BrainStorms Q4 2019

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Q4 | 2019

Quarterly Publication of the University of Miami Department of Psychiatry and Behavioral Sciences

In This Edition: Teaching Children to Balance Gifts and Gratitude Preservation, Moderation, Preparation: Staying Calm Amidst Holiday Chaos New Adult Mental Health Program to Launch in 2020

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A Message from the Interim Chairman

ear Friends,

When I look back at 2019, I am filled with gratitude and pride. I am honored for the opportunity to lead this incredible department and delighted to share the outstanding accomplishments our divisions have achieved.

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Our faculty, staff, and residents all devote an incredible amount of time and energy to ensuring our community and beyond receive the care they need. I am privileged to work with these extraordinary individuals who consistently go above and beyond the call of duty. We are exceptionally fortunate to have them as part of the U. Some highlights from 2019 include: the UHealth Tics, OCD and Related Problems Program being designated a Center of Excellence; more than $12M in new grants awarded; faculty published dozens of articles in high impact journals including Neurology, Nature Communications, Personalized Medicine in Psychiatry, American Journal of Psychiatry, Aging Cell, and more; and we’ve welcomed 20 new members to the Department!

Our Center for Cognitive Neuroscience and Aging has flourished. A year-and-a-half in, they’ve already been awarded millions in funding, welcomed several new members to the expanding Center, and are taking on an enhanced role in the NIA-funded 1Florida Alzheimer’s Disease Research Center.

I’m pleased to announce that in early 2020, we’ll be launching the UHealth Therapeutic 2 | BrainStorms | Q4 | 2019

Program for Adult Suicide Prevention. A year in development, the program combines evidence-based techniques to create and administer a personalized treatment plan for each individual participating in the program. It is geared towards adults 44 and older, a population in which suicide continues to rise. We are proud to be implementing another initiative to combat the unrelenting epidemic of suicide in the U.S. More information can be found on page 5.

As we enter an election year, I think we can agree that healthcare—especially for mental health disorders—is an important issue to watch closely. You can help keep the conversation going by reaching out to your state representatives and policymakers and urging them to support mental health legislation. All the information you need can be found on www.house.gov.

Thank you for your meaningful support throughout 2019. Wishing you a happy, healthy holiday season and joyous new year.

Radu

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This Holiday Season, Give the Gift of Balance | By Nicole Mavrides, MD s the gift-giving holidays approach, many children and teens are hoping that they receive the newest and best that technology has to offer. As a result, parents may worry that by giving their child another screen or piece of technology, they are, in fact, contributing to the massive amount of daily screen time many children/teens are already using.

According to one study, teens between 13-18 years of age are currently spending an average of seven hours and 22 minutes per day on screens. This time does not include home or schoolwork.

With this knowledge, it is reasonable for parents to question the merit of bringing even more screens and technology into the house even when they are at the top of their children’s wish lists.

Many parents question how to balance their child's holiday wishes without encouraging an increase in the amount of time that they are already spending on their phones. They are asking for advice on ways to motivate their teens to become more involved in the family.

Others simply want help in limiting their teen’s phone time.

In this digital age, it’s unrealistic to cut off screen time altogether. However,

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boundaries can be enforced. Time limits should be set, monitored and divided into short time blocks. As parents, it is our responsibility to guide our teens to choose individual programs to watch instead of endlessly streaming videos on their devices. It is also critical to establish a designated “No Screen Time” for all family members, including adults.

Suggestions for “No Screen Time” may include family mealtimes like dinner or breakfast. Without competing with social media and screens, family conversations will begin to evolve. Planning family game nights, special holiday meals and outings, like looking at holiday lights, can facilitate bonding. These family activities cannot include screens without minimizing their importance.

So should parents ignore their kids’ iPad, iPhone, screen requests and declare it a tech free holiday? No, we don’t need to be that extreme. Our children and teens need access to computers, phones, and iPads for both schoolwork and for connecting with friends. We can embrace the gift requests as long as an understanding has been established between parents and kids as to time and appropriate places for screen usage.

The World Health Organization and the American Academy of Pediatrics advocate for zero screen time for children under two years old and only an hour a day for those between two and five years of age with high-quality programs. For children older than six, we need to have consistent screen limits to establish a healthy balance between/media, sleep, exercise, being with family and friends, and extracurricular activities. Interestingly, it has been established that children who excessively use electronics are more likely to have poorer grades, read fewer books, exercise less, and become overweight as compared with kids who do not engage in too much screen time.

