PSYCHIATRISTVolume 67, Number 4 December 2018 Newsletter of the Southern California Psychiatric Society

This Saturday, December 8, 2018, the SCPS will be hosting a career dayfrom 10 am to 3 pm where residents, fellows, and early career psychia-trists will have a chance to learn about types of practice settings. Therewill be opportunities to talk to psychiatrists in different fields and to meetpotential employers.

Something new this year will be a speakers to give a background in financial and in-vestment strategies. Drs. George Fouras and Zeb Little will be speaking on these is-sues that aren’t taught to us in medical school yet are so important after residency.

Also during the first part of career day, there will be a panel of psychiatrists speakingabout the fields of managed care, private practice, academic psychiatry, public psychi-atry, and group practice.

Next there will be time to meet employers. Various hospitals will be represented likeCedars-Sinai and Las Encinas. Community mental health and public psychiatry willbe there like DMH and San Fernando Valley Community Health. There are grouppractices and managed care as well as many more.

All are welcome. If you haven’t rsvp’d, it’s not too late to come. Lunch will be served,and the event is free to SCPS members. (By the way, it’s free for PGY1, 2, and 3 resi-dents to join the SCPS for one year.) Career day is $15 for non-members. Pleasecontact us. Also, anyonecan find me or email mepersonally for more info oncareer day or becoming in-volved in the SCPS at an-itaredmd@gmail.com.

SCPS’ Annual Career Fair

P r e s i d e n t ’ s C o l u m n

Anita Red, M.D.

December 2018

In This Issue...Letter from the Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

The Culture of Correctional Psychiatry . . . . . . . . . . . . . . . . . .5

SCPS Goes to Beirut, Lebanon . . . . . . . . . . . . . . . . . . . . . . . . . .7

Thank You Life Members! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Book Review: Braving the Wilderness . . . . . . . . . . . . . . . . . .11

Council Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Laughter is the Best Medicine . . . . . . . . . . . . . . . . . . . . . . . . .14

SCPS/SCSCAP Joint Meeting . . . . . . . . . . . . . . . . . . . . . . . . . .16

Southern California

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Schedule8:15 a.m. - Registration, Continental Breakfast, Booth Exhibits 8:55 a.m. - Opening Remarks

9:00 a.m. - Treatment of Obesity with Emphasis on Topics of Interest to Psychiatrists

Frank Greenway, M.D., Medical Director and Professor, Pennington Biomedical Research Center Baton Rouge, Louisiana

This talk will discuss the role played by the reward system compared to the hypothalamic hunger system by drugs approved for thetreatment of obesity. We will discuss the cannabinoid system and potential approaches to treating obesity and avoiding the depressionproblems seen with cannabinoid-1 inverse agonists like rimonabant. Causing weight loss at the body locations people feel are problemareas as a way of improving self-image when losing weight will also be discussed.

10:30 a.m. - Neuromodulation: The Future of Treatment for Neuropsychiatric Illness

Andrew Leuchter, M.D., Professor of Psychiatry and Biobehavioral Sciences; Director, TMS Clinical and Research Service; Di-

rector, Neuromodulation Division.

Neuromodulation treatments are an emerging class of technologies that apply magnetic or electrical energy to the brain to treat depres-sion, Obsessive-Compulsive Disorder, chronic pain, and other neuropsychiatric illnesses. Neuromodulation treatments can be used aseither an alternative or an addition to medications for the treatment of illness. These cutting edge technologies modify the activity ofneural networks, and include non-invasive methods that utilize electromagnets or small electrodes applied to the scalp, and invasivetechniques that involve insertion of electrodes into the brain. Non-invasive treatments include repetitive Transcranial Magnetic Stimula-tion (rTMS), Electroconvulsive Therapy (ECT), transcranial Direct Current Stimulation (tDCS), Trigeminal Nerve Stimulation (TNS), andsynchronized Transcranial Magnetic Stimulation (sTMS). Invasive techniques include Deep Brain Stimulation (DBS) and Vagal NerveStimulation (VNS). These techniques offer new hope for the the treatment of patients who have received inadequate benefit from med-ications. This talk will review the effectiveness of neuromodulation treatments that currently are available, as well as major experimentaltreatments in development.

1:00 p.m. - An Update on Anxiety Disorders

Mark H. Pollack, M.D., The Grainger Professor and Chairman, Department of Psychiatry, Rush University Medical Center.

This talk will review pharmacologic strategies to improve the outcomes for treatment of individuals with anxiety disorders.

