Supported by an unrestricted educational grant from Merck & Co., Inc. 

ACNP

  August 2003 - American College of Neuropsychopharmacology- Volume 9 No. 3 

 

        ACNP Announces New Media Relations Effort  

In its July 13 meeting Council approved an important new media relations initiative. The ACNP will engage a media relations firm to work with us in planning and implementing an on-going campaign to secure more positive media coverage of the work of our members and the field of neuropsychopharmacology research. The goal of the media relations effort is to better educate people about the work being done in this scientific community. The firm we engage will help us to achieve that goal by securing more effective media coverage of ACNP events such as our Congressional Briefings, of the work done by task forces, by developing a media resource center on the ACNP Website, and by developing and distributing stories that feature new research developments as well as stories that summarize the current state of important bodies of work.

An important part of this new initiative is the formation of a new Public Information Committee. President Dennis Charney and President-elect Carol Tamminga have named Ellen Frank to chair this committee. Ellen and her committee will work closely with Council in selecting a media firm and in further defining and implementing the plan of action for this new initiative.

Past discussions regarding the media in the ACNP have focused on the debate of whether to invite the media to the Annual Meeting or not. This current initiative will focus on the overall goal of securing positive media coverage of our field. We will ask the professionals from the firm we hire to attend our meeting, to learn about the College, and to learn about the many aspects of the Annual Meeting that make it unique. No media representatives will be invited to the meeting this year. Council will then seek advice from these specialists regarding the meeting and the role it might have in this media initiative.

This initiative will give us an opportunity to educate the media, to develop relationships with them, and to improve the quality of the work they do. A part of the ACNP mission is to educate, and the public media is one of the most important target audiences for that educational mission. This is an important as well as exciting new challenge for our College.

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        ACNP Terrorism Task Force 

Steven E. Hyman

The terrorist attacks of 9-11-2001 and the subsequent anthrax attacks underscored important gaps in our knowledge about how to respond to terrorist acts and threats. Even where we had solid understandings, there was a dangerous disjunction between what the science showed and the panoply of interventions that were proffered. With the anthrax attacks still ongoing, and with many in the Washington area still jittery, I recall giving a joint NIH Clinical Center Grand Rounds with Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases. He discussed the "bio" in bioterrorism and I discussed the "terror". It was quite clear that the microbiology and the issues related to cognition and emotion were both critically important and that both demanded attention Indeed, the goal of terrorism is clear from its very name: to create destabilizing fear. With regard to the anthrax, it was even noted that the infection was not contagious from person to person but that fear was.

From the spring of 2001, there has appropriately been an enormous new national investment in research on the microbiological aspects of biological warfare. In contrast, there has been almost no incremental investment in studying the impact of terrorism on brain and behavior. Against this background I agreed wholeheartedly with Dennis Charney's idea that ACNP should create a task force on terrorism. The goals of this task force are to define what we know about the impact of terrorism on brain and behavior, to highlight what is solid enough to inform practice and policy, and to develop a compelling agenda for future research.

The initial goal of the task force is to write a white paper for our membership and peers. This document can then form the basis for educational materials for the general public and for policy makers. The task force has been hard at work on the white paper. The first large portion will address what we know about the biological, behavioral, social, and economic impacts of terrorist acts and threats. Under this rubric, the first section will discuss responses to terrorism in broad, generally healthy populations, including both acute responses and longer term issues of adaptation, recovery, and vigilance. A second section will deal with pathological responses to terrorism. A third section will be devoted to children, analyzing the issues through a developmental lens. A fourth section will be devoted to the neurobiology of both normal and pathological responses to terrorism.

The second major portion of the white paper will deal with practical knowledge. The first section will discuss the issue of preparedness so that we can reduce psychological casualties when terrorism occurs and prepare the broad population in ways that are adaptive. The second section will be devoted to interventions for those who are affected. The final section will summarize what science can contribute to communications related to terrorism or threat of terrorism. It will review what is known that is useful for the media, for parents, and for policymakers. Each section will contribute to what I believe will be an important research agenda. The section editors will be asked to present their findings and recommendations at a panel at the upcoming ACNP meeting.


ACNP task force members (Section editors *)

Steven E. Hyman, chair
Jane Costello, Duke University
Edna Foa*, University of Pennsylvania
Matthew Friedman*, Dartmouth
Ron Kessler, Harvard University
John Krystal*, Yale University
Joe LeDoux, New York University
Anne Masten, University of Minnesota
Richard McNally, Harvard University
Danny Pine*, NIMIH
Robert Pynoos, UCLA
Arieh Shalev, Hadassah University Hospital
Paul Slovic*, University of Oregon
Robert Ursano*, USUHS
Rachel Yehuda*, Mount Sinai
Dennis Charney, NIMH, ex officio

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        Geriatric Neuropsychopharmacology Model Curriculum Development Project

David Oslin and Dilip V. Jeste

Mental disorders in late life are major clinical and public health problems that all too often go unrecognized, untreated, undertreated, or mistreated. As the population ages, it is increasingly important to understand and recognize that late life behavioral health problems differ in a number of important ways from those in younger adults. It is well recognized that mental health problems in late life lead to a high morbidity, disability, and mortality; there is also considerable financial cost associated with these disorders. The most common psychiatric disorders in late life include dementia, depression, anxiety disorders, and delirium. However, psychotic disorders and substance use disorders are also commonly encountered by practitioners, and expertise in these areas is essential for clinicians caring for the elderly. The ANCP Task Force on Geriatric Neuropsychopharmacology (chaired by Dilip Jeste) recognized the need to raise awareness of and increase training in the area of geriatric neuropsychopharmacology within the College and amongst our colleagues. The Task Force was aware that access to experts on a broad array of clinical issues relevant to geriatric psychiatry is not available in all training programs. In fact, many training programs have only limited geriatric expertise beyond issues related to depression and dementia. As such, the Task Force created a Workgroup to develop a Model Curriculum focusing on Geriatric Neuropsychopharmacology as a teaching tool for residents, fellows, and colleagues. A model curriculum is seen as a way to enhance residents' and fellows' experience in training, and provide additional resources to training programs on these required elements of content. The Workgroup was chaired by David Oslin, and co-chaired by Dilip Jeste. Its members included Ira Glick, and Craig Nelson.

The Workgroup set out to create a set of PowerPoint presentations focused on the major illnesses and problems facing practitioners and junior faculty. The topics were chosen by the Workgroup as representative of the clinically relevant issues in geriatric psychiatry. The areas covered include not only the most common disorders such as depression and dementia, but also specialized areas of content such as delivery of care in the nursing home, and developing a career in geriatric psychiatry. The content of each disease-based lecture includes epidemiology, clinical presentation and course, and treatment. In addition to each set of slides we have provided hypertext links for handouts, and have annotated many of the slides for ease in presenting or for self study. The presentations were obtained from leaders in the field of geriatric psychiatry, and include both clinically useful information as well as cutting edge science. The principal audience for the curriculum is that of psychiatric residents and fellows but could also include medical students and Continuing Medical Education (CME) seminar attendees. The presentations are packaged in a CD-ROM and will be distributed (at no cost) to the appropriate fellowship directors. A CD-ROM product was chosen as the preferred media in view of the relative ease in duplication and low cost. Shortly, the presentations will also be placed on the ACNP website and thus made accessible to a much broader audience.
We should stress that this Model Curriculum is not intended to be exhaustive. Moreover, there would be disagreements among different experts about certain elements, and some of the content is likely to become dated with new advances. We hope to maintain the presentations current by adding new information. We also recognize that some additional topics will need to be included and plan to do so in the future. Nonetheless, the stated limitations must be taken into account by the users of this (or for that matter, any other) Model Curriculum.

A listing of the content areas and the contributing authors is given in Table 1 below.

Table 1. List of presentations and contributing authors for the ACNP Geriatric Psychiatry Model Curriculum.

  • Behavioral Health and Aging (Introduction)
  • Depression in Later Life: Epidemiology and Assessment
    James Ellison, M.D., MPH
  • Treatment of Late Life Depression
    Gary Small, M.D.
  • Treatment of Depression in Nursing Home Residents
    Ira Katz, M.D., Ph.D.
  • Anxiety Disorders in the Elderly
    Eric Lenze, M.D.
  • Bipolar Disorders in Late Life
    Robert Young, M.D.
  • Schizophrenia and Aging
    Dilip Jeste, M.D.
  • Dementia
    Gary Small, M.D.
  • Treatment of Depression in Dementia
    Gary Small, M.D. and Jason Olin, Ph.D.
  • Psychosis and Agitation in Dementia
    Dilip Jeste, M.D.
  • Delirium
    Barbara Kamholz, M.D.
  • Late Life Addiction
    David Oslin, M.D.
  • Drug Interactions
    Bruce Pollock, M.D., Ph.D.
  • Ethical and Legal Issues
    Laura Dunn, M.D.; David Naimark, M.D.;
    Ramila Duwal, M.D.; Dilip Jeste, M.D.
  • Health Services for Older Adults
    Gary Gottlieb, M.D., M.B.A.
  • Careers in Geriatric Psychiatry
    George Alexopoulos, M.D.

We invite you to use this Model Curriculum and provide any feedback through the ACNP office. We realize that the slide sets are not perfect, but hope to make them as user friendly as we can, based on your input.

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        Report from Washington

Policy Directions

National Academies and Mental Health Commission Release Reports

Two government-inspired reports, recently introduced, may ultimately affect ACNP researchers and practitioners. The first report, Enhancing the Vitality of the National Institutes of Health: Organizational Change to Meet New Challenges was drafted by a joint Committee of the National Academies' Institute of Medicine and the National Research Council. The second report, Achieving the Promise: Transforming Mental Health Care in America, was written by the President's New Freedom Commission on Mental Health..

