complete second half(includingthe important courtroom dialogue) and then we had a discussion by Dr. Jennings, Dr. Komrad, and Dan Sharfstein. We talked about the Scopes “Monkey Trial” that had occurred in Dayton TN in 1925 and about how the issues raised by the film were affecting our lives now.
There were a lot of good talks and lively discussions. Try to come to the next SPA Annual Meeting in Biloxi in August!
The Panacea How Advocacy Can Help Us
By: Michael Young, MD
Often, when I pick up a medical magazine orreadanon-line newsletter, I'm reminded of the many problems within our American healthcare system, including the high rates of burnout among practitioners. Problems with access to affordable and quality healthcare are highly prevalent. Burdens of required documentation, prior authorization for medications, and limitations on care cause additional frustration and distress for millions.
Burnout among physicians has reached staggeringly high levels, which was exacerbated in the context of the pandemic years. There have been many stories about physicians leaving hospital practice behind, limiting their practice in other significant ways, or leaving the healthcare field altogether. The emergence of mid-level providers in efforts to expand the workforce; has additionally changed the workplace; however, this also risks decreasing the quality of care. All these challenges takejoyoutofpracticingmedicineand lowerthephysician morale; they increase burnout, increase workforce shortages, and worsen clinical outcomes.
So, is there a panacea to address this bleak picture? Of course…we’re physicians and we don’t give up on our patients or our profession!
The panacea can be found within professional organizations and, more specifically, in their advocacy. This is at the heart of why we go into Medicine – “to help people and make the world a better place”. I hear it from ourmedicalstudents interviewingforresidency programs. I hear it from undergraduates pursuing medical school. I hear it from high school students who are hoping to go to medical school. Working together for positive change is the type of engagement that remedies burnout and helps us carry on when the times get tough.
I have benefitted from advocacy through participation with my District Branch of the APA – the Maryland Psychiatric Society. Our Legislative Committee, which reports to the organization’s executive committee, is comprised of over 25 psychiatrists. In our 2025 committee kickoff meeting this month, I was inspired to see the diversity, which included trainees as well as practicing psychiatrists in the fields of addiction psychiatry, child and adolescent psychiatry, collaborative-care models, consultationliaison psychiatry, correctional psychiatry, emergency psychiatry, forensic psychiatry, medical hospital-based practice, and private practice with a focus on psychotherapy. Members from the Washington Psychiatric Society participate on legislation affecting Maryland counties bordering Washington, DC, and the district itself. Such an incredible level of professional diversity enables a better understanding of proposed legislation, as well as an awareness of needed legislation.
During the meeting this month we reviewed past successes, including making inroads to reduce the prior authorization requirements for psychiatric medications. We also discussed the assisted outpatient treatment bill passed last year and an important amendment being proposed this year to restrict gun access
Advocacy with professional organizations has been an effective way for me to resist the bureaucratic forces that risk taking the joy out of practicing medicine. It's also a way to engage with other psychiatrists – an important part of both my professional identity and sense of overall wellbeing. I like feeling I'm impacting many more lives than I can in my day-to-day clinical work.
I encourage all of us to reach out to our local district branch of the APA, or within our other professional organizations,to bolsterouradvocacy. A medical student I was interviewing this week started off her interview by stating that she's going into Psychiatry “to be the change I want to see in the world”. That was a good reminder of what so many of us set out to do!
MEDICAL MARRIAGES
Shrink-Squared in the Southern
By: Mary Helen Davis, MD
The Southern Psychiatric Association boasts at least five dual-psychiatrist couples that are association members, all of whom are active and engaged in professional leadership. Our shrink-squared couples include the following:
Ali Farooqui and Audrey Summers
As a partner in a non-psychiatric dual-physician marriage over the past 46 years, I have been curious about what similarities and differences contribute to making these relationships work.
Physician Marriages are common: about 20% of physicians are married to other physicians and another 25% are married to non-physician health care professionals. Female physicians are more likely to be married to another physician than their male counterparts. Overall, the physician divorce rate is about 25%, lower than the general U.S. population divorce rate of 40-50% for first marriages. Among specialties, the divorce rate is reported highest for psychiatrists, followed by surgeons, compared to other medical specialties, although the specialty data does not separate out physician-to-physician marriages.
While I was interviewing some of our couples during the annual meeting or communicating by e-mail with others, several common themes emerged. All couples report developing strong friendships and colleague relationships prior to forming partnerships, and felt the benefits outweighed any of the challenges of a dual professional relationship. Some relationships started in college, medical school or residency, and others later along the professional continuum. Common themes were negotiating work-life balance, maintaining some boundaries between professional and personal lives, and devoting time to mutual decompression. Most of the couples cited the benefit of frequent walks together becoming part of their routine. Having a partner who understands the demands of a psychiatric patient population increasing the ability to discuss challenging cases was beneficial. However, several cited the importance of not bringing work home as well as the challenges of handling disagreement when you do. Marina Nikhinson captured this the best: “The level of trust we had to develop to comment on each other’s patients has been remarkable. It’s been important not to weaponize our clinical skills and knowledge and still see eachotheras an intimate partnerthroughitall and notjust a colleague”.
Another benefit of the dual-psychiatrist relationship was the opportunity to benefit from each other’s perspectives. They also emphasized the importance of sharing individual outside interests – cooking, running, cycling, travel, walking and hiking. Can you guess which of our 5 couples did triathlons together in the early phases of their relationship?
Many of their issues regarding work life balance, time management andparenting did notreally differfromthose of non-physician couples. However, being psychiatrists raised their standard of self-expectations in a couple of cases. For example, they tended to judge themselves a bit harshly when they lost “their cool”.
I am married to a pathologist. Having had the opportunity to work together over the past two decades, since I
Corey Jackson and Chasity Torrence
Tom Franklin and Marina Nikhinson
Clint Martin and Janaki Nimmagadda
Hal Ginsburg and Jenny Boyer
entered the psycho-oncology realm, has been a true professional joy. I had a similar experience when my son became an oncology nurse, as we got used to sharing caregiving experiences together. There are also several parent-child physician relationships in the Southern; perhaps those members might share those experiences with us as well.
We are all human and our relationships are complicated. I congratulate all the couples for collaborating in their personal relationships, while managing their professional lives and sharing in the work of the Southern Psychiatric Association.
Firearm Shootings: A Serious Public Health Issue
Thoughts Prompted by the U.S. Surgeon General’s Pronouncement
By: Steven Lippmann, M.D.
In June, Surgeon General, Vivek Murthy, M.D., declared gun violence to be a public health crisis. He gave a renewed warning about the impact of firearm shootings. He wants to turn this matter more toward a medical issue rather than a personal rights’ political battle.
Dr. Murthy stresses a trend among physicians to consider shootings a preventative medicine focus. He says that, since 2020, firearm-induced injuries are the number one cause of child death in this country. Out of >48,000 gunshot fatalities during 2022, over half were suicides. Recently, about two out of three gun-related deaths are self-induced, with negative emotional consequences for families. Survivors of non-fatal shootings suffer too. This burdens our healthcare industry and drives up costs.
Gun violence also harms mental health. Young-peoplesuicide, including adults into their 30s, is rising. Doctors are now more cognizant of this. We already have been encouraged to think about hazardous-instrument access when evaluating a patient for dangerousness.
Nowadays, some children are afraid of going to school. Many protective precautions like metal detectors, armed personnel, see-through backpacks, etc., heighten a focus on danger. There should be ways to restore some comfort and safety.
I am concerned beyond suicide and school shootings – to homicides, mass shootings, and how much we worry about self-protection. These incidents are too-often followed by little remediation. As a nation, it seems that we favor firearm ownership over the well-being of youngsters.
“Action speaks louder than words.” U.S. policies are often not supportive enough, or, sometimes, even counterproductive. For example, dithering about lowering purchasing age requirements, possibly by dropping
criteria for ownership of an assault weapon from 21 years to 18. This actual consideration followed the recent Uvalde school tragedy, despite that the powerful gun involved was procured by a teenager.
In the past, the National Rifle Association provided some good leadership about gun safety, handling, and storage. But now it and our government often resist curbing gunrelated problems. There is opposition to pre-purchase background checks, assault weapon bans, and “red flag laws” that allow police to confiscate weapons once a judge determines that someone is dangerous. Some people say we should try to limit such access to someone experiencing emotional stress, sort of like - “Friends do not let friends drive drunk.” At least, we ought to expand that to firearms when a person is upset.
This is a call for activism by our profession. Physicians have credentials for public advocacy. We often have access topoliticians and widenetworks ofsocialcontacts. We vote. Professional medical societies ought to lobby for better public health – including greater firearm safety.
We need to do something about this!
Tianeptine: “Gas Station Heroin” For Your Kids?
By: Steven Lippmann, M.D.
What (?), another addictive drug available, dangerous, and uncontrolled? YES. Tianeptine, an opioid, appeared in Europe about five decades ago and was distributed all around the world as antidepressant medication.
It’s sometimes called “gas station heroin,” being an unregulated narcotic marketed in such places. “Tia,” is another nickname. It is addictive, potentially lethal in overdoses, worsens narcotic withdrawals, and can complicate pharmaceutical interactions. Despite its reported efficacy as an antidepressant, it shares little established similarity with them. The precise mechanism of action is not clarified.
Humans frequently seek ways to alter mental awareness and other people are often available to exploit that for financial gain. Tianeptine has just recently come to public awareness. New substances can often evade prohibitive laws and regulations.
Because it is not listed as a federally-controlled substance, it is sold without restriction, despite its considerable risks. Many stores offer a myriad of mindaltering substances. For example, kratom, another potentially dangerous opioid, is also available over-thecounter and is widely sold in Kentucky. Perhaps, we shall soon see more tianeptine here, too?
Because it is unregulated, its quality, purity, and concentrations in commercially available products are not under scrutiny. Some supplies are mixed with other
chemicals like synthetic cannabinoids, adding additional safety concerns. We already know about popular drugs of abuse being contaminated with fentanyl, xylazine, and/or medetomidine, etc. Do we need more of them?
Fortunately, some governments are gradually becoming aware of this hazardous situation. Some states (e.g., Florida) have banned tianeptine sales. The medical community needs to be aware of and to counter unrestricted use of this drug, and we should warn patients about it.
Physicians are in a position to use their credentials in lobbying lawmakers. Similarly, we should spread information about our concerns at community gettogethers, like school board meetings, especially those dealing with young people.
The dramatic rise of teenaged suicide in this country adds urgency to this call for action; hopefully, better control and/or banning of tianeptine could be helpful. We all need to take whatever steps we can and not leave this issue to “somebody” else.
Depression in Immigrant Populations
By: Lilia Isabel Burns, M.D. and Steven Lippmann, M.D.
Immigrants comprise a large group of the people within the U.S.A. and immigration is predicted to be the driver of most of our population growth between now and 2050.
They experience similar or higher rates of mental illnesses than the general public. Stress-related issues like post-traumatic conditions or adjustment disorders, depression, and anxiety are frequently encountered. However, there is conflicting evidence about whether the rates are higher or lower, compared to that in indigenous populations.
This group is more likely to arrive with emotional issues and to encounter socioeconomic disadvantages, harsh living conditions, demanding work, and/or fears of deportation or of being judged a failure. They also suffer from limited healthcare access. They usually experience problems with learning a new language/culture. Distrust of the healthcare and government systems is another difficulty. This might prevent them from accurately reporting information to their doctors.
I, Lillia Burns, was born and raised in Cuba, where I graduated from medical school at the University of Medical Sciences. After that, I pursued emergency pediatrics; I loved working with children, and that led to an opportunity in family medicine. After leaving Cuba to escape oppression, I worked in Mexico as a family and emergency medicine doctor. I had wonderful experiences
as a family practitioner and pediatrician in both countries. I came to the U.S.A. and, being a refugee physician and a native Spanish speaker, I volunteered as a medical translator. So, serving at the Family Community Clinic in Louisville was a natural. It provided free medical care to an indigent, uninsured population of refugees, of whom most spoke Spanish. Doing this work, I met Steven Lippmann; together, we decided that I should write about my observations.
Depression and PTSD are the most self-reported emotional concerns among refugee patients in primary care practices. Thoughts about death, with suicide attempts and a plan for killing themselves are common. Children and adolescents more often evidence irritability or psychomotor changes.
These signs and/or symptoms are not due to substance abuse, medication, or a medical condition. Most truly depressed individuals experience functional impairment. People with undiagnosed depression often have decreased quality of life and a risk for mortality and/or adverse health outcomes. Thus, screening of high-risk immigrant patients has substantial health benefits. Effective management of depression in this group of patients requires a culturally sensitive, patient-centered approach. Doctors need to adjust their communication attempts so they can best respond to their patients’ concerns, including employing a perspective that is sensitive to how culture can affect clinical presentations.
Xanomeline/Trospium: Something New For Schizophrenia?
By: Muhammad Hussnain Cheema M.D., Research Scholar
Biplab Adhikari, M.D., Research Scholar, & Steven Lippmann, M.D.
Schizophrenia is a debilitating mental illness that affects 2.8 million adults in the United States (and 24 million people worldwide). Manifestations include hallucinations, delusions, flat affect, social withdrawal, and emotional apathy. It also induces a significant risk of suicide – 4.5 times higher as compared to the general population.Past treatments have been disappointing.
What has changed since the introduction of chlorpromazine in 1952? Over the past seven decades, approximately 50 additional antipsychotic agents have been introduced, most of them primarily targeting the dopamine D2 receptor. The majority of these medicines function as antagonists; however, aripiprazole is an exception evidencing partial agonist properties. Xanomeline/trospium (Cobenfy) has recently become available and has a different pharmacology.
The dopamine D2 receptor remains a target for antipsychotic pharmacotherapy, documenting the significance of dopamine modulation in diminishing the
manifestations of schizophrenia. Yet, xanomeline/ trospium targets brain muscarinic receptors, regulating neurotransmitter signals, and dampening dopamine release. By pairing xanomeline with trospium – a muscarinic receptor antagonist with selective affinity for peripheral receptors – some debilitating cholinergic effects potentially might be counteracted.
Previous antipsychotic drugs often created troublesome extrapyramidal features, including dystonias, parkinsonism, and/or tardive dyskinesia. Additionally, some patients experienced sedation, weight gain, hyperprolactinemia,and/ormetabolic disturbances, which increase the risk of vascular pathology. The firstgeneration antipsychotic medicines also induced the risk of neuroleptic malignant syndrome (rare). These adverse consequences compromise treatment adherence, quality of life, and/or overall patient outcomes.
Xanomeline/trospiumis approvedforprescribing andmay not cause the classical antipsychotic side effects. (Time will tell.) It may induce nausea, vomiting, and constipation. Approximately one-third of the subjects who were treatment-resistant to past medicinals are reported to benefit from its distinct mechanism of action. Yet, short trial durations may not reveal long-term efficacy, safety, and tolerability. Without an active treatment comparator arm, this limits direct comparison with previous antipsychotic drugs. Research is ongoing to determine its clinical efficacy and safety.
I (MHC) recently came to the U.S.A. to do research at the University ofLouisville,SchoolofMedicineand,hopefully, find a residency. While in a medical writing group, we discussed this interesting pharmaceutical, and I thought to tell about it to a wide audience. As a member of this seminar, I (BA), decided to contribute to writing about something so different that might help lots of patients. As a psychiatrist who meets with both of them in this medical writing group, I (SL) want to share this report of what may be an important advance with our SPA members. None of us has yet prescribed this drug, but its pharmacology deserves attention.
There is an excellent, extensive review in volume 66 of the November 11, 2024, Medical Letter, which also mentions its cost.
What About Gender Dysphoria?
By: Leena Gundumalla, M.D. Assistant Professor of Psychiatry University of Louisville School of Medicine
Duringmyjust-completedpsychiatric residency,Ibecame increasingly aware of transgender issues. The number of people who openly identify as having a transgender persuasion and/or being non-binary has increased sharply in recent years. Many patients are presenting to
psychiatrists with gender issues and co-morbid psychiatric conditions,so it is increasingly important for us to learn more about them. After joining faculty at the University of Louisville in July 2024, I wanted to disseminate this knowledge to a wider group of my colleagues.
Gender dysphoria and its treatments are controversial. Many states, including Kentucky, have enacted bans on gender-affirming care for minors, including puberty blockers, hormone therapy, and/or surgery. Britain's National Health Service similarly prohibited interventions with puberty blockers in cases of gender dysphoria or gender incongruence for transgender minors in March 2024. They indicate that there is "not enough evidence to support the safety or clinical effectiveness of [puberty blockers] to make the treatment routinely available at this time". The AMA, the Endocrine Society, the American Psychological Association, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Pediatrics oppose bans on puberty blockers for transgender children.
In December 2020, an Endocrine Society report stated there is evidence for a biological underpinning to gender identity and that pubertal suppression, hormone therapy, and medically-indicated surgery are effective and relatively safe when monitored appropriately. These have been established as the standard of care. There is a decrease in suicidal ideation among patients with access to gender-affirming care and less depression in cisgender, socially-transitioned pre-pubertal youth. In their 2017 intervention guideline for treating those with gender dysphoria, the Endocrine Society report states that puberty blockers can begin when a child enters puberty. They recommend cross-sex hormones initiation at age 16, but they note that there “may be compelling reasons to initiate sex hormone treatment prior to the age of 16”.
According to the World Professional Association for Transgender Health Standards of Care, psychotherapy is not currently mandated before or during biological interventions.
Psychiatrists who manage gender dysphoria care should provide assessment and therapeutic support, treat psychiatric comorbidities, and supply appropriate documentation. They must also be aware of currently issued guidelines and prohibitions.
Medical management of children/adolescents may include social transition, puberty blockers, hormone therapy, and gender-affirming surgery. GnRH agonists are used off-label as puberty blockers. These agents release a GnRH analogue that desensitizes GnRH receptorsinthepituitary gland.They inhibitluteinizingand follicle-stimulating hormone secretion, reduce gonadal steroid levels, and induce a pre-pubertal physiologic status. After suppressing puberty, adolescents may pursue hormone treatments to initiate puberty of the sex that aligns with their gender identity.
Those who did not undergo puberty blockade may be prescribed gender-affirming hormone therapy, as can adults who never received puberty blockers as adolescents. Testosterone is used for masculinizing hormone therapy, and estrogen/estradiol for feminizing therapy. Alternative gender-affirming agents include antiandrogens, such as spironolactone or cyproterone, and progestins such as medroxyprogesterone.
Masculinizing and feminizing surgical options are available. Masculinizing procedures include chest reconstruction, phalloplasty, facial procedures like forehead lengthening, cheek augmentation; reshaping the nose, chin, or jaw, and thyroid cartilage enhancement to construct an Adam’s apple. Feminizing surgery may include vaginoplasty, penectomy, orchiectomy, and facial procedures such as brow lift, cheek or jaw reshaping, diminishing an Adam’s apple, hairline restoration, and earlobe reduction.
Gender-affirming treatment has risks. Adolescents who were administered GnRH agonists may have bone density decreases. However, subsequent administration of cross-sex hormones substantially returns bone density back to age-appropriate levels. Estrogen administration increases risk for thromboses and androgens can cause erythrocytosis. Hormone therapy is likely to cause infertility. However, there are options to preserve fertility, such as testicular or ovarian tissue banking.
Gender dysphoria and its treatments are controversial; they remain politically and socially contested. There is uncertainty about the stability of gender dysphoria and concern about irreversible effects of gender-affirming treatment, especially for children. Time and further research may clarify the quality of outcomes and the safety of the current guidelines.
Guns Over Kentucky – And Beyond
By: Maureen Ryan, M.D., VA Psychiatrist Steven Lippmann, M.D.
Click ... click ... click ... click … heard over the phone line. It wasn’t marbles dropping but bulletsdropping ona table …from a gun. A patient threatening to kill himself had called me and, on my request, he was unloading his gun. He then agreed to interventions that Veterans’ healthcare staff and I provided.; one death from gun violence avertedthat day. One physician and her team members left with heart palpitations.
Many psychiatrists reading this have had a similar patient experience to this experience of gun violence. Here, I would like to discuss some steps to prevent gun violence
in the clinical setting. However, I’d also like to discuss other ideas of what psychiatrists can do outside of the clinical hours to address gun violence. I propose that beyond clinical care we can learn more about gun legislation and become advocates for gun safety. And I propose that we learn about innovations in mental health care to provide access and wellness for persons outside of our own practices. We can take what we learn and communicate this knowledge, as does my co-author Dr. Lippmann who soon is to speak publicly to address gun violence in schools.
At Veterans’ Health Care our psychiatrists routinely ask about lethal means. We encourage relocation of weapons and provide gun locks. We have same day appointments and emergency services to help those in suicidal or homicidal crisis. We also prohibit firearms on federal property. We have a “Safe at Home” group to help those at risk to commit acts of domestic violence. However, we must look beyond clinical approaches to do more to prevent gun violence.
I am prompted to write and to take other actions now because of the recent shooting deaths of five people at the Old National Bank in downtown Louisville. One young man who’d lost his job at the bank had a cache of weapons and fired them on April 10, 2023.
From psychiatrists in Kentucky, the southern US, and well beyond, our communities are asking for leadership and guidance in preventing gun violence. I wanted to do what I could and so I’ve joined a nonpartisan organization called Moms Demand Action. We wear red T-shirts with white letters. We have some men as members and there’s an affiliate group called Students Demand Action. Our groups support common sense gun laws aimed to reduce firearm carnage.
In February 2024 with Moms Demand Action, I attended a rally in our state capitol of Frankfort in support of new proposed legislation. There I learned about a proposed safe gunstorage bill(HouseBill 240)and the Crisis Aversionand Rights Retention (CARR) amendment (Senate Bill 13).
House Bill 240 would require owners to securely store weapons to prevent access by children and others. However, some gun owners will demand immediate access to their weapons. To meet this demand these persons could consider a “smart” gun. Such a gun could include facial or fingerprint recognition as safety features which restrict firearm use to the identified owner.
Beyond safe storage and use of “smart” exclusion features, there is the need to separate weapons from owners during emotional upset. Some such individuals voluntarily and often temporarily surrender their firearms to a gun shop or to a trusted friend. Yet, many in crisis lack insight and do not take initiative to relocate their firearms.
The Crisis Aversion and Rights Retention (CARR) amendment proposes mandatory but temporary transfer of weapons from people in crisis. Early, legal transfer of firearms to law enforcement storage could save lives. This proposed amendment is similar to existing “red flag” laws.
Although House Bill 240 and Senate Bill 13 may become law, legislation changes alone will not stop the epidemic of gunviolence.As psychiatrists,wearekeenly awareof many societal ills, attitudes, and/or mental health issues that escalate risk of danger.
Citizens can encourage funding increases and access to psychiatric care while destigmatizing mental illness. A return to more social connectedness and communal spirit should help in improving mental health for us all. Efforts to improve medical care access include providing telehealth and collaborative care. Peer support programs are accessible and can reduce stigma. Accessibility to mental health care remains a problem in the US and beyond.
I‘ve read about a program on the African continent which improves opportunities for care. In Zimbabwe, psychiatrist Dr. Dixon Chibanda was moved to Improve mental health access following the loss of a young patient to suicide. He developed a program which trains and supervises older community health workers (often women) to administer cognitive behavior therapies. These ladies are typically already known as respected grandmothers in the community. As facilities were lacking, Dr. Chibanda set up private “Friendship Benches” where a client and community worker could meet. His associated research in 2016 evidenced better symptom reduction in the clients who met with these trained community workers (as compared to those who met with nurses administering conventional psychoeducational treatment).
In the USA students have been coping with numerous stressors and need help with emotional regulation. The David Lynch Foundation, which promotes transcendental meditation, has established daily quiet times of 15 minutes in some school districts. Students are not required to meditate during quiet time but can opt to learn the methodology. The Foundation’s studies document improved interpersonal relationships and less anxiety and/or depressive symptoms. Hopefully this results in better health and safety.
My colleagues may agree with me that many acts of gun violence are not related to mental illness at all. These acts may take place due to lack of respect for life, the desire for revenge and other motivations. I think more support of families and schools is needed in teaching prosocial values.
Dr. Lippman, who co-authored this paper describes his involvement in this issue of gun violence here: I (SL) joined Dr. Ryan in preparing this paper because of concerns about gun violence in the USA during recent times. Growing up in Texas during the 1940s / 1950s, rifles were practically ubiquitous, and I obtained a National Rifle
Association marksmanship achievement award as a teenager. However, my parents did not believe in firearm possession, partly because being of 1930s European immigrant status.
Gun violence became an interest during my faculty years because of the rising incidence of shootings in this country during the last two decades. Firearm-related suicidal and homicidal issues were sad, but not rare events in my practice. I have been active in gun-violence research, oral presentations, and publication. Most of my collaborators were psychiatrists, emergency medicine doctors, or generalists. I am currently invited by a surgeon colleague from the University of Louisville School of Medicine to present a talk discussing school shootings in early 2025.
Education and dialectic about the issue of gun violence is the beginning. Opinions vary, but we can find common groundnomatterwhatourpoliticalaffiliations are.Principle 7 of our AMA code of ethics asks physicians to contribute to the improvement of our community and the betterment of public health. Please join us in promoting more discussions and more actions to help eradicate the tragedy of gun violence.
CREATINE … A Nutritional Supplement?
By: Sabrina Sivaraman, M.D., Clinical Extern Physician Steven Lippmann, M.D.
Taking creatine to augment exercise and health has attracted the attention of numerous young people and athletes. Many of them express interest in gaining muscle mass and/or enhancing their physical performance.Creatine,anaminoacid,is naturallypresent in red meat and seafood. It prompts enhanced energy output, especially during strength training. This consequently stimulates muscle growth.
I (S.S.) became interested in how creatine was being used as a supplement after witnessing its popularity among young adults, including my own brother. Many people, especially the younger ones, may decide to take a supplement based on the information they receive by wordof mouth orsocial media, and Idesired to learnmore about this substance to better understand its safety. I felt itwas especially importanttoinformmycolleagues sothat they can understand more about the short and/or long duration risks and benefits of creatine ingestion.
The majority of creatine is stored in muscle, in the phosphorylated form known as phosphocreatine, as well as free creatine. Together, they function to aid in replenishing adenosine triphosphate (ATP) levels while minimizing adenosine diphosphate (ADP) concentrations. This is the main mechanism by which creatine has a role
in metabolism and contributes to increasing stamina. Note: ADP is less metabolically active.
Creatine supplementation increasingly became a topic of interest after being used in the Barcelona Olympic Games, and several dosing schedules have been tested since 1992. Among the multiple administration regimens performed, all documented an increased level of muscle creatine stores that enhanced performance. However, research protocols for creatine administration were inconsistently implemented.
Nevertheless, the effects of creatine supplementation may vary depending on the individual. Of those taking it, 20-30% do not demonstrate a noticeable response. This may be because the key factor influencing creatine levels after supplementation is a person’s baseline quantities of creatine. People may safely benefit from ingesting creatine. To improve performance, elevated creatine stores can enable an individual to increase maximum effort during various exercises, such as in sprinting, as well as to shorten recovery times.
Although most research has been performed on men, the ergogenic effects of creatine have also been observed among varied demographics, including elderly women. Creatine, along with physical training, can improve the ability of women to perform daily physical activities even into their seventh decade.
Beyond its use in sports, it potentially may provide a number of health benefits. Reportedly, it may diminish adverse cardiac and/or cerebrovascular events by improving lipid and carbohydrate metabolism. It even might also enhance immunity, retard some malignancies, diminish inflammation, improve brain function, and/or promote psychological well-being.
Safety remains a concern over short and/or long-term effects of creatine supplementation. Several more brief experiments involving people from young adulthood through geriatric age groups have not documented illeffects. However, the lack of prolonged studies indicates that the safety profile remains inconclusive. Despite this, the International Society of Sports Nutrition has declared that creatine supplementation is safe for most healthy people.
The answer to the question of whether creatine should be used as a nutritional supplement may depend on the individual. As the long-term effects of creatine are unknown, it may be best to exercise caution in its application as a long-term supplement. However, its use is permitted by the International Olympic Committee, and there are numerous studies demonstrating its ability to aid competitive athletes. This may further support its benefits as a short-term supplement before competitions.
FENTANYL: Illicit Origins & Fatal Economics
More Commonly Used than Heroin
By: Christian Flynn, M.S., Senior Medical Student, Courtney Eaves, D.O., & Steven Lippmann, M.D.
As a senior medical student on the Substance Use Disorder Service (SUDS) team at the University of Louisville Hospital, I personally witnessed the devastating impact of fentanyl overdoses, with many people unknowingly consuming it while intending to use heroin or other opiates. This sparked my interest in why it has become so prevalent, the economics of illicit drugs, and fentanyl’s role in the ongoing opioid crisis.
Fentanyl is a synthetic opioid 50 times more potent than heroin.Its ascendancy over heroin inthe illicit drug market is attributed to its higher potency, lower cost, and easier production. It is alarmingly more dangerous following an overdose. This risk is compounded when someone consumes substances laced with fentanyl, as it is tasteless, odorless, and even a minuscule amount –about the size of a grain of rice – can be fatal.
According to the National Center for Health Statistics in 2022, Kentucky had the 7th highest per capita death rate from drug overdoses. Opioids were involved in 90%. Fentanyl was the most prevalent drug contributing to these deaths. It accounted for nearly 73% of overdose deaths in the U.S A that year. Methamphetamine frequently contributed to its toxicity.
Since 1999, opioid-related deaths have surged, evolving through three major increases. Initially, deaths were primarily linked to prescription opioids in the early 2000s, followed by a rise in heroin-related fatalities around 2016. The third wave has been dominated by fentanyl, which has induced a dramatic rise in deaths since 2019. There are several fentanyl analogs, ‘fentalogs – including alfentanil, remifentanil, sufentanil, furanylfentanyl, and carfentanil – which are up to 100 times more potent than it is. Despite declines in overdose deaths from prescription opioids and heroin, fatalities from fentanyl continue to rise
A potential 'fourth wave' began in 2021, characterized by the frequent co-occurrence of stimulants like cocaine and methamphetamine in fentanyl-related overdoses. This introduces complex health risks and new challenges at intervention. The medical community has less experience in managing the complexities of combined opioid and stimulant use, or the effects of mixing opioids with other drugs. This complicates medical stabilization efforts for individuals withdrawing from multiple substances.
Fentanyl overdoses typically kill by disrupting the brain's feedback mechanism that is supposed to induce respiratory drive in response to elevated CO2 levels. Intravenous fentanyl concentrations peak within minutes,
but substantial accumulation can occur with a single large dose or repeated dosing, extending its duration of effect. The lipophilic nature of fentanyl results in rapid association with – and dissociation from – receptor sites into the bloodstream, yet its action lasts only about 30-60 minutes significantly shorter – and more dangerous –than heroin's 4-5 hours. Following a heroin overdose, there exist about 20-30 minutes to administer naloxone and reverse the drug effects. However, this timing diminishes to just 2-3 minutes during a fentanyl overdose often,too brief to intervenebefore the onset of hypoxia. The narrow “therapeutic index” of fentanyl means that even slight increases in dosage can significantly hamper respiratory function.
Expanded fentanyl use may be more supply-driven than user-determined, due to heroin shortages, changes in prescription opioid availability, lower costs, and risks for suppliers.Thistrendis also exacerbatedbyfentanylbeing deceptively marketed, i.e., labeled as being some other drug.
The synthetic nature of fentanyl allows for production in small, concealed laboratories, making manufacturing more lucrative than for heroin, which requires poppy cultivation. It also yields higher profits. For instance, one kg can sell for about $1.6 million, in contrast to heroin’s value of a few hundred thousand.
China is the leading exporter of fentanyl, providing a substantial portion of the U.S. opioid market. The Yuancheng pharmaceutical company, for example, sources us with large volumes of it. Chinese authorities have thus far not diminished supplies. Chemists frequently modify the drug’s molecular structure to evade legal controls with new, unregulated analogs having unpredictable, even potentially lethal, effects. It is most often trafficked through Mexico and Canada, presenting law enforcement challenges due to the volume and logistics at detection. Utilization of the “dark web” and cryptocurrencies further complicates interception. Unlike the violence associated with the South American drug trade, the Chinese fentanyl market benefits from stringently limited gun availability and discreet, profitdriven operations.
Mexican cartels frequently adulterate fentanyl with stabilizers and chemicals to increase volume and profits. These operations are conducted without pharmaceutical regulation, sterilization, and/or properly calibrated equipment. Even minor errors in measuring such a potent substance might result in a fatal dose, evidencing the dangers of non-controlled handling.
Fentanyl presents a serious public health challenge. Its illicit origins, economic allure, and devastating potency have made it more dangerous than heroin. We need innovative medical strategies and regulatory measures to combat this evolving threat.
Whooping Cough Outbreak
By: Mercy Gohil, M.B.B.S., M.S.H.A., Clinical Research Assistant, Norton Healthcare Steven Lippmann, M.D.
I am Mercy Gohil, a physician with multicultural exposure and fluency in 3 languages – Hindi, Gujarati, and English. I moved to the United States in 2021 to pursue my desire to learn about U.S. healthcare systems and the business side of Medicine. I graduated in May 2023 with a Master of Health Administration degree from the University of Louisville and am a Clinical Research Assistant at Norton Cancer Institute. My investigations focus on phase one clinical trials.
I also volunteer at Louisville's Family Community Clinic, where I met Dr. Steven Lippmann. Through him, I joined his writing seminar. There, news about a pertussis outbreak in Kentucky was being reviewed by this team; we often discuss many such events. Resurgence of this otherwise preventable illness is related to the rising number of people refusing the whooping cough vaccination. The infection rate has now sadly risen all over the USA, as “herd immunity” has declined.
Pertussis had been largely forgotten, thanks to effective vaccine campaigns. However, nowadays some healthcare personnel may not recognize its manifestations. The public is less fully-immunized. That can be dangerous, especially for infants and people with compromised immune systems. As a new physician, hopefully joining the U.S. medical system, I wanted to disseminate information to a wider group of physicians. It’s important for us all to learn about pertussis. Also, during this time of vaccine refusal and misinformation, it is critical to counter erroneous immunological mythology. We all need to know and to teach about the facts; hopefully this will boost protection for the good of everyone.
The Kentucky whooping cough epidemic shows that low vaccination rates can cause outbreaks. This understanding can help psychiatrists handle their patients’ concerns like access and cost. Asking patients about vaccine compliance at regular appointments is crucial.
The Kentucky Cabinet for Health and Family Services announced that whooping cough, also known as pertussis, is increasing at an alarming rate in Kentucky in 2024. There were 130 documented cases recorded through July. In recent years, whooping cough has been less common, with a median number of 42 cases annually in 2020-2023.
This rise was first noted in Lexington school children. There were two students affected in late April, followed by 7 more in May. The health department alerted parents, caregivers, school officials, and healthcare providers
about the manifestations of pertussis. People who are unvaccinated or immunocompromised contract it at an increased rate. Currently, patients with whooping cough include infants, school-aged children, and adults
Whooping cough is a respiratory bacterial infection caused by Bordetella pertussis. It was a leading cause of childhood illness and death before its vaccine was invented. The vaccine was effective in reducing the incidence significantly in the 1970s. Infants and old people are not the only ones affected. The bacteria spreads when people inhale droplets in the air.
Following an incubation period of 8-10 days, the illness starts with flu-like symptoms for 1-2 weeks – with fever, runny nose, and/or cough. This is followed by paroxysms of uncontrolled coughing. These episodes may end with a whooping sound and vomiting. Infected persons often suffer with insomnia, dyspnea, and/or fatigue.Infants can also experience serious complications like pneumonia, apnea, and/or dehydration. DTaP vaccine (diphtheria, tetanus, and acellular pertussis) is indicated for babies and even preteens and adults who are unvaccinated. The usual schedule for vaccinating babies is at two months, 4 months, 6 months, and 12-15 months. It is also recommended for already-vaccinated women during the 27th to 36th week of each pregnancy.
Pertussis outbreaks are usually due to reduced vaccination rates among children. After the COVID-19 pandemic, lots of false information circulated about immunizations being dangerous. In 2022, the World Health Organization reported a worldwide drop in all childhood vaccination frequencies over the past three decades.
The risk of pertussis spread can be reduced by timely immunization. Protective universal precautionary measures also include isolating, soap-and-water hand washing, and/or covering one’s face while coughing and/or sneezing. Though whooping cough can occur anytime during the year, summer and fall are the peak seasons. For self-protection, people should promptly address early symptoms and quickly secure an appointment for proper medical treatment, instead of taking non-prescribed, over-the-counter therapies.
She specializes in General Adult inpatient psychiatry as well as Child and Adolescent psychiatry, and she is board-certified in both. Dr. Littlewood is particularly interested in the acute treatment of serious mental illness, especially in transitional age youth and young adults. She is the Medical Director for the adult inpatient psychiatric units at UMMC Midtown Campus. She is also a member of the Maryland State Board of Physicians.
Dr. Daphne Glindmeyer is a graduate of the Louisiana State University Health Sciences Center, where she completed a residency in Adult Psychiatry, a fellowship in Child and Adolescent Psychiatry, and a fellowship in Forensic Psychiatry. She is a Distinguished Fellow of the APA, past President of the Louisiana Psychiatric Medical Association, and past President of the Louisiana Council on Child and Adolescent Psychiatry.
She is currently in private practice, providing psychiatric evaluation and medication management services to child, adolescent, and adult patients, as well as doing forensic consultations. In addition, she is interested in equineassisted psychotherapy, western dressage riding, and LSU Tiger football.
Dr. Alden Littlewood received her medical degree at LSU School of Medicine in New Orleans. She completed an internship in Internal Medicine at Ochsner Clinic Foundation in Jefferson, LA, and her adult psychiatry residency at the LSU New Orleans/Ochsner joint program. She then completed a fellowship in Child and Adolescent Psychiatry at the University of Maryland/ Sheppard Pratt.
Dr. Audrey Summers currently serves as Assistant Professor in the Department of Psychiatry at the University of Louisville. She is the director of the Psychiatric Consult-Liaison Service at the University of Louisville Hospital and the director of the Women’s Mental Health Clinic at its Outpatient Center.
She completed her undergraduate education at the U of L with a degree in molecular biology and obtained her MD there in 2020. She completed her psychiatric residency including the time she served as Chief Resident – there in 2024.
She has published and presented on topics related to reproductive mental health at a regional and national level. She is also involved in the education of medical students and resident physicians. In addition to her clinical work, she is involved with organizations including the Kentucky Psychiatric Medical Association and the Greater Louisville Medical Society.
Dr. Kathy M. Vincent is Professor and Vice Chair of EducationintheDepartmentofPsychiatry and Behavioral Sciences, University of Louisville. A life-long Louisvillian, shereceivedherBachelors andMastersdegreesfromthe University of Louisville, before she completed medical school and psychiatry residency there as well.
Her academic career has focused on education and training, and her former role as residency training director connected her with many professional organizations over the years. She interacts with trainees as a clinical supervisor and a psychotherapy supervisor on various sites within the Department. Dr. Vincent looks forward to joining friends and colleagues in the Southern as she continues her journey in lifelong learning.
IN MEMORIAM: FRANCIS CLEVELAND KINNEY, MD
By: Bruce Hershfield, MD
Dr. Cleve Kinney, who joined the SPA in 2013 died around the end of November.
Born in Maine in 1945, he attended Birmingham-Southern College, then served in the US Navy in Norway. He returned to Alabama and got a PhD in anatomy at UAB. He taught for 5 years, then entered med school at the University of Alabama. He did a psychiatric residency and a geriatric psychiatry fellowship there, then remained on its faculty for many years. Besides being Director of Geriatric Psychiatry for many years, he was interim Chair of Psychiatry for 5 years and Senior Assistant Dean of Medicine for two years. In 2007 an endowed Chair in Geriatric Psychiatry was established in his name.
He served as Chair of the Jefferson County Board of Health in 2010 and was President of the Jefferson County Medical Society in 2015.
Dr. Kinney received Distinguished Alumnus Awards from both Birmingham-Southern College and the University of Alabama Alumni Association. In addition, he served as a Trustee of the Birmingham Historical Society.
LETTER from the EDITOR:
What Has 6 or More Legs & No Brain?
By: Bruce Hershfield, MD
It’s an old riddle. The answer, of course, is a committee.
But that is just ajoke.I canthink ofa couple of good works done by committees like the King James version of the Bible and the Declaration of Independence. Those should be good enough.
The SPA has multiple committees: Program, Financial, Long-Range Planning, Nominating, Constitution & Bylaws, and the Resident Research Award, plus the Editorial Advisory Board of Southlands and the New Member Task Force. Also, our Council meets in-person twice per year and by video as needed. Some of these are functioning very well in particular, the Program Committee.
I would like to see them function better. One way would be to add new members. I think it’s important to ask all new members if they would like to serve. That’s because it would help them to get to know everyone and because we tend to value those organizations that ask us to do something. PeoplewhoarealreadymembersoftheSPA should be encouraged to join one or more, too. Of course, if everyone decides to join one or more, that could create a new problem, but I bet we could figure out a way to handle that
The SPA is also forming a Task Force to report back to the Council about how we can get more folks to attend our annual meetings. I thought the one in Chattanooga was wonderful, but only 68 people attended. I understand this is part of a long-range trend that is affecting all sorts of organizations. But it’s particularly important that our members attend so that they develop the relationships that make the SPA so special.
As Franklin commented about the American Revolution, we can all hang together or we can hang separately. I suggest we hang together. Constructing a more vibrant system of functioning committees that encourages more folks to get involved would really help.
SPA OFFICERS 2024-2025
President: Rodney Poling, MD
President-Elect: Raymond Kotwicki, MD
Vice President: Mark Wright, MD
Secretary-Treasurer: Jenny Boyer, MD
Board of Regents, Chair: Chasity Torrence, MD
Board of Regents, 2nd Year: Rahn Bailey, MD
Board of Regents, 1st Year: Phil Scurria, MD
APA Assembly Representative: Felix Torres, MD
Immediate Past President: Mary Jo Fitz-Gerald, MD
Executive Director: Janet Bryan
“Southlands” articles represent the views of the authors and are not official positions of the Southern Psychiatric Association. Comments and Letters to the Editor are welcome and should be addressed to the Editor at BHershfiel@aol.com
(BruceHershfield,MD,1415Cold BottomRd, Sparks,MD 21152)
“SOUTHLANDS” EDITORIAL ADVISORY BOARD
Steven Lippmann, MD
Jessica Merkel-Keller, MD
Denis J. Milke, MD
Larry Miller, MD
Editor: Bruce Hershfield, MD
Assistant Editor: Janet Bryan
Save the Date – 2025 Annual Meeting In Collaboration with Mississippi Psychiatric Association
August 20 – 23, 2025 Golden Nugget Biloxi Hotel & Casino