2:15 p.m. - The Top Ten Drug Interactions that Limit Efficacy in Psychiatric Treatment

Paul Zarkowski, M.D., Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, Harborview Medical

Center, University of Washington; Psychiatrist, Seattle, Washington.

Although there are numerous resources to guide prescribers away from harmful drug interactions and pharmacokinetic interactions,there is less written on interactions that limit efficacy. These are common and can be grouped in three categories including functionaldrug interactions with opposing functions and side effect profiles, drug interactions with antagonistic mechanisms of action and contro-versial drug interactions with opposing pharmacology. Each of these categories is represented in the top ten drug interactions that limitefficacy. The relative prevalence of each efficacy limiting interaction will be presented and discussed.

To Registerhttp://www.socalpsych.org/psychopharmacology-registration.html

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Should we use Genetic Testing in the Evaluation and Treatment of

Adults with ADHD?

By: Matthew Goldenberg D.O.

SCPS Newsletter Editor

I recently wrote an article for my patients and the public about the present and future treat-ment of ADHD in Adults. The impetus came from an article I read, “Discoveries on the Ge-netics of ADHD in the 21st Century: New Findings and Their Implications”, in the Octoberedition of the American Journal of Psychiatry.

While the treatment for ADHD has not changed much over the past decade or so, the ar-ticle discusses that twin studies originally led to the discovery of the genetic predispositionfor ADHD. It then goes into the subsequent research which has shown that it is a combi-nation of genetic and environmental factors that lead to ADHD in Adults. It is currentlythought that the genetic heritability of ADHD is between 60 and 90%.

Genetic studies have shown some overlap with other diagnoses such as conduct disorder, Autism and Intellec-tual Disability. Reading this, a patient could fear they will be at risk of developing these other conditions. The ar-ticle points out that is not the case, but rather that the genes that lead to and contribute to each disorder aresimilar and likely overlap. Recent studies have shown that ADHD does not come from a single gene but is rathermulti-factorial and polygenetic.

So, a question is raised: should we use genetic testing to help diagnosis and possibly differentiate between treat-ments of ADHD in Adults?

The article reviews the available data and explains that the current consensus is that routine genetic testing forADHD is not indicated. The authors opine that for most patients, without other conditions (i.e. autism or intellec-tual disability), it would not change the diagnosis or management of ADHD.

The authors’ conclusion is that there are tests commercially available but that their utility is suspect at this point.The authors do acknowledge that may well change in the future.

Have you used genetic testing for ADHD or other conditions in your practice?

Do your patients ask you about genetic testing or request to have it performed?

Do you agree with the authors conclusions?

Send me your thoughts by email and I will be eager to share your thoughts in next month’s newsletter.

Best,

Matthew Goldenberg D.O. SCPS Newsletter EditorEmail: docgoldenberg@gmail.com

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HIPAA VIOLATIONSHIPAA enforcement continues to increase at the federal and state levels.

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ASSAULT BY A PATIENTViolence by patients against psychiatrists is more common than against other physicians.

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The Culture of Correctional PsychiatryBy Kavita Khajuria, M.D.

Enter a correctional facility, and you may think you’re in another world. A grim austerity may bethe first observation. Florescent lights add to the unnatural feeling along with the occasionalnasal assault from industrial strength chemicals. Hallways are often stark and unadorned.Heavy sliding and clanking of sally port doors are the norm, and no one gets in without properclearance and identification. Keys are monitored and surveillance is taken seriously.

The term ‘corrections’ generally refers to agencies and programs that interact with individualswho have been either accused of, or convicted of crimes. Correctional settings can vary inscope and include lockups, jails and prisons. Jails are short term, local facilities that serve as

pre-arraignment or pretrial structures and incarcerate individuals with sentences for less than a year, whilst pris-ons are state and federal facilities and generally incarcerate prisoners for more than a year. These distinctionshave changed, especially in California, where federally mandated sentence reductions to the prisons operatedby the California Department of Corrections and Rehabilitation have resulted in a significant number of sentencedfelons being housed in county jails for as long as 10 years (1).

Working in a correctional setting requires an understanding of the culture, structure, rules and regulations. Dailyroutines occur on a consistent schedule, yet life in corrections can be unpredictable. New psychiatrists may feelanxious and inmates may test them in several ways with medication requests or demands. A doctor’s reputationcan spread quickly, but even appropriate or well intentioned care may result in grievances or complaints. Sea-soned psychiatrists are also not immune to being subject to intimidation, verbal abuse and dangerous behaviors,including assault or being spit at. Higher rates of communicable diseases prevail, and violence and the use of forceare not uncommon. In 2012, correctional officers were one of the top seven professions cited for nonlethal injuryand illness (2).

Other professional frustrations can include formulary restrictions, medication hoarding and/or swapping, limitedprivacy, and a physiological sense of drain. Communication can be challenging at times, and the psychiatristneeds to be skillful at managing countertransference. Disagreements with custodial and medical staff may be in-evitable and require ongoing tact. Correctional officers spend significant time in proximity with inmates which canbe helpful in terms of observation and feedback to mental health staff. Occasional delays as a result of emer-gencies, altercations or other incidents may be inevitable and unforeseeable. Respect, boundaries, adherencewith rules and regulations, and sensitivity to correctional concerns are key factors to keep in mind.

Inmates have been traditionally been described as a unique social group, with their own roles, language andnorms, but research argues the notion of the prison subculture to be no longer true, given the decreased isola-tion from the outside world with the increased use of TV, newspapers, increased visitation and legal representa-tion (3). Regardless, incarceration can be stressful and dehumanizing. Stressors include a potential loss offinances, property and relationships, tedium, limited autonomy, loneliness, and a fear of predatory behavior, in-cluding assault and rape. Those with mental disorders are especially vulnerable, and some may have difficultyunderstanding or following rules. Emotions can range from frustration, fear, anger and rage, to gratitude or hope.Prominent themes amongst inmates include respect, doing time, not snitching and the avoidance of the appear-ance of weakness (2). Female correctional institutions have a different culture in some regards: female prisonstend to be smaller and less threatening in appearance and the female adaptation usually involves creation ofsurrogate families and kinship networks (3). More than 76 percent of the female prison population are mothers(3).

Many factors determine how and why individuals with mental illness are treated in correctional settings as opposedto the community (4), yet the quality of care in many correctional facilities is superior (2). A provision of basic ne-cessities and medical care allow for a level of patient care that may be difficult to obtain in the community. It maybe baffling as to why a psychiatrist would want to work in such daunting conditions, but the rewards can be sig-nificant. The United States has the highest incarceration rate in the world (3) and contains some of the most illmembers of society. Correctional facilities offer the opportunity to provide public service and treat some of the mostbehaviorally disorganized and underprivileged. A competent and caring psychiatrist can provide valuable contri-butions to the health and well-being of this population.

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References:

1.Dvoskin J, Brown M. Jails and Prisons. In: Oxford Textbook of Correctional Psychiatry. USA: Oxford UniversityPress, 2015; 31-35.

2.Gage B. Working Inside the Walls. In: Oxford Textbook of Correctional Psychiatry. USA: Oxford UniversityPress, 2015; 35-41.

3.Adler, A et al. A Research Focus on Corrections. In: Criminology. 9th edition, New York, NY; McGraw–Hill Pub-lication. 2018; 447-471.

4.Scott CL, Falls B. Mental Illness Management in Corrections. In: Principles and Practice of Forensic Psychia-try. Third Edition. Boca Raton: CRC Press; 2017: 8-13.

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Wishing You a Safe, Happy, and Healthy Holidays from SCPSCouncil and Staff.

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SCPS goes to Beirut, LebanonBy Linda Do, D.O.

On October 13, 2018 Linda Do, D.O., Michelle Furuta M.D., Mindi Thelen, Tim Thelen and MaryAnn Schaepper M.D. attended the Lebanese Psychiatric Society’s World Mental Health Day atBeirut, Lebanon. This is the second international trip for the group to showcase their docu-mentary, “The Art of Storytelling: The Human Experience of Being a Psychiatrist” which was re-leased in 2016, a documentary about the personal journeys of 12 psychiatrists practicing inCalifornia. The first trip was in Berlin, Germany where the film premiered at the World Psychi-atric Association and it was first seen by Josyan Madi-Skaff M.D. president of the Lebanese Psy-chiatric Society (LPS) who invited SCPS to Beirut for the event. The LPS is made up of 80

psychiatrists and the event was open to the public however most of the audience was made up of psychiatrists,psychologists, therapists and other mental health workers. The topic this year was Mental Health in the Work-place.

The agenda included a variety of topics ranging from “Physician Burnout” to “Mental health of Women MigrantDomestic Workers in Lebanon.” The Art of Storytelling was a special event shown to the public in collaborationwith Lebanese documentary film maker, Hady Zaccak. The documentary was well received by the audience. Itsparked discussion about the similarities seen in both countries regarding mental health stigma, the difficulty withbeing vulnerable as a psychiatrist as well as the power of story-telling. Audience members were moved by thecommon themes of love, vulnerability and spirituality. Cynthia Jelwan, a psychotherapist commented, “Away fromthe cold, lonely and scary medicated world of mental disorders... You successfully revealed yourselves unmasked.Each one of you shared with the audience a piece of their heart, discussing previous traumas, present resourcesand future plans. I think it is so important to take time to understand past events which marked someone’s ownlife, it is extremely important to identify your own traumas before healing others. In one of the systemic therapytechnics, Phillipe Caillé talks about a coat of arms... each one of you traced their own coat of arms.”