The National Academies' Review of NIH

The NAS study was commissioned in the FY2001 Labor-HHS-Education Appropriations bill. Congress, despite noting its "confidence in NIH's ability to fund outstanding research," inserted language instructing the National Academy's Institute of Medicine (IoM) to study "whether the current structure and organization of NIH are optimally configured for the scientific needs of the twenty-first century."

In the course of evaluating the need to restructure NIH, the Committee met with both current and former institute directors, NIH staff, current and former members of Congress, health groups and scientific and professional societies. While it is accepted that the NIH is successful as the world's largest supporter of biomedical research and training, the Committee determined organizational changes are needed to continue that level of success and meet future challenges.

The Committee was not directed to evaluate NIH's research priorities or programs. Although there has been some speculation that the Committee's primary efforts would focus on movement to consolidate institutes, the Committee report states that was not the Committees' exclusive focus, in fact, after much discussion, it decided widespread consolidation was not the best path for NIH. The Committee reasoned the cost would outweigh the benefit, and believes there are better ways to increase coordination. However, with regard to specific institutes, it does suggest the National Institute on Drug Abuse and the National Institute on Alcohol Abuse & Alcoholism are candidates for merging, as are the National Human Genome Research Institute and the National Institute of General Medical Sciences. The Committee explained that the missions of the two organizations are similar and because of the link between alcoholism and drug abuse, many treatments are the same. The Committee concluded by saying, "There are undoubtedly other mergers, additions, or closures that might be studied."

The Committee recommends a new, NIH director-level program for special projects resembling the Defense Advanced Research Projects Agency (DARPA). The goal of the program is to provide additional funding for high-risk, innovative research projects that potentially offer a high payoff. Also at the director level, it recommends reconsidering the "special status" of the National Cancer Institute as it affects the NIH director's authority over the entire NIH budget, and providing the NIH director with the authority to hire and fire institute directors. The report recommends term limits of six years for the NIH director and two five-year terms for institute directors.

The Committee strongly supported collaborative research and encouraged NIH to adopt new methods for integrating research that cuts across the individual institutes and centers. These "trans-NIH" projects should be included as part of the overall NIH strategic plan. Furthermore, the report suggests the NIH director require that a certain percentage of each institute budget be directed toward trans-NIH initiatives. For the additional authority and burden imposed by these recommendations, the Committee suggests an additional $100 million in new funding for the director's special projects program the first year, with the annual budget eventually growing to as much as $1 billion.

The Mental Health Commission's Review of Mental Health Services

The Mental Health Commission report is the outcome of a yearlong effort to review existing treatments and services for individuals with mental illness and suggest polices to improve coordination of these services. During the year, commissioners met each month to hear testimony from mental health service providers, consumers, advocates and researchers. Based on the Commission's study, Commission Chair Michael F. Hogan, PhD emphasized that "the time has long passed for another piecemeal approach to mental health reform…the time has come for a fundamental transformation of the…mental health care."

Included in the findings the report listed mental illness as the first among illnesses that cause disability. In the U.S., the annual economic, indirect cost of mental illness is estimated at $79 billion. According to the World Health Organization (WHO) suicide worldwide causes more deaths each year than homicide or war. Armed with these compelling statistics, the Commission reasons that everyone should be engaged in improving the delivery of mental health services. The Commission sets forth six goals of a transformed mental health system. To achieve this, it provides several specific recommendations. The goals include:

  • Understanding that mental health is essential to overall health;
  • Ensuring mental health is consumer and family driven;
  • Eliminating disparities in services;
  • Early mental health screening, assessment, and referral to services are common practice;
  • Excellent mental health care is delivered and research is accelerated.
  • Technology is used to access mental health care and information.

In discussion of the fifth goal, to accelerate research on mental illness, the report indicates problems inherent in current research, long delays in research outcomes reaching the consumer, limited consumer populations who benefit from research, inadequate reimbursement policies to provide an effective transition from research to practice and a Commission determination of four areas that have not been studied enough. This includes minority disparities in mental health research, long-term effects of medications, the impact of trauma, and acute care.

The Commission recommends making a national commitment to creating a research program with a long-term goal of developing cures for major mental illnesses. It also suggests that National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA) partner with the National Institute on Disability and Rehabilitation Research to "promote research on factors contributing to rehabilitation and recovery from mental illnesses." The Commission also recommends expanding collaboration between NIH and SAMHSA to conduct peer-reviewed mental health research. While supporting continued research, the Commission also supports implementing programs to disseminate and promote evidenced-based practices. It refers to this process throughout the report as a "science to services" process.

Implicit throughout the report is the understanding that mental illness remains largely stigmatized and implementing actions to achieve these goals requires that misconceptions and misunderstandings of mental illness be eliminated.

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        Upcoming Deadlines

 

Membership applications due

September 1, 2003

Poster, Panels & Study Group abstracts due

 

September 22, 2003

Hot Topics submissions due

 

September 22, 2003

Education & Training Public Outreach Initiatives Proposals due

 

October 1, 2003

Registration Deadline

 

November 14, 2003

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