It is the parents’ job to guide his/her child on how to use screens appropriately in order to learn and to create as well as to encourage connections with people and to build healthy exercise regimens.

A good rule of thumb for this holiday season may be to emphasize the importance of family time, friendships, gratitude and kindness, while acknowledging and respecting the advantages of electronics.

Happy Holidays!

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Dr. Rosie Curiel Cid Touches Down in Spain to Speak at Spanish Society of Neurology’s Annual Meeting osie Curiel Cid, PsyD, recently traveled to Sevilla, Spain where she was invited to give a lecture in the Plenary Session of the LXXI Annual Meeting of the Spanish Society of Neurology (SEN). The Plenary Session is one of the most distinguished scientific events of the SEN. The lecture is offered in honor of Dr. Antonio Subirana Oller (1903-1992), a prominent neurologist from Barcelona, Spain and a founding member of the Spanish Association of Neurology, where he served as president.

Dr. Curiel Cid’s lecture was titled Novel Cognitive Paradigms for the Detection of Preclinical Alzheimer’s Disease. The lecture focused on presenting the latest data about novel cognitive paradigms such as the LASSI-L,® developed at the CNSA, and their association to early brain biomarkers of preclinical and prodromal Alzheimer’s disease and related dementias. Notably, Dr. Curiel Cid also presented the work that was carried out in collaboration with our colleagues at Complutense University of Madrid—which validated these paradigms for use in a Spanish population.

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top photo: Dr. Curiel Cid with her collaborators, neurologists from the Complutense University of Madrid/Hospital Clínico San Carlos. L-R: Jorge Matias-Guiu, MD, Dr. Rosie Curiel Cid, PsyD, Jordi Matias-Guiu Antem, MD and Vanessa Pytel, MD.

Hundreds of neurologists, neuropsychologists and neuroscientists from all over the world attended the session.

The Loewenstein-Acevedo Scales for Semantic Interference and Learning, or LASSI-L®, is a cognitive stress test akin to an exercise electrocardiogram. It is highly related to biological AD changes in the brain before the emergence of clinical symptoms such as amyloid load, fMRI functional connectivity, and loss of volume and cortical thickness in the brain. Early detection leads to a better

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understanding of the pathogenesis of AD, preventive and earlier interventions, and helps more effectively assess who many benefit from these newer interventions.

Dr. Curiel Cid is a geriatric neuropsychol ogist and currently serves as the Chief of Cross-cultural Neuropsychology at UM’s Center for Cognitive Neuroscience and Aging (CNSA). Her research focuses on Alzheimer’s disease and related disorders,

particularly identifying new ways to assess cognitive processes (memory, executive functions) that are sensitive to detecting subtle neurodegeneration and developing computerized instruments that can reliably measure these changes.

In 2018, Dr. Curiel Cid received a $3M NIH R01 grant for her research making her the youngest Hispanic female ever to receive this prestigious award at UM.

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Launching in 2020: The UHealth Therapeutic Program for Adult Suicide Prevention

hanks to the Fields Galley Private Foundation, we are thrilled to announce that in 2020 we will launch The UHealth Therapeutic Program for Adult Suicide Prevention.

Recent data shows that more than 47,000 Americans over age 18 take their own lives each year. It is the only top 10 cause of death in the U.S. that is rising; it has become a public health crisis, and the Department is committed to doing everything we can to fight it.

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“I am excited to be leading this suicide prevention program for adults. Unfortunately, suicide still ranks as the tenth leading cause of death in the U.S. and we must take critical measures to change that. I am so grateful to the Fields Galley Private Foundation for trusting us to develop this program and funding this important cause.”

—Dr. Ingrid Barrera, Program Director

The program will combine evidencebased therapies including Dialectical Behavioral Therapy (DBT) and Cognitive Behavioral Therapy (CBT). Together, these treatments have proven to reduce the risk of suicide among patients with suicidal ideations and/or thoughts. It is imperative the therapies are administered by a trained professional to an appropriate candidate for treatment, and Program Director Dr. Ingrid Barrera has spent the last year assembling an expert team.

To help address the rising suicide rate among the adult population, the program is aimed specifically at those age 44 and older. A core component of the program involves teaching skills that help the individual regulate, tolerate and label their emotions, resulting in their ability to help eliminate suicidal thoughts and reduce the risk for attempts. It requires a minimum six-month commitment that includes both individual and group therapy.

Each patient receives personalized treatment based on his or her behaviors and works with the therapist until their goals are achieved. The Department is proud to be able to offer this new program and utilize the skills of our

43 million

10 million

Americans age 18 and older suffers from a diagnosable mental disorder in a given year

of these people experience suicidal ideation

Suicide costs the U.S.

$69 million annually

“In 1986 my father committed suicide at only 63 years old. It was devastating.

Sharon and I are hoping that this new program will prevent others from reaching the level of depression that my father experienced, and save their loved ones from the pain that my mother and I have had to live with. It is truly our belief that if this program prevents just one suicide, its value is immeasurable.”

—Nat Galley Fields and Sharon Hartman, Trustees, The Fields Galley Private Foundation

mental health professionals in such an important area.

Private gifts in support of initiatives such as this are crucial to advancing treatments for those struggling with mental illness and putting an end to a tragic public health crisis. The Department is grateful to The Fields Galley Private Foundation for their generosity and dedication to suicide prevention.

If you or someone you know might be a candidate for the program, please email Samantha Richter at sfr30@med.miami.edu or call 305.243.7452.

One person dies by suicide every three hours in Florida

It is the

fifth leading cause of death for people ages 45-54 in Florida

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Stay Calm and Carry On! | Dr. Phil Harvey he holiday season is upon us, starting with Thanksgiving last week and continuing through the end of the month of December. Although this is supposed to be the ‘most wonderful time of the year’, it can be stressful for everyone and depressing for others.

Let’s start with stress. Although it is fantastic to give and receive gifts, for many the process poses challenges to both time and money. Although shopping is easier than ever and for many Black Friday is now a virtual experience, it is still challenging to get the right gift for everyone. It can also be a problem for some people to be able to pay for things that others expect (or that you think that they expect).

Another form of stress is disruption of routines. Although it may be nice to cook dinner for 20 of your relatives, shopping, cooking, and clean-up takes a significant amount of time. If you are working up until Christmas Eve, the time has to come out of other parts of calendar.

Often this means missing the gym or

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echnology is constantly changing and everyday tasks are more technology-driven than ever before. Almost everything we do now requires the use of some type of technology, and this trend will continue. Keeping up with these constant changes can be challenging but is essential to function in today’s world.

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For some, it will be easier than for others. Aging individuals or those with compromised cognition may struggle to adjust in a technology-dominated world, where activities once done face-to-face are now completed through an app on a computer or mobile device. Important tasks like refilling prescriptions, paying bills, purchasing travel tickets, and even grocery shopping can now be done with a few touches and swipes on an iPad and have actually become more challenging to perform in person. Learning how to

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your other physical activities. Given the combination of calorie overload and physical activity reduction, it is no wonder that people gain weight and gyms sell more memberships in January than any other month.

How do you keep your body and mind in shape over the holidays? There are several different things you can do.

1. Preservation. Preserve your routine to the extent that you can. Even if you can’t get to the gym, you can walk.

The weather in South Florida will not be causing the problems seen in the midwest or northeast. You can put food in the oven and walk the dog for 30 minutes. engage with a digitized universe will be essential for the aging population if they want to maintain their independence.

Dr. Phil Harvey explains, “Our team has been studying cognition in older adults for years. We recognized there was an absence of any meaningful, affordable and evidence-based mechanism for teaching these individuals how to adapt to changing real-world scenarios, so we built our own. Our team of psychologists, psychiatrists, engineers, tech gurus, and

2. Moderation. Maintaining moderation is important. While you don’t want to completely avoid desserts, snacks, and drinks, keeping the portions reasonable is a key part of the plan.

3. Preparation. If you can plan ahead to avoid the breakneck rush at the last minute, your life will be less stressful. Doing as much of your shopping online as possible will be a real help. Also, making sure that when order the gifts you order the giftwrap will keep you out of CVS at 11 p.m. on Christmas Eve. Finally, we need to make sure that people who do not have family or friends around are taken care of. If you can’t see your relatives, you can call or FaceTime them. It will make them (and you) feel good, and is an excellent guilt reduction strategy for those unable to travel or be together over the holidays.

Phil Harvey, PhD is the chief of the division of psychology.

CEOs have each lent their expertise to developing a product called i-Function.” i-Function is an evidence and technology based functional skills assessment and training platform. The platform offers technology-based training exercises targeting critical everyday skills that can be challenging to aging individuals and those with compromised cognition.

“Initial results from our study of 100 older individuals, half of whom had evidence of mild cognitive impairment (MCI), show that the majority of them were able to master the six different tasks completely and both people with normal cognition and MCI doubled in their efficiency with training. We just heard that our new grant to expand our study and upgrade the technology is likely to be funded and we’re excited about offering this platform that holds life-changing prospects for our aging population.” For more information, visit http://www.i-function.com/

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Members of the Division of Child and Adolescent Psychiatry Attend 66th Annual AACAP Meeting, Dr. Barbara Coffey Honored

his year marked the 66th Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP). We were thrilled to have UM attendees represent our Child and Adolescent Psychiatry program, including Division Chief Dr. Barbara Coffey, who was presented with the Virginia Q. Anthony Outstanding Woman Leader Award! The award recognizes her exemplary career and contributions to the mental health field as a child and adolescent psychiatrist.

Dr. Coffey, Maria Cruz, Research Assistant (UM), Cynthia Fundora, Research Associate (UM), Irene Malaty, MD, Director of Tourette Syndrome Clinic (UF), and Diana Shineman, PhD, VP, Research and Medical Programs (TAA) collaborated on an abstract and poster presentation, Suicidal Ideation/ Self-Harm in Children and Adolescents with Tic Disorders. Using data from a survey conducted by the Tourette Association of America (TAA) in 2018, they aimed to examine the suicidal ideation/self-harm rate among children with tic disorders and explore the impact of associated risk factors.

According to the 567 parent-reported responses, children with tic disorders

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Dr. Barbara Coffey, Chief, Division of Child and Adolescent Psychiatry, accepting the Virginia Q. Anthony Outstanding Woman Leader Award with Dr. Karen Wagner, President of AACAP. Photo: Dr. Fred Seligman

have an alarmingly high rate of suicidal ideation/self-harm. Rates of discrimination and negative school impact were high across children with tic disorders, and those with a history of suicidal ideation/self-harm had a reported 20% augmented rate.

Psychiatric comorbidities were deemed the most challenging factor in tic disorder management and influenced suicidal ideation/self-harm. Overall, children with tic disorders experience an elevated rate of risk factors associated with suicidal ideation/self-harm.

Maria Cruz, Cynthia Fundora Trujillo, Dr. Coffey and PGY-2 resident Dr. Valentina Metsavaht Cara.

Dr. Gregory Fritz, Professor Emeritus of Psychiatry, Brown University and past President of AACAP with Dr. Fred Seligman, Voluntary Faculty UM. Photo: Dr. Fred Seligman

Our team is currently conducting analyses on the adult survey data. With the adult and child analyses combined, we aim to shine more light on the staggering suicidality/self-harm rates found across all age groups in the tic disorder population.

At the UHealth Tics, OCD, & Related Problems TAA Centerof Excellence, we are always accepting new patients and participating in novel research to help patients combat the factors that place them at risk. If you know of anyone that may be interested in participating in a research study about tics and Tourette Syndrome, please contact 305.243.6489.

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Events UM Consultation-Liaison Team Gives Five Presentations at ACLP’s Annual Meeting In November, the Academy of Consultation-Liaison Psychiatry (ACLP) hosted its annual meeting in San Diego, CA. This year’s theme was The Future of the Subspecialty, designed to highlight topics related to new clinical developments, medications, treatments, technology, research and education.

The Department was well-represented, attended by our own CL team including Maria Rueda Lara, MD, Zelde Espinel, MD, Lujain Alhajji, MD and Vanessa Padilla, MD; residents Cody Bryant, MD, Fred Jones-Rosa, MD, Maria Hadjikyriakou, MD, and Natalie Martinez Sosa, MD; and fellows Mitchell Rovner, MD and Amalia Martinez, MD. The team presented three posters, one oral paper and one symposium,

Drs. Cody Bryant, Vanessa Padilla, Amalia Martinez, Lujain Alhajji, and Fred Jones-Rosa. All University of Miami.

covering a variety of topics including: collaborative care in human trafficking, psycho-oncology, disaster psychiatry, and medication-induced mania in ulcerative colitis.

Our Consultation-Liaison Psychiatry division is dedicated to the psychiatric care of medical and surgical patients who develop neuropsychiatric manifestations of their medical illness, as well as exacerbation of a pre-existing psychiatric conditions.

Drs. Jennifer Knight, Medical College of Wisconsin, Maria Rueda-Lara, UHealth, Sylvester Comprehensive Cancer Center, Hermioni L. Amonoo, Brigham and Women’s Hospital, and Sheila Lahihani, Stanford Cancer Center.

Drs. Durand, Pani Sit on International Advisory Board in Europe, Ahead of New Drug Launch Recently, Dr. Dante Durand, Director of Clinical Services and Associate Professor of Psychiatry, and Dr. Luca Pani, Professor of Psychiatry, traveled to Rome, Italy to participate in the Otsuka/Lundbeck International Advisory Board. Dr. Pani was asked to assemble and chair the board to transfer the US and Canadian experience with Brexpiprazole to Italian and Spanish senior psychiatrists in light of the foreseen launch of this molecule in these countries. Brexpiprazol is an antipsychotic that was developed for use in the treatment of schizophrenia and supplementary treatment of Major Depressive Disorder.

Dr. Durand provided clinical insights regarding his experience with Brexpiprazole to the Board’s Italian and Spanish colleagues before the launch of this novel antipsychotic in Italy and Spain next year. He also exchanged his clinical experience with colleagues from Canada and the USA to provide a patient profile that could benefit from Brexpiprazole.

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Drs. Luca Pani and Dante Durand

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Perinatal Program Assists Women Experiencing Mental Health Challenges Related to Pregnancy | By Richard Westlund

or women who face feelings of depression or anxiety related to pregnancy, the University of Miami Miller School of Medicine’s Psychiatric Clinic offers a specialized Perinatal Program to address those challenges.

“Pregnancy can be a wonderful time, but it can also trigger other issues,” said Nicole Mavrides, M., assistant professor, Department of Psychiatry & Behavioral Sciences. “We use evidence-based treatments to help women at all stages of pregnancy, including post-partum depression.”

Dr. Mavrides directs the Perinatal Program clinics with Vanessa Padilla, MD, assistant professor. Services are available on Tuesday and Wednesday afternoons, and the program accepts most types of insurance.

“Our expert physicians offer initial diagnostic evaluations, second opinions,

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and medication management for mood and anxiety disorders,” said Dr. Mavrides.

“As an academic site for teaching and training future psychiatrists, our specialty clinic provides access to advanced psychiatric treatment and care.”

The Perinatal Program team helps women who develop psychiatric

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symptoms during pregnancy or after delivery, women who are planning to become pregnant and looking to maintain stability during pregnancy, or women experiencing emotional distress as a result of infertility and loss.

Individual treatment is tailored to optimize the well-being of women, children, and families. Services include psychotherapy and medications that have been shown to be safe for women who are pregnant or breast feeding.

“Some women come for several sessions, while others continue for longer periods,” said Dr. Mavrides. “We make sure they have appropriate options available if they wish to continue with therapy on a longer-term basis.”

The Perinatal Program clinics are located in the Soffer Clinical Research Center, 1120 NW 14th Street.

To schedule an appointment, please call 305.243.2301.

ICIAL!

The UM Department of Psychiatry and Behavioral Sciences is on Facebook!

Keep up with the latest developments in psychiatry inside and outside of UM. Join our community at: facebook.com/PsychatUM/ @ PsychatUM

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Clinical Trials Corner Development of Novel Measures of Cognition and Function for Alzheimer’s Disease Prevention Trials: NOMAD his project examines the usefulness of traditional neurocognitive measures used to evaluate treatment outcomes. The older measures or tests were developed for severe cognitive impairments like AD but they are being used in cases with minimal impairments and are not sensitive to detect small changes in cognition. The NoMAD study will evaluate the use of newer neurocognitive tests in detecting small changes compared to the traditional neurocognitive measures.

The newer tests simulate realistic everyday challenges, which are common in people with milder to minimal cognitive impairments. The new cognitive tests are also designed to be easy to take and more fun while being challenging.

These novel measures include cognitive tests that are designed to have No Practice Effects (The NOPE Battery) as well as the UM Computerized Functional Skills Assessment System (CFAS). Additionally, CFAS and NOPE will be examined for sensitivity to preexisting cortical thickness and hippocampal volume, as well as APO-E genotypes, in participants selected for the absence of MCI. Participants are randomly assigned to traditional vs. novel assessments and followed for one year. A planned expansion of the study will include a second MRI at the one-year assessment point and markers of Tau-related biomarkers.

ALAUNUS Study This study looks to compare the effectiveness of a single Stem Cell infusion in reducing symptoms of Depression

and Alcohol Use Disorder, AUD, and elevated levels of inflammation and provide a non-pharmaceutical approach to improving symptoms.

Introspective Accuracy Self-awareness and the ability to directly evaluate one's own abilities and performance are important for everyday functioning. The present study explores how IA and IA deficits among those with severe mental illness relate to everyday outcomes which may have implications for treatment.

In this study, we are using remote and in-person assessments to examine people's daily activities as well as their ability to evaluate their memory performance. This study involves several weeks of daily self assessment and reports of everyday activities.

Clinical trials are the backbone of evidence-based medicine. Broadly speaking, clinical trials evaluate the safety and effectiveness of a medical strategy, treatment, or device. Moreover, clinical trials provide an opportunity for the general public to participate in the process of developing novel treatments for a variety of conditions. The results from these clinical trials provide the data necessary to assist in future medical decision-making.

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FACES

The UM Department of Psychiatry and Behavioral Sciences extends a warm welcome to new members of the team: Dandan Zheng, PhD Biostatistician

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The Department of Psychiatry & Behavioral Sciences is dedicated to generating the scientific knowledge behind the clinical best practices we incorporate in the treatment of difficult and complex mental health conditions.

The Behavioral Research Assessment Center (BRAC) is the research hub that fulfills the Department’s mission to develop the next line of treatments.

For more information on participating in available clinical trials, please email brac@miami.edu or call 305.243.5840.

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from the

Department of Psychiatry & Behavioral Sciences

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What to Do & Where to Go For a Mental Health Emergency, CALL 911 if you believe someone is in danger of hurting themselves or others.

Jackson Behavioral Health Hospital Triage 305.355.7332 Silver Alert If your loved one has gone missing, please CALL 911 immediately. Silver Alert is a statewide

initiative to involve the public in locating a cognitively impaired person who has gotten lost driving or while on foot. For more information visit florida silveralert.com.

Jackson Behavioral Health Hospital 305.355.9028 *Option 2

Office Numbers

Boca Raton 561.939.4044

Main Psychiatry Appointment Scheduling 305.355.9028 *Option 1 Chairman’s Office 305.243.6400

University of Miami Hospital 305.689.1352

Common Purpose

Transforming lives through teaching, research and service.

Courtelis Center 305.243.4129 Deerfield Beach 954.571.0117 Center for Cognitive Neuroscience and Aging (CNSA) 305.355.9080

Child & Adolescent 305.355.7077

Brain Fitness Pavilion 305.355.9080 *English, Option 3

Soffer Clinical Research Center 305.243.2301

Memory Disorders Clinic 305.355.9065

The University of Miami Leonard M. Miller School of Medicine Department of Psychiatry and Behavioral Sciences is committed to: Conduct research that deepens our understanding of the development, pathophysiology, and prevention of psychiatric illness and the nature of human behavior, and apply this knowledge to the development and delivery of more effective, evidence-based treatments.

Offer comprehensive treatment and consultation to our patients, their families, and the community.

Provide outstanding mental health education and multidisciplinary training to the next generation of healthcare providers and investigators.

DIRECCT Core values l Diversity l Integrity l Responsibility l Excellence l Compassion l Creativity l Teamwork

Q4 | 2019

BRAINSTORMS Quarterly Publication of the University of Miami Department of Psychiatry and Behavioral Sciences Executive Editor Samantha Richter Soffer Clinical Research Center 1120 NW 14th Street | Suite 1457 Miami, FL 33136

Senior members of the CNSA Drs. Kitaigorodsky,Crocco, Saveanu, Loewenstein and Curiel Cid 12 | BrainStorms | Q4 | 2019

Health

UNIVERSITY OF MIAMI HEALTH SYSTEM Psychiatry & Behavioral Sciences