On one of the trip days, SCPS members toured Psychiatric Hospital of the Cross in Beirut, one of two psychiatrichospitals in the city. In a beautiful backdrop of the Mediterranean Sea, the cross perched on the top of the hillhonors the many people who died without a proper burial in the multiple wars in Beirut. The hospital houses 900beds and up to 1000 patients and is both an acute and long term facility. The hospital is run by 300 nuns andwas first built by Father Jacques Haddad in 1930 but was turned into a psychiatric hospital in 1950. “No patientsare turned away, regardless of religion or income. We will not turn away anyone who is in danger of hurtingthemselves or their parents,” stated Sister Josephine, one of the administrators of the hospital. Adorning thewalls, are paintings of Father Jack, a priest who dedicated his life to caring for the mentally ill in the area and liveda simple life. He raised money to build the hospital with strong faith and intention. It has both a public and a pri-vate hospital. There are spacious rooms for patients to do art therapy: basket weaving, painting, jewelry mak-ing, mosaics and knitting. Patients cook in the kitchen and fix chairs that are broken. Fostering the patient’sindependence and self-reliance is an important part of the treatment in addition to medication treatment. Pa-tients can stay there for as little as a week or up to years if they have no home to go to. Additionally, the psychi-atrists in Lebanon volunteer at a local free clinic ensuring that care is provided for patients that come from lowincome backgrounds. The hospital visit is a reminder of how California’s psychiatric facilities were before man-aged care limited hospital stays. It is inspiring to see how psychiatrists take responsibility for the mental well-beingof their communities while in turn, these communities support the autonomy of their patients.

SCPS’ visit to Beirut is a glimpse into a beautifully resilient city with courageous people who live each day to thefullest. With all its history of religious war and civil unrest, Beirut is also a fertile bed for progress as evidencedfrom the giant skyscrapers adjacent to bombed out buildings. It is a fine example of the potential of the humanspirit under duress, and the perfect backdrop to a documentary that celebrates the adversity that spans acrossall cultures.

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Mindi Thelen, Linda Do, D.O., Michelle Furuta, M.D., JosyanMadi-Skaff, M.D., and Mary Ann Schaepper, M.D.

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Each year, the SCPS President reaches out to our dues-exempt members to remind them aboutwhat SCPS is doing and to ask for voluntary dues. We wish to gratefully and sincerely thank

the following members for their voluntary contributions:

William Bondareff, M.D.Daniel Borenstein, M.D.

Michael Blumenfield, M.D.Thomas Brod, M.D.Murray Brown, M.D.

Yung Sik Chung, M.D.Thomas Ciesla, M.D.

Ned Cowan, M.D.Richard Deamer, M.D.Beverly Feinstein, M.D.

Raymond Friedman, M.D.Elizabeth Galton, M.DArmen Goenjian, M.D.

Richard Greenberg, M.D.Howard Hansen, M.D.Hiawatha Harris, M.D.

Neil Haas, M.D.Kenneth House, M.D.

Brian Jacks, M.D.Quinton James, M.D.Julian Kivowitz, M.D.

Edwin Kleinman, M.D.Arthur Kornhaber, M.D.

Boyd Krout, M.D.Doryann Lebe, M.D.John Lundgren, M.D.Richard Mack, M.D.

Hassan Mahfoozi, M.D.King Mendelsohn, M.D.

Clinton Montgomery, M.D.Jay Mortimer, M.D.

Marvin Osman, M.D.Allen Pack, M.D.

Richard Palmer, M.D.Marta Pariewski, M.D.Norma Pariewski, M.D.Robert Pasnau, M.D.Charles Portney, M.D.

Lackshman Rasiah, M.D.Nancy Rosser, M.D.

Alberta Samuelson, M.D.Albert Sattin, M.D.Irwin Schultz, M.D.

Joseph Sicignano, M.D.

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Jerald Simon, M.D.James Teague, M.D.Thomas Trott, M.D.John Wells, M.D.

Sanford Weimer, M.D.Loren Woodson, M.D.

Your contributions and continued support is highly appreciated!

Getting Serious About Mental Health

Gavin Newsom

When it comes to healthcare in California, we for far too long have tolerated two different and unequal worlds. I don’tmean rural and urban. I don’t mean rich and poor. While both those dichotomies are true, I am talking about the funda-mental differences in our approach to illness of the body and illness of the brain.

In any given year, one in four families in California deal with a mental health condition. An estimated one in 20 adults inthe state are living with a serious brain illness. Each year, thousands of young Californians will experience their first psy-chotic break, enduring the terrifying delusions and hallucinations that are a hallmark of schizophrenia, bipolar disorder andsome forms of depression.

We all know someone, don’t we? Whether we’re living with brain illness ourselves, or it’s a spouse, a child, a sibling, afriend. And more often than not we’ve heard about their struggles to find quality care: the long wait times for appointments,and shift to cash-only psychiatrists; the shortage in licensed providers and crisis beds; limited insurance coverage; thepunishing side effects of medications; the fear that a boss or colleague or neighbor will learn the truth and look at you dif-ferently.

Our system of mental healthcare in California falls short, not for lack of funding. We’ve done the right thing in this state:Thanks to the vision of Sacramento Mayor Darrell Steinberg, we passed a millionaire’s tax in 2004 that now funnels morethan $2 billion a year into services. We fall short because we lack the bold leadership and strategic vision necessary tobring the most advanced forms of care to scale across the state. We lack the political will necessary to elevate brain ill-ness as a top-tier priority. We lack the unity and fervor needed to rally the medical and research communities around anunyielding search for ever-better diagnosis and treatment.

We’re all living with the fallout. As a mayor, I was acutely aware of the many ways untreated mental illness tore at the fab-ric of community. We moved over 12,000 folks off the streets and into housing with supportive services. Yet still, more than7,500 people live homeless in San Francisco, and research indicates about a third of them are dealing with untreatedmental illness. Across the state, 134,000 people are living on the streets, a third of them suffering with progressed stagesof mental illness.

One-third of the people living behind bars also deal with a brain illness, making our jails de facto asylums. The Los Ange-les County Jail actually doubles as the nation’s largest mental health facility. Students struggle in silence with depressionand anxiety. Our suicide rate hasn’t fallen in two decades. Families are ripped apart because they can’t get their childrenthe care they need.

It’s hard to think of a public policy issue not impacted by the state of mental healthcare.

For the complete article:https://medium.com/@GavinNewsom/getting-serious-about-mental-health-8c09ad95a5ae

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Braving the Wilderness

By Brene Brown PhD, LMSW

2017

Penguin Random House

208 pages

$15.74 paperback, $18.79 hardcover

ISBN 978-0-525-50869-4

Book reviewed by Kavita Khajuria, MD

“True belonging doesn’t require you to change who you are. It requires you to be whoyou are.”    

Brene Brown is a Research Professor at the University of Houston,whose areas of expertise and research include vulnerability, courage,belonging, shame and empathy. Presented in an unfiltered, easy toread style, the book combines a mixture of down-to-earth storytelling with research and cultural conversation. Her style includes passion, humor, sass and compas-sion.

A story of shame, aloneness, and invalidation ultimately shapes Brown’s life trajectory. She describesthe pain of soul-searching, self exploration, a need to understand pain and fear, and more importantly, the underlying rea-sons.  Brown explores the potential costs of a broken heart & spirit, damaged self worth, and the need for validation. Sherefers to always saying the ‘right thing in the right way’ as akin to being a chameleon and a stranger, and stresses the im-portance of core values in order to truly be oneself. 

Brown delves into the meaning of belonging and connection. Her grounded theory based research reveals a culture with adiminished sense of shared humanity and a fear of disagreement, yet a yearning for connection and to be part of some-thing bigger. The need for courage, authenticity, vulnerability, and trust are examined, without sacrifice of the true self.Hence, the dichotomy and paradox- to be alone & our true selves, yet to belong and to be connected with others. (TheLatin paradoxicum meaning ‘seemingly absurd but really true’).

Brown describes political divides and refers to the world as in a ‘collective spiritual crisis’, with division and lonelinessfueling defensiveness, numbing and lack of empathy. She explores reasons for disconnect, which include fear of vulnera-bility, hurt, criticism, inadequacy and failure. She stresses the need to truly listen, allow for vulnerability, and to step out-side of self preservation in order to brave the world. 

Concepts of anger, dehumanization, and shame are discussed, including the cost of denying emotions and anger. Brownrecommends we channel these emotions into more positive and productive pathways and emphasizes the need for conflictresolution and a deeper understanding of ourselves, with a focus on the present and future, rather than the past.

Given the consequences of demeaning comments, rude behaviors, keeping silent or stewing under duress, Brown exploresthe meaning, manner, and ingredients of civility. The cost of force-fitting into a culture are cited as missed opportunitiesfor personal drive and purpose. She warns of the misappropriate use of words as weapons. Brown explains the need for human connection, lack of which risks intolerance, isolation, and a tendency to dehumanize

others. The power of ‘collective joy and pain experiences’ transcend this, described as sacred experiences that cut throughour differences. She reminds us of music and art as powerful collective experiences, and as tools for connection. Benefitsof face-to-face and in-person interactions are noted to include improved physiology, immunity, and increased longevity.Gratitude is cited as the key to countering the negative ‘what-if’s’ that inevitably tend to recur for all of us.

Brown suggests the ‘braving’ tool to develop trust and strengthen the courage muscle, which cultivates self-love and self-respect. She writes: ‘The wilderness is where all the creatives and prophets and system-buckers and risktakers have al-ways lived, and it is stunningly vibrant. The walk out there is hard, but the authenticity out there is life’. Vulnerability isspecified as the most accurate measure of courage, with love, belonging and joy as the most important elements in life.The practice of gratitude is emphasized as the key to joy. 

Influenced by Maya Angelou and Carl Jung, Brown offers understanding and connection that encourages authenticity andcourage. She shares the individual and collective experience in a straightforward and empowering style, helpful for any-one, given that we are all part of the universal experience.

PRESIDENT’S REPORT Dr. Red

Media Training/Public Affairs Committee:

Dr Red commended Dr Haddad for organizing the media training. Dr Haddad then went overthe role of the public affairs committee and reviewed the just concluded media training, firstmeeting of the committee held after the training and some of the plans of the committee forthe coming year namely establishing a speakers’ bureau with guidelines, featuring speakerson the SCPS website, having some presence on social media (some concerns about con-tent on social media) and partnering with other organizations such as NAMI and PER.

Council members present at the meeting were appreciative of the media training

Cyber Insurance:

Dr Red and other council members had agreed that more research will be done regarding this following last meet-ing’s discussions about SCPS’ purchase of additional insurance. Ms Thelen reported that SCPS currently has aDirectors and Officers liability insurance (D and O) insurance through APA for ethics and membership but web-site issues are not covered. No other DB currently has one. Ms Thelen notes that she is working to get a cyberinsurance for SCPS and cost is about $1200 for the year.

CPA Political Action Committee:

Dr Red noted that one of the SCPS council members; Dr Fouras has just been nominated to chair this commit-tee. Dr Fouras brings a wealth of experience from his work at the San Francisco medical PAC. He encouragedcouncil members to get into the habit of donating to the PAC to allow CPA move the organization’s agenda for-ward. He suggested that we add $25 to our current dues for PAC activities. Various members weighed in on this;for and against this addition. He also noted that PAC updates will be included in the newsletter periodically.

Council Expenses:

Dr Red reported that after meeting with Dan Willick Esq, our legal counsel, he is happy to stay on call for the timescouncil has meetings and to bill SCPS according to actual time his service is utilized. He will also bill for reviewof the minutes which he will continue to do on a regular basis.

Newsletter:

Dr Goldenberg thanked the contributors to this month’s newsletter. He highlighted some of the points from ‘rightto know act’ which he reviewed in the current newsletter. He encouraged members to continue to make contri-butions. A sign-up sheet for members to contribute to the newsletter was passed around.

NAMIWalk LA:

The walk will be at the grand park on Saturday October 6, 2018 and SCPS will have a booth in a choice spot.Members are encouraged to attend and show support.

Art of Psychiatric Medicine Committee:

Dr Furuta informed council that the committee has an event coming up on November 17; ‘Art of Comedy: laugh-ter is the best medicine’. She also stated that there are two upcoming showings of the SCPS documentary withinthe month; at the IPS in a few days and in Lebanon later this month.

PER:

Dr Lymberis approached council to request for funding for a screening of ‘Do No Harm’, a movie about burn out

Council HighlightsOctober 4, 2018Ijeoma Ijeaku, M.D., Secretary

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issues in medical practice. The council members asked very pertinent questions and refrained from supportingthe funding at this time specifically because there were a lot of unknowns and details were too vague regardingthe technicalities of the proposed screening event. Additionally, SCPS is being very careful with expenses at thistime given the current financial status.

PRESIDENT-ELECT’S REPORT Dr Cheung

Dr Cheung noted that it is time to establish a nominating committee for upcoming elections. Various members vol-unteered for the role.

PROGRAM COMMITTEE REPORT Ms Thelen

Psychopharmacology meeting update; a talk on Top 10 DDIs that inhibit efficiency will be the 4th lectureJoint SCPS/SCSCAP meeting; new date for event is November 14, 2018. Those interested in attending are en-couraged to sign up.

TREASURER’S REPORT Dr Rees

SCPS is under budget as far as expenses, over budget as far as cash on hand when compared to same time in2017, over budget as far as dues due to early collections, over budget as far as publications. A unanimous votewas passed to accept the report.

ASSEMBLY REPORT Dr Fogelson

Dr Fogelson thanked council members for responding to the access to care surveys sent out earlier this week byMs Thelen. Council members noted that the survey had problems with its content, excessive generalization, theoverall flow and the fact that it was qualitative not quantitative. He noted that he will be sending the feedback men-tioned by members back to the assembly committee he is working with.

MEMBERSHIP REPORT Dr Ijeaku

Membership Report Current Active Membership –927, Total Membership 1100Four new RFMs applied and one GM; all have met the basic criteria for membership. A unanimous vote waspassed to accept the new members.

Dr Ijeaku introduced Dr Wagriech’s idea of sending out letters to training directors to encourage membership oftheir trainees. Dr Wagriech then read the letter to council. Two additional membership benefits were added bycouncil members. This is a follow up to the conversation from last month about ways to increase the member-ship of the organization.

LEGISLATIVE REPORT Dr Shaner

Dr Shaner provided an update about some of the bills that were of interest to CPA/SCPS especially given recentcut-off date of September 30, 2018

—SB 1045; expansion of existing conservatorship laws…signed—AB 1971; expansion of ‘grave disability’…died—AB 2983; voluntary psychiatric care and responsibility of health care facilities regarding transportation…signed—SB 931; conservatorships within the jail system…signed—AB 186; safe injection site bill…died

ADJOURNMENT Dr. Red

Meeting adjourned at 9.05pm

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On November 17th, the Art of Psychiatric Medicine Committee held its comedy event: Laughter is theBest Medicine. SCPS members learned about the history of comedy and tricks for doing stand-upfrom our two guest facilitators, comedians; Andrew Searles and Jim Coughlin. Here are some photosfrom that fun and funny day!

Andrew Searles, Kavita Khajuria, M.D., and Jim Cough-lin

Attendees listen to the history of comedy.

Our own comedians: Drs. Elizabeth Galton, Janet Mar-tin, Sophie Duriez, and Nadia Haddad.

Nadia Haddad, M.D.

Sophie Duriez, M.D.--who does standup in LA. Comedy in action. Our attendees performing an exer-cise.

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California Fires

Capitol Public Radio in Sacramento published this guide to more general Northern resourcesHERE. See Southern California Psychiatric Society Wildfire material HERE under

"L.A. and Ventura County Fires.'

Dear District Branch and State Association Leadership,

This weekend, I sent out a press statement expressing our condolences for the passing of President Bush. Regardless ofyour politics, there is no denying that he brought mental health treatment to the forefront at Health and Human Services.President Bush created the Linkage Initiative that today is embedded in the Collaborative Care model that links primarycare with mental health and substance use disorders treatment. We are grateful for his service to our great nation. Youcan find the full statement here.

Regards,

Saul Saul Levin, MD, MPA, FRCP-ECEO and Medical DirectorAmerican Psychiatric Association

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Photos from the joint meeting of the SCPS and the Southern California Society of Child and Adolescent Psy-chiatry, held on November 7th, 2018, at the home of William Arroyo, M.D. The topic was school violence andthe speakers were Sheryl Kataoka, M.D. and Marlene Wong, Ph.D.

Bullet Points from Assembly Committee on MOC • The May Action paper looking for APA to urge ABPN to revert definition of Board Certification backto pre-1995 definition of being board certified (not requiring MOC) was unfortunately ‘closed’ by the JRCwith no further action. The change in definition of Board Certification that post 1995 requires ‘MOC’ hashad great impact on our psychiatrist members that practice in an institution that requires Board Certifica-tion. • The ABPN MOC pilot program, offered in place of part 3 ten year exam, now has 8800 Adult and2100 Child and Adolescent participants. • The ABMS Vision Initiative results were discussed in which 36K physicians and stakeholders weresurveyed and provided testimony for an appointed committee of ABMS. Results were not surprising in thatthe majority of physicians did not feel that MOC in current form was particularly useful or had mixed feel-ings of its usefulness, and found cost to be number one among the burdens associated with its currentform. • The Committee continues to explore recognition of other paths to serve our members with regardto being recognized as ‘Board Certified’. In light of the recent Department of Justice letter to the state ofMaryland encouraging competition with regard to Board Certification, suggestions were made for APA asour professional organization to recognize other boards such as the National Board of Physicians and Sur-geons and also to consider its own version of Board Certification for APA members. • With regard to the Department of Justice acknowledging with their recent letter to Maryland legisla-ture that ABMS acts as a monopoly for Board Certification inclusive of Maintenance of Certification, thethought of raised of the APA pursuing a lawsuit against ABMS around restraint of trade. • Please encourage your constituents to join the MOC Caucus on their APA profile page if they haveinterest in MOC issues. The Caucus is chaired by Dr. Ranga Ram, Delaware assembly representative.

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DISCLAIMERAdvertisements in this newsletter do not represent endorsement by the Southern

California Psychiatric Society (SCPS), and contain information submitted for

advertising which has not been verified for accuracy by the SCPS.

ALL EDITORIAL MATERIALS TO BE CONSIDERED FOR PUBLICATION IN THE NEWSLETTER MUST BE RECEIVED BY SCPS NO LATER THAN THE 1ST OF THE MONTH. NO AUGUST PUBLICATION. ALL PAID ADVERTISEMENTS AND PRESS RELEASES MUST BE RECEIVED NO LATER THAN THE 1ST OF THE MONTH.

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SCPS OfficersPresident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anita Red, M.D.President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Erick H. Cheung, M.D.Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ijeoma Ijeaku, M.D.Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Galya Rees, M.D.Treasurer-Elect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Michelle Furuta, M.D.

Councillors by Region (Terms Expiring)Inland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . David Seigler,M.D. (2021). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VacantSan Fernando Valley . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Marc Cohen, M.D. (2020). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Matthew Goldenberg, D.O. (2019)San Gabriel Valley/Los Angeles-East . . . . . . . . . . . . . . . . Zaheib Idrees, D.O. (2021)

George Fouras, M.D. (2019)Santa Barbara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vacantSouth Bay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Linda Do, D.O. (2019)South L.A. County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Haig Goenjian, M.D. (2020)Ventura . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Julia Krankl, M.D. (2019)West Los Angeles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Zoe Aron, M.D.(2019). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sophie Duriez, M.D. (2020). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Zeb Little, M.D. (2021). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ariel Seroussi, M.D.(2019)ECP Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patrick Wiita, M.D. (2019)ECP Deputy Representative. . . . . . . . . . . . . . . . . . . . Michelle Meshman M.D. (2020)RFM Representative . . . . . . . . . . . . . . . . . . . . . . . Katherine Unverferth, M.D. (2019). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Eric Wagreich, M.D. (2019)

Past Presidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Heather Silverman, M.D.Curley Bonds, M.D.

Joseph Simpson, M.D.Federal Legislative Representative . . . . . . . . . . . . . . . . . . . . . . Steve Soldinger, M.D.State Legislative Representative . . . . . . . . . . . . . . . . . . . . . . . Roderick Shaner, M.D.Public Affairs Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nadia Haddad, M.D.

Assembly Representatives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . David Fogelson, M.D. (20120) Mary Ann Schaepper, M.D. (2020)Heather Silverman, M.D. (2022) Steve Soldinger, M.D. (2021)

Executive Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mindi Thelen

Desktop Publishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mindi Thelen

CPA OfficersPresident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Robert McCarron, M.D.President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mary Ann Schaepper, M.D., M.D.Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Steve Koh, M.D.Trustee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Melinda Young, M.D.Government Affairs Consultant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Randall Hagar

SCPS NewsletterEditor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Matthew Goldenberg, D.O.

Recurring Featured Writer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kavita Khajuria, M.D.

SCPS website address: www.socalpsych.org

© Copyright 2018 by Southern California Psychiatric Society

Southern California PSYCHIATRIST, (ISSN #10476334), is published monthly, exceptAugust by the Southern California Psychiatric Society, 2999 Overland Ave., Suite 208,Los Angeles, CA 90064, (310) 815-3650, FAX (310) 815-3650.

POSTMASTER: Send address changes to Southern California PSYCHIATRIST, South-ern California Psychiatric Society, 2999 Overland Ave., Suite 208, Los Angeles, CA90064.

Permission to quote or report any part of this publication must be obtained in advance fromthe Editor.

Opinions expressed throughout this publication are those of the writers and do not nec-essarily reflect the view of the Society or the Editorial Committee as a whole.The Editorshould be informed at the time of the Submission of any article that has been submittedto or published in another publication.

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