Virginia newsT H E P S Y C H I A T R I C S O C I E T Y O F V I R G I N I A

SPRING 2013

A MessAge froM the outgoing President

W. Victor R. Vieweg, MD, DLFAPA Outgoing PSV President

In 1850, Henry Clay for the Whig Party and Stephen Douglas for the Democrat Party brokered a com-promise consisting of five bills that defused a four-year confrontation be-tween the Southern slave states and the Northern free states regarding the status of territories acquired during the Mexican-American War (1846–1848). The Compromise of 1850 (temporar-ily) avoided secession or civil war and reduced sectional conflict. However, this compromise left in place slavery and provided no clear guidelines for the introduction or rejection of slavery as new states joined the Union. Those opposed to slavery (“abolitionists”), in general, and/or slavery as a new state joined the Union were left to form a new party that unfolded as the (Black) Republicans and Abraham Lincoln.

A mid-19th Century Rip Van Winkle falling asleep in 1850 and awakening in 1865 (or, maybe, 1965) would surely ask if the consequences of the Civil War, reconstruction, Jim Crow, and the Civil Rights movement could have been accomplished at a lessor cost. The jury is still out on that one—human nature being what it is.

In the mid-19th Century, sadness, anxiety, “nerves” and “nervous break-down” explained much non-psychotic/non-demented behavior/conditions in the field of psychiatry and mental health/mental illness. Melancholia was then a very rare condition. Freud ar-rived in the latter part of this Century bringing with him “anxiety neurosis”.

Depression in the form of Major De-pressive Disorder appeared in 1980 with the arrival of DSM-III and incorporated

much that had been subsumed under sadness, melancholia , anxiety neuro-sis, and nervous b r e a k d o w n . N a r r a t i v e medicine was replaced by checklists with an “atheoretical” under-standing of psychiatric illness as a core feature of DSM-III. Depressive disorders and anxiety disorders were as separate as “apples” and “oranges”.

There is a slow return to recogniz-ing the enormous overlap between depressive disorders and anxiety disor-ders. Much suffering exists outside the rigid confines of DSM-IV (soon to be replaced by DSM-V) and this suffering can be helped by those with training in psychiatry. Below are recent books convincing me, at least, that we need to rethink our psychiatric nomenclature. Could we have arrived at this place in a less costly manner?

Allan V. Horwitz and Jerome C. Wakefield (2007) “The loss of sadness. How psychiatry transformed normal sorrow into depressive disorder.”

Allan V. Horwitz and Jerome C. Wakefield (2012) “All we have to fear. Psychiatry’s transformation of natural anxiety into mental disorders.”

Edward Shorter (2013) “How every-one became depressed. The rise and fall of the nervous breakdown.”

A DISTRICT BRANCH OF THE AMERICAN PSYCHIATRIC ASSOCIATION

How Long Have We Come?

W. Victor R. Vieweg, MD, DLFAPA

Outgoing PSV President

inside this issueVirginia Offers Access to Mental Health Care to Veterans with Post Traumatic Stress Disorder ...... 2

Message from the PSV Incoming President .........................3

Legislator of the Year .......................4

General Assembly Wrap Up ......... 5

PSV Day on the Hill .......................5

Tricky Problems in Psychiatry ............ 6

MSV Needs Your Input .....................7

Senator Northam Talks On Healthcare and Politics .................. 8

NAMI Virginia ............................... 8

Become an APA Fellow ................ 8

In the News ................................ 10

A Bright Spot on the Horizon ........11

VCU Residents are 100% ............11

Area V Council Meeting Recap ... 12

Welcome New Members ............ 12

Treatment of Substance Abuse in the Military ............................. 14

see you this fAll!

PsV fAll 2013Meeting

Advances in Psychiatry Through Molecular &

Genetic ResearchSeptember 20-21, 2013Renaissance Portsmouth Hotel

and Conference Center Portsmouth, VA

Spring 2013 | Virginia news | pSychiatric Society of Virginia PAge 2

Virginia newsT H E P S Y C H I A T R I C S O C I E T Y O F V I R G I N I AT H E P S Y C H I A T R I C S O C I E T Y O F V I R G I N I A

Virginia news

President Rizwan Ali, MD, DFAPA

President-Elect Brian E. Wood, DO, FAPA

Secretary Caroline V. Coster, MD

Treasurer Varun Choudhary, MD, FAPA

Newsletter Editors J. Edwin Nieves, MD, DFAPA

Kathleen M. Stack, MD, DFAPA

Executive Director Stewart A. Hinckley

Association Manager Andrew Mann

Membership Manager Greg Leasure

Financial Services Ken Tweedy, CPA

Director of Information Technology Daniel Gainyard

Manager of Corporate & Educational Support

Matt Van Wie

Graphic Design & Publications Beverly V. Bernard

Psychiatric Society of Virginia

2209 Dickens RoadRichmond, VA 23230-2005

Phone: (804) 754-1200Fax: (804) 282-0090

Email: psv@societyhq.com

www.psva.org

Letters to the editor and editorial contribu-tions are welcome. Submissions may be sent to Jose Edwin Nieves, MD, DFAPA, or to Kathleen M. Stack, MD, DFAPA, via email at jose.e.nieves3@us.army.mil or to kathleen.m.stack.civ@mail.mil. Paid ad-vertising is accepted on a first come, first served basis. To place your advertisement or to request a rate sheet, contact Beverly Bernard at PSV Headquarters via email at beverly@societyhq.com or by phone at (804) 565-6321.

Virginia Offers access tO Mental HealtH care tO Veterans witH POst trauMatic stress DisOrDer

J. Edwin Nieves, MD, DFAPA; Gregory W. Briscoe, MD; Maninder Singh, MD, DFAPA

There are several factors influencing the use of mental health services by vet-erans with Post Traumatic Stress Disorder.1 Among the top three are, in order of influence: veterans’ place of residence and proximity to care, service era and third is the presence of comorbid conditions. It is not surprising that those that live close to where mental health services are provided use them more frequently. In Virginia, thanks to a large VHA/DoD presence throughout the state, it is easier for Virginia veterans to seek and receive mental health care.

This presence is more pronounced around the North-Central and Tidewater parts of the State. In the Tidewater area, the United States Navy Medical Center Portsmouth (NMCP), a large medical and training facility, serves a large number of active duty, dependents and veterans offering several kinds of mental health services. Joint Base Langley/Fort Eustis also has a large footprint as they are home to the First Air Wing Command and the Transportation and Training/Doctrine Commands respectively, they serve a large number of patients both DoD and civilian.

The Veterans Health Administration (VHA) has three large medical centers across the state, each with one or more community-based outpatient clinics (CBOCs) in more distant rural locations. These bring services closer to veterans living in those areas. The increased collaboration between the VHA and DoD to deliver services and the deployment of sophisticated telehealth service net within the VHA hospital network bring the delivery of mental health services closer to the patients’ home as well. In addition, each CBOC extends education and prevention clinical services to veterans and caregivers via home telehealth programs, such as weight reduction, smoking cessation and post traumatic stress disorder family support. The net effect for the patient is reduced travel and improved access to expanded services.

The gracious lifestyle and temperate weather of the Commonwealth entice a large number of active duty service members to make Virginia their permanent home once their service commitments are completed. This accounts for the large number of veterans in the state, around 833,000.2 Many of these retirees remain enrolled in DoD facilities, either because of proximity, preference or both. Many already have built a therapeutic alliance with their providers over time. For those who transition to VHA care, the new OEF/OIF VHA teams facilitate the transition to enrollment and care.

Virginia is home to many veterans from all conflicts and all eras of service, a large VHA/DoD presence in the state ensures that services are accessible. Many of the psychiatrists providing these services are members of this society.

References:1. “Personal Characteristics Affecting Veterans’ Use of Services for Posttraumatic Stress

Disorder” E. Brooks, D. K. Novins, D. Thomas, L. Jiang, Ph.D Vol 63 #9 862-867.2. http://www.va.gov/vetdata/Veteran_Population.asp Accessed 12/14/2012.

Visit www.psva.org for the latest society information

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Rizwan Ali, MD, DFAPA

Continued on page 4

Rizwan Ali, MD, DFAPAAssistant ProfessorDepartment of Psychiatry and Behavioral MedicineVirginia-Tech Carilion School of Medicine & Veterans Affairs Medical Center Salem, VA

With excitement and joy, I report that PSV Spring 2013 meeting was a great success. Thanks to all of you who attended the meeting. We had a re-cord attendance of 110+ registrants. There were few from adjacent states. I know two psychiatrists who came from Greensboro, NC and I also saw Dr. Rob-ert W. Johnson, President Elect of the Northern Virginia Chapter of the Wash-ington Psychiatrist Sociey, in attendance as well. We also had record support from the exhibitors. My heartiest thanks to them for their support because with-out their support we would not be able to do such a grand program.

Our activities started on Friday, March

a Message frOM tHe incOMing PresiDent Of PsV

22, 2013 with a board meeting and then a reception. We presented the Legisla-tor of the Year Award to Delegate Jo-seph Yost of Virginia’s 12th District for his exemplary work and support related to mental health in the state of Virginia.

After morning breakfast meetings, Dr. Vic Vieweg welcomed the audience and asked me to introduce the speakers. It was a pleasure and honor to be able to do that. We were very lucky to have Dr. Eric Platkun as our keynote speaker. Later, Dr. Keyhill Sheorn, President-elect of the Psychoanalytic Society of Virgin-ia presented a case, highlighting the im-portance of empathy and therapeutic alliance, which is needed in our work as psychiatrists. We had a break and thanked our exhibitors for their support. After the break, Dr. Jerome Blackman, current President of Psychoanalytic So-ciety of Virginia, talked about the ‘tricky problems in psychotherapy’ (see page 6 for a recap of his presentation) which was followed by a panel discussion with

very open and candid ques-tions from the audience.

D u r i n g the lunch break, Dr. Vieweg intro-duced State Senator Ralph Northam who is the only physician in the State Senate and is running for Lieutenant Governor. Senator Northam highlighted several pertinent issues related to mental health and gun control laws and answered questions from the audience after his speech. Dr. Vieweg handed over the gavel and president’s pendant to me, as I was installed as President of PSV. I then presented a plaque to Dr. Vieweg for his dedicated services to the organi-zation as an outgoing President.

After lunch the afternoon session began with Dr. John Urbach‘s compre-hensive talk outlining the different forms of psychotherapy, the fact that residency programs especially MCV/VCU is heav-ily invested in training residents in the

PSV Spring Meeting Was a Success!

Fourth year UVA medical students, Drew Matz, Maria Moreno and Elle Sowa join Meredith S. Lee, MD, Geriatric

Fellow at UVA, catch up at the Friday night reception.

During the annual membership meeting at the PSV Spring Meeting, Ralph Northam, MD, State Senator from District 6, answers

questions from the PSV membership after giving a state health-care update while Vic Vieweg, MD, DLFAPA looks on.

Humberto Gomez, MD, DL-FAPA and David Markowitz, MD, DFAPA catch up at the

Friday night reception.

From left: Cal Whitehead, PSV Lobbyist, Kathleen Stack, MD, DFAPA, Ananda Pandurangi, MD, DFAPA, Rama Pandurangi, Shaheen Mustafa, MD and J. Edwin Nieves, MD, DFAPA

From left: Ron Kent, exhibitor with Merck, catches up with John P. D. Shemo, MD, DLFAPA.

Spring 2013 | Virginia news | pSychiatric Society of Virginia PAge 4

art and science of psychotherapy and also highlighted the rea-sons why psychiatrists are shying away from psychotherapy in general after their residency training. Dr. William Nay pre-sented on the importance of training residents in the art of CBT and brought four residents with him who endorsed the fact that training in CBT has broadened their horizons and changed their outlook towards psychotherapy altogether. Fi-nally Dr. Ram Shenoy with Ms. Daphne Weaver presented the role of behavioral psychotherapy in the treatment of patients with intellectual disabilities. All four presenters participated in a panel discussion and answered questions from the audience.

Our membership is getting close to 700 but only 100+ members attend our spring meetings, which is close to 12% of the total membership. Please help us understand what is miss-ing in these meetings and how we can improve our quality and how we can engage more members. My goal for the Fall Meeting is to get attendance up to 50% of the total member-ship; I will call it a success. Please send us your feedback, concerns, topics of interest, things we could improve, etc. This is your organization and without your feedback and support we can never improve or can make a difference. Send your comments to psv@societyhq.com

I am honored to be the President of PSV this year.

A Message from the Incoming PresidentContinued from page 3

James Reinhard, MD, DFAPA, gets a chance to chat with Vic Vieweg, MD, DLFAPA, PSV President.

Delegate Joseph Yost thanks PSV for the recognition and award during the Friday night reception.

YOst is naMeD PsV “legislatOr Of tHe Year”

The Psychiatric Society of Virginia (PSV) has named Delegate Joseph Yost (R-Blacksburg) the 2013 Legislator of the Year. Delegate Yost was recognized and presented with the award at the PSV Spring Meeting reception on Friday, March 22, 2013 in Richmond at the Sheraton Park South.

“Virginia’s psychiatrists and other physicians who care about access to quality mental health care are pleased to watch Delegate Yost take a leadership role so quickly,” re-marked PSV President, Dr. Vic Vieweg. During his first term, Delegate Yost has quickly become a leader on mental health issues in the General Assembly. In 2012, he advocated for and successfully placed $1.2 million in the 2012-14 state budget for crisis assessment centers in Virginia. In 2013, he was success-ful in advocating for new and increased monies for mental health/suicide awareness training, children’s mental health services, discharge assistance planning and additional monies for more crisis assessment centers in the Commonwealth.

In January, Delegate Yost was placed on the Governor’s Task Force for School and Campus Safety as a legislative member as well as a mental health advocate. Delegate Yost is also Chair of the Virginia Health Workforce Development Authority that oversees the creation of a pipeline to direct healthcare professionals, especially mental health, to Virginia’s medically underserved areas.

Speaking on the award Delegate Yost stated, “I am truly honored to be recognized by the Psychiatric Society of Virginia. For many years, advocating for individuals with men-tal illness and their families has been a passion and while we have accomplished a lot over the past two years, much work remains to be done. I look forward to continuing my advocacy for the one in four Virginians struggling with mental illness.” PSV President-Elect Rizwan Ali remarked, “As a psychiatrist in Southwest Virginia, I am particularly pleased that Delegate Yost is able to take his profound interest in access to care to Richmond where he can champion initiatives that will help patients across here and across Virginia.”

Vic Vieweg, MD, DLFAPA, PSV President, presents Delegate Joseph Yost with the Legislator of the Year Award.

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2013 general asseMblY wraP uP

By Cal Whitehead & Ralston KingPSV Government Relations Advocates

The 2013 General Assembly came to a last minute agree-ment on Medicaid expansion that was ultimately decided by budget language.

The budget language consisted of:• Establishment of the Medicaid Innovation and Reform

Commission - Directed to pursue reforms from Centers for Medicare

and Medicaid Services (CMS)• If federal government is unable to pay matching

funds then allows for disenrollment of newly eligible population

• Permission for the Department of Medical Assistance Services (DMAS) to pursue expansion on July 1, 2014 upon approval of Medicaid Innovation and Reform Commission

• DMAS must develop five year forecast for costs and savings with the involvement of outside stakeholders

The Medicaid and Innovation and Reform Commission will consist of five senators, five delegates, the Secretary of Health and Human Resources and the Secretary of Finance. Starting in June, the Commission will hold its first meeting with Delegates John O’Bannon, MD (R – Henrico), Johnny Joannou (D – Portsmouth), Steve Landes (R – Augusta), Jimmie Massie (R – Henrico), and Beverly Sherwood (R – Frederick). The five senators have yet to be named. The Commission will review and oversee reforms that include; quality and costs outcomes, payment reform, service delivery, and benefit design.

While a compromise was made out of the Legislature, Governor McDonnell has once last chance to look at the budget and amend language. While he was pleased with the overall approach to Medicaid expansion, he did want more specific reforms achieved before the Medicaid Innovation and Reform Commission could purpose expansion.

This specific reforms included:• Prevention efforts with a Recovery Audit Contracting

(RAC), data mining, service authorization, enhanced coordination with the Medicaid Fraud Control Unit (MFCU) and Payment Error Rate Measurement (PERM)

• Limited high-performing provider networks and medi-cal/health homes

• Financial incentives for high quality outcomes and al-ternative payment methods

• Improvements to encounter data submission, reporting and oversight

• Standardization of administrative and other processes for providers

• More support of the health information exchange• Funding for a Centralized Call Center for Medicaid

which would provide additional access to the eligibil-ity determination process

The Legislature also included a physician-managed care liaison committee established under DMAS. The committee will consist of physicians, hospitals and other stakeholders

to develop recommendations on the creation of an inflation adjustment formula for reimbursement for physicians partici-pating in Medicaid. This budget language was maintained in the Governor’s amended budget.

2013 PsV DaY On tHe Hill

The Psychiatric Society of Virginia (PSV) participated in its Annual Day on the Hill on Thursday, January 29th. The PSV Annual Day on the Hill had a great turnout this year with three VCU residents, Michael Villania, David Freeman and Arslan Muzaffer, who took the time out of their busy schedules to come to the General Assembly. We would like to thank all those in attendance and invite you to come to Richmond next year and make PSV’s voice be heard.

• Helen Montague Foster, MD • David Marshall Freeman, MD• Arslan Muzaffer, MBBS • Louis Joseph Nardelli, DO• Walter Victor Vieweg, MD • Michael Anthony Villania, MD

Please call Cal Whitehead (804 389-2825) or Ralston King at (804 310-2717) if you have anyquestions.

VCU Resident, David Freeman, MD discusses mental healthcare with Adri-enne Cole, Legislative Assistant to Delegate Rosalyn Dance (D - Petersburg)

while Helen M. Foster, MD, reviews MSV handouts.

Delegate Joe Morrissey welcomes Arslan Muzaffar, MBBS, to his office, while David Freeman, MD, and Michael Villania, MD, look on.

Spring 2013 | Virginia news | pSychiatric Society of Virginia PAge 6

Jerome S. Blackman, MD, DFAPA

Thanks to the Psychiatric Society for asking me to submit this sum-mary of my presentation at the PSV meeting in Richmond on March 23, 2013. That lecture was taken from my book, The Therapist’s Answer Book: Solutions to 101 Tricky Problems in Psychotherapy, which was recently published by Routledge in New York.

The book has 101 chapters, each a few pages long, addressing technique for each of the 101 prob-lems. The presentation covered about a dozen of those problems. Below, I have chosen a few.

____________

Is this Technique “Supportive” or “Interpretive”?A 55-year-old man consulted me because of frustration

with his 80-year-old mother. Even though he had been suc-cessful, had a good marriage, and his grown children were doing well, his mother, each time he saw her, criticized his manners, his work, his wife, and his children. At first, I tried to clarify that his conflict seemed to be between anger and guilt. He responded, “I didn’t come here to get analyzed! I need some advice! What can I tell my mother?”

I decided to change technique, and instead of explain (in-terpret) conflict, give him advice (supportive). I told him if I were him (modeling), I would tell his mother that he is a grown man who is happy except for her; that he cannot stand her criticisms any longer, that he does not deserve them, and that if she did not stop, he would have to stop seeing her. He responded, “Good idea. My father would never have said that. He was such a wimp . . .”

In this case, my supportive techniques of modeling, advice, and exhortation to behavior led to the patient making his own psychoanalytic interpretation: that he had identified (defense) with his passive father, which had caused an inhibition of his speech and assertiveness (another defense) with his mother.

The point is that although we can separate techniques into supportive versus interpretive (explanatory), things are often not so simple.

Medication, Psychotherapy, or Both?There is continuing controversy about when to medicate

(especially depressed) patients versus when to prescribe therapy, versus when to prescribe both.

One way to assess the indications and contraindications to different therapies is to examine “AIRS”: Abstraction ability (understanding symbolism, metaphors), Integrative functioning (tight vs. loose associations), Reality testing, and Self-preservation (suicide attempts or not). If these functions are intact, this is not enough to eliminate possible medication.

Next, we can look at affect tolerance and impulse control (does the patient’s affect overwhelm capacities to think, work,

trickY PrObleMs in PsYcHOtHeraPY get out of bed; are the patient’s eating, sexuality, or destruc-tiveness out of control); capacity for trust (in the therapist); and superego (can the patient be trusted – have integrity, honesty, shame and guilt).

If these elements of mental functioning are also more or less intact, then the “affective disorder” should be treated with understanding conflict (insight-directed [analytic] therapy); if there are deficits in affect tolerance, medications are indicated in addition; if the patient is very mistrustful, “relational” or “interpersonal” supportive techniques are indicated; if the patient’s self-image is unrealistically critical, CBT techniques are indicated.

What is the Alliance and What to Do When Patients Break It?The “alliance” (as described by Greenson) consists of the

duties of both the patient and the psychiatrist.

They must:1. agree on a chief complaint for which the patient wants

the doctor to help2. agree that patient and doctor will only talk to each

other in the doctor’s office3. agree that the patient will pay the doctor’s fee and pay for

missed appointments according to the doctor’s policy.Moreover,

4. the patient must agree to talk5. the therapist and patient agree to start and end on time6. the therapist agrees to offer helpful opinions about the

patient’s pathology7. the patient agrees to give feedback to the doctor

about reactions to the doctor’s statements and about the treatment

When the patient engages in any activity outside of this “frame” (as described by Langs), this affords the doctor a chance to try to understand the breach. With a few excep-tions (such as cases of emergency), in my opinion, any breaks in the frame must be discussed and understood before trying to handle anything else. Much of the rest of my presentation concerned such breaks in the alliance, and tips on how to handle them; here are a couple of examples.

What Can Be Learned From a Broken Frame?A 42-year-old man is experiencing anxiety. History re-

veals he is chronically passive with his wife, saying “Yes, Dear,” when he doesn’t mean it. At work, he is a bulldog.

He brings his own latte to each session (a break in the frame!). I tell him that I think bringing his own drink indicates that he doesn’t like to depend on anyone else, including me (he supplies his own “oral gratification”). He sees this, and adds, “You’ll love this: After my wife tells me to take out the garbage, while I’m walking back through the backyard, I piss on her flower garden.”

We then figure out that he feels asking anyone to pay attention to him is associated with being feminine – which makes him feel ashamed. So, instead, he said “Yes, Dear” – taking care of his wife and feeling masculine, but feeling so angry at her that he “pissed” on her flowers (symbolic of her).

In this case, examination of his bringing his own latte led to our understanding his passivity, and he became more as-sertive with his wife. His anxiety diminished.

Jerome S Blackman, MD, DFAPA

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What about Patients Who are “Too Smart” For Their Own Good?

A highly intelligent, married, 32-year-old woman has read DSM, decided she has a brain-based dysthymic disorder, and needs Wellbutrin in a moderate dose. This is a break in the frame, in that she is not talking about her problems and is ordering me around.

I suggest, with highly intelligent patients, to first argue with them (sup-portive technique) so they will know you are as smart as they are; then point out their intellectualization defense.

So I told her SSRI’s were only indi-cated in some depressions, and that her argument that depression was due to a chemical imbalance was tautological: all mental functioning is caused by the chemical, electrical, and cellular func-tioning of the brain. I then pointed out that I did not yet know what was going on in her marriage. She responded, “I’m an expert at avoiding painful issues. You’re good!”

She had a secondary depression: she was unhappy because her sexual inhibition with her husband was mak-ing him irritable with her, and they were arguing about nothing. That was the beginning of our exploration and under-standing of her sexual difficulty – which had something to do with her husband’s attitudes toward her.

In this case, the patient’s demand for medication before I could perform a psychiatric evaluation (including marital history) was a break in the frame – we had not yet found the chief complaint (sexual inhibition) – and therefore, if I had medicated her depressive affect, we would have established a “misalliance.”

These and other tricky problems make our field difficult. Nevertheless, deciding on indications for medication and/or psychotherapy, and selecting dif-ferent therapeutic approaches based on those indications, can lead to enhanced treatment outcomes and greater career satisfaction for the psychiatrist.

Dr. Blackman is Professor of Clinical Psychiatry at Eastern Virginia Medical School in Norfolk and President of the Virginia Psychoanalytic Society. He has a private practice in Virginia Beach and can be reached at jblackmanmd@aol.com

Russell Libby, MD, FAAP

The 2013 General Assembly session has come to an end. It is amazing how fast the session can come and go, and as usual, there are many lessons to be learned about how we, as physicians, ad-vocate for our profession. Overall, we did quite well with most of the bills that were health-related. That success was, in no small part, due to your participation and I thank those of you who took the time out of your busy schedules to come to Richmond for our White Coats on Call (WCOC) days and everyone who sent messages to your legislators through our grassroots action center. It makes a tremendous difference when our legislators hear directly from you, offering them your perspective on the issues so important to healthcare, protecting our patients and the work that we do. I encourage you to look over the 2013 General Assembly Wrap Up (www.msv.org) to learn more about what happened this year.

Despite our successes this session, it is clear that there are continuing efforts on the part of special interest groups to impose their agenda upon the practice of medicine through the legislature. What is more disconcerting is that we have seen our legislators, from both sides of the political spectrum, conferring upon themselves the authority to determine standards of care and willingly impose mandates that interfere with the patient-physician relationship. We cannot let up and it will be important for us to educate our local legislators on the problems their actions can create for patients, doctors and, ultimately, themselves. You can help by reaching out to them in their home districts throughout the year. We can help you with the message, but only you can make them listen.

MSV provides many ways and resources for you so that you can learn, work with your colleagues from around the state, and help to develop a shared legislative agenda. If you are not already a part of MSV, I encourage you to join so you can take advantage of our e-mail member alerts, MSV E-News, grassroots website, Legislative Summit and Annual Meeting, which are vehicles for action that you should explore and participate in. You do not have to have a formal leadership position; all members are welcome.

Healthcare is changing rapidly and we must be the force that brings the most impor-tant perspective and skills to that process. We will need to be aware of the threats and the opportunities in order to speak and act with a united voice on behalf of healthcare in Virginia. We need to stand true to our mission to make Virginia the best place to practice medicine and receive medical care. Dr. Libby is a pediatrician in Fairfax, VA and has been a MSV member since 1984.

MsV neeDs YOur inPut

The PSV delegation joins Delegate Joe Morrissey in his office on Thursday, January 29, 2013 during White Coats on Call. Pictured from left to right: Michael Villania, MD, Del. Joe Morrissey(D-Richmond), Helen M. Foster, MD,

David Freeman, MD, Arslan Muzaffar, MBBS and Louis Nardelli, DO.

Advertise with PSV and Reach Over 450 Active Psychiatrists!

Do you need help with your practice? Or are you interested in selling an active practice and retire? This is the best way to get the

word out to fellow psychiatrists. PSV produces three issues of the Virginia News yearly.

For inquiries, email Beverly@societyhq.com or call (804) 565-6321.

Spring 2013 | Virginia news | pSychiatric Society of Virginia PAge 8

State Senator Ralph Northam addressed the Psychiatric Society of Virginia (PSV) mem-bership at its Spring Business Luncheon on Saturday, March 23, 2013 in Richmond. Northam, a pediatri-cian and candidate for the Democratic nomi-nation for Lieutenant Governor, discussed the recently conclud-ed General Assembly

session, policy issues for patients and doctors, and the 2013 campaign season.

“We were grateful to hear from Dr. Northam on a number of issues impacting access to health care and the doctor-patient relationship,” outgoing PSV President Vic Vieweg remarked. “As a practicing physician and sitting legislator who has launched a statewide race, he can provide psychiatrists with perspectives that few others can offer.” Attendance for the meeting was its highest ever, with over 100 psychiatrists, residents, and students in the crowd.

Senator Northam remarked, “I enjoy speaking to health professionals, or any group of Virginians, who want to learn more about how laws and regulations can affect health care. My time in the Senate and conversations during my cam-paign for Lieutenant Governor reminds me that everyone has a stake in the health care debate.” Dr. Northam reminded the audience members to meet with their Delegates and Senators to share how laws can impact physician’s practices and patients.

senatOr ralPH nOrtHaM, MD talks On HealtHcare anD POlitics witH Virginia PsYcHiatrists

State Senator Ralph Northam

aPPlY tO becOMe an aPa fellOw

Are you ready to take the next step in your professional career? Being a fellow of APA is an honorary designation to recognize early career members who have demonstrated allegiance to their profession and commit-ment to the work of the APA. Members

who pursue fellow status perceive it as one of the first steps to enhancement of their professional credentials. Members who apply and are approved this year for fellow status will be invited to participate in the Convocation of Fellows and Distinguished Fellows during the 2014 APA Annual Meeting in New York City. The deadline for submitting a fellowship application is September 1. Revised guidelines make it even easier to apply.

Sarah Steadman, MSWDirector of ProgramsNAMI Virginiassteadman@namivirginia.org

The National Alliance on Mental Illness of Virginia (NAMI VA) offers a variety of recovery focused programs designed to address the basic need of individuals diagnosed with mental illness, support to know they are not alone or abnormal and the information to build confidence and awareness. The com-bination of these efforts creates hope for personal recovery. The programs also create the foundation for continued growth and meaningful engagement. Jessica’s story highlights this process.

I mentored my first Peer-to-Peer (P2P) educational program in the Fall of 2012. I was excited and committed to taking on a position of leadership for the P2P program. I had been a participant the previous fall and received so much from it. The material was still fairly fresh in my head, as were my fond memories of the ten Saturdays I spent learning about various aspects of living with a mental illness and taking refuge in the fellowship of peers who, like me, shared their struggles and triumphs and strengthened my one-time, non-existent sense of community.

Of course, since I had never Peer Mentored before, I was nervous going into our sessions. What I quickly found out was that it didn’t matter if I read the materials perfectly every night or if I was a little worn thin from a day at work and not as energetic as I would have liked – our group of dedi-cated participants was there because they wanted to be there, cared about the information we were presenting, and as I had discovered when I was a participant, were invested in each other and the sense of shared experience P2P fosters. As a Peer Mentor, it was really a special thing to watch these bonds develop and see some of the participants grow in comfort and confidence as together, we tackled some pretty heavy issues related to our personal recovery with mental illness. By our tenth week together, the participants were visibly and vocally saddened to see the program end and to have to leave this little community of support and mutual acceptance we had created. So was I. But I was gratified that we, as Peer Mentors, had managed to successfully present the materials and help nurture meaningful bonds among the participants along the way. And because I facilitate the local NAMI Connections Support Group, I hope to see a few of the course graduates at upcoming meetings.

To learn more about NAMI VA programs for both indi-viduals living with a mental health diagnosis, and their family members, please visit our website at www.namivirginia.org or feel free to contact us 804-285-8264.

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PAge 9Psychiatric society of Virginia | Virginia news | sPring 2013

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Spring 2013 | Virginia news | pSychiatric Society of Virginia PAge 10

in The newsCheryl Al-MAteen, Md reCeiVes 2013 Jeanne sPurlOck MinOritY fellOwsHiP acHieVeMent awarD

Dr. Cheryl Al-Mateen, FAACAP, DFAPA, has worked at Virginia Commonwealth University School of Medicine for over 20 years. She is a graduate of Howard University and the Howard University College of Medicine, and completed her psychiatry residency and child psychiatry fellowship at Hahnemann University in Philadelphia. Dr. Al-Mateen is Board Certified in General, Child and Adolescent, and Forensic Psychiatry. She serves as the Director of Inpatient Services at the Virginia Treatment Center for Children (VTCC) of the VCU Health System. She is an Associate Professor in the Departments of Psychiatry and Pediatrics at VCUSOM and serves as Chair of the School’s Multicultural Affairs Committee and Chair of the Clinical Subcommittee of the Curriculum Council. She is Clerkship Director in Psychiatry, and Co-Course master of the Physician, Patient, and Society Longitudinal Curriculum. Dr. Al-Mateen received the VCU Presidential Award for Community Multicultural Enrichment, and the Excellence in Teaching award from the VTCC Trainees. She has also received the Service and Dedication awards from the VCUHS psychiatry residents and from the VTCC Trainees and has received the Outstanding Teacher Certificate Award from VCU medical students. Dr. Al-Mateen serves as co-chair of the Diversity and Culture Committee of the American Academy of Child and Adolescent Psychiatry. She is married to Dr. K. Bakeer Al-Mateen and is the mother of two.

VCu dePArtMent of PsyChiAtry resident uPdAte

Dr. Sameer Hassamal, a VCU Resident and PSV Member in Training will be presenting a Poster at this year’s APA Annual Meeting. The study is on QTc Prolongation and Arrythmia risk in Veterans on Methadone Maintenance. The authors are Sameer Hassamal, MD; Lilian Flores-Stevens, PhD; Antony Fernandez, MD and Victor Vieweg, MD.

The study is a bivariate analysis comparing risk factors to QTc prolongation. Essentially, we looked at the effect of electrolyte abnormalities, liver/heart failure, gender and meth-adone dose on the QTc. We found that individual risk factors do not significantly impact the QTc.

Call for AbstractsPSV is calling all Medical Students, Residents and

Fellows to submit abstracts for the Fall Meeting Poster Session. Deadline for submitting abstracts is August 16, 2013. PSV is especially interested in studies on suicide prevention. There is a $500 prize available for the best study on suicide prevention. APA has also given PSV a grant to promote this activity. If your abstract is ac-cepted you may be eligible for reimbursement of travel expenses. There are no registration fees for Members in Training.

For more information please visit the PSV website: www.psva.org

Send questions to: psv@societyhq.com

PAge 11Psychiatric society of Virginia | Virginia news | sPring 2013

Brian E. Wood, DO, FAPAPresident Elect PSV

We often hear about long standing attempts to attract psy-chiatrists to the rural parts of the Commonwealth and, in fact, many of our members appreciate first-hand the difficulties in recruiting to those areas. The problems inherent in filling rural practice positions are complex and likely reside in many plac-es including financial constraints, practice supports, and even our own attitudes within the medical profession in general. Although recruiting and retention of psychiatrists in Virginia, particularly south-side and southwest Virginia, will likely re-main a challenge for years to come, there are certain bright spots on the horizon that I believe our membership should be aware of. One of these is the consistent production of stu-dents choosing to enter careers in psychiatry from the Edward Via College of Osteopathic Medicine (VCOM) in Blacksburg, VA. VCOM opened its doors in 2002 with approximately 150 students in the first class. As of this June the school will have graduated over 1000 students with over 50 of them having pursued training in psychiatry, consistently exceeding national averages. Not only are many of these students now in the early stages of their careers in psychiatry but many of them are prac-ticing in our state and particularly in areas most in need of psychiatrists. This year’s graduating class will be no exception. Ten students of the class of 2013 will enter psychiatry residen-cies in July representing over 5% of the class, a figure, again, well above national averages.

One might ask, “What is it that makes this school success-ful in producing psychiatrists?” While there are certainly many factors to consider and the school’s strong service mission may be a part of the answer, there are clearly other factors as well. I am convinced that, above all other factors, students choose training based on their personal and professional experiences with mentors and those people that share their interests in ar-eas of medicine where they might consider careers. Those people are us! Whenever we meet students at our confer-ences, serve as mentors or preceptors or even just answer the occasional student inquiry on our email, we are influencing these decisions. Many times we may never know the extent of our influence but it is vitally important that we are there when the possibility of a career in psychiatry crosses that student’s mind. We, then, are all a part of this success.

Our membership and leaders should continue to be mindful of our successes and never miss an oppor-tunity to encourage those students and residents who will become the future of PSV and psychiatry in Virginia. Let us all encourage them and reiterate the importance of dedi-cating ourselves to the service of our patients wherever that might be and however we might do it. Despite the

constantly increasing flow of work and decreasing, sometimes unfair reimbursement, we can all feel good about what we are doing to encourage students to pursue psychiatry in or-der to better serve patients in the future. We are making a difference!

I hope we will all take the opportunity to speak to stu-dent groups, greet students who attend our meetings and consider serving as unofficial or even official mentors. All of us have the potential to make a difference with that student who might just be considering psychiatry. If you have other ideas to improve PSV’s outreach to trainees, please let your board representatives know…we want to help you in helping psychiatry in Virginia.

Brian E. Wood, DO, FAPA was recently elected as the President Elect for the Psychiatric Society of Virginia. Dr. Brian Wood is a graduate of the West Virginia School of Osteopathic Medicine. He completed residency training in general psy-chiatry at Eastern Virginia Medical School and fellowship in geriatric psychiatry at the University of Virginia, Roanoke-Salem program. He has served in numerous academic capacities with the Carilion/University of Virginia Roanoke-Salem Psychiatry Residency Program and geriatric psychiatry fellowship and is a past Director of Residency Training with the program. His current position is as Associate Professor and Chair, Department of Neuropsychiatry and Behavioral Sciences, Edward Via College of Osteopathic Medicine in Blacksburg, Virginia. He also maintains clinical and academic practice in geriatric psychiatry at the Veterans Affairs Medical Center in Salem, Virginia. Throughout most of his career Dr. Wood has been active in the Psychiatric Society of Virginia and Southwest Virginia Chapter currently serving as President elect of PSV. He and his wife, two sons and many animals make their home in rural Botetourt County near Roanoke, Virginia.

a brigHt sPOt On tHe HOrizOn

Brian E. Wood, DO, FAPA

Vcu’s resiDencY PrOgraM JOins tHe aPa’s PrestigiOus 100% club fOr resiDencY training PrOgraMs

With the encouragement of the VCU Staff all of the VCU Residents have joined the APA as Members in Training. They are the first school in the Commonwealth to achieve this rank. Pictured to the left Faculty & Residents from VCU School of Psychiatry receive the Certificate of recognition from Dr. David Moody, PSV Membership Committee Chair. Each Resident will also receive a special gift from the APA. APA will also recognize VCU in the Psychiatric News and on the APA website.

Spring 2013 | Virginia news | pSychiatric Society of Virginia PAge 12

John P.D. Shemo, MD, DLFAPARam Shenoy, MD, DLFAPAAssembly Representatives

The Psychiatric Society of Virginia held another successful “White Coats on Call” day-on-the-hill on January 29, 2013. Included among those who attended were several Medical College of Virginia residents.

Virginia’s adopted budget, which is now before Governor McDonnell, includes several major items related to Medicaid and mental health care.• Establish the Medicaid Innovation and Reform Commission,

which will be comprised of five delegates, five senators, the Secretary of Finance, and the Secretary of Health and Human Resources, who will oversee reforms and potential expansion of the Medicaid program. It is noted that all of these members are either politicians or political appointees with no direct representatives of the medical community.

• Allow the Department of Medical Assistance Services (DMAS) to pursue coverage expansion on July 1, 2014 upon approval of the Medicaid and Reform Commission.

• Direct the state to pursue reforms from the Centers for Medicare and Medicaid Services (CMS) and develop and implement pilot programs that yield cost savings and improve equality. $3.5 million has been earmarked for these projects.

• Allow for the disenrollment of the newly eligible population if the federal government pulls back from its commitment to pay matching funds in effect on January 1, 2014 (100% in the first three years and down to 90% in 2020).

• Require DMAS to develop a five year forecast for costs and savings of expansion and engage stakeholders in how to best meet savings targets.The Psychiatric Society of Virginia supported the establish-

ment of a physician-managed care liaison committee under DMAS which will meet throughout the year and report back to the chairs of the Senate Finance and House Appropriations Committee every fall. As of yet, it is unclear whether this

Committee will, in fact, be established and how it will inter-face with the preexisting and long-standing PSV Managed Care Liaison Committee.

Mental health funding and programs:• $900,000 was appropriated to expand the capacity for

“therapeutic assessment drop-off centers” to provide an alternative to incarceration for people with serious mental illness. Programs that have implemented Crisis Intervention Teams - A Governor’s Taskforce on school and campus safety has been established.The Psychiatric Society of Virginia and the Medical Society

of Virginia together have successfully advocated for stronger safeguards for medical record progress notes in cases where records are shared with campus and local officials. • $500,000 has been allocated for statewide suicide preven-

tion program efforts.• $1,900,000 has been allocated for psychiatry and crisis re-

sponse services for children requiring mental health services.• $600,000 has been allocated to provide mental health first

aid training and certification on how to recognize and re-spond to mental or emotional distress.

• Fifty additional waivers for the developmentally disabled and 200 additional waivers for the intellectually disabled have been established.

• $750,000 has been allocated for discharge assistance funds for patients ready for discharge from state run facilities to allow the establishment of support systems.Just an item of interest: Beginning on January 1, 2013 the

standard mileage rates for the use of a car as established by the Internal Revenue Service are as follows:

* 56.5 cents per mile for business miles driven.* 24 cents per mile driven for medical purposes.* 14 cents per mile driven in the service of charitable

organizations.Which of these groups makes the largest political

contributions?

recaP Of area V cOuncil Meeting HelD MarcH 16 – 17, 2013

WelCoMe to our neW MeMbers

GENERAL MEMBER

Joshua K. Chandy, MD ............................................. Richmond, VARobert Dean, MD, PhD ........................................... Blacksburg, VA Varuna Joshi, MD, MBBS.................................................Salem, VA Timothy J. Kane, MD ................................................ Fisherville, VA Mohd Aleem Khan, MD ..............................................Danville, VA Venkata Mukkavilli, MBBS .......................................... Ashburn, VA Mahmudur Rabbi, MD ...............................................Culpeper, VA Sofia Rizwan, MD ....................................................Springfield, VA William Rodriguez Cartagena, MD .........................Chesapeake, VA Robyn M. Treadwell, MD ............................................. Norfolk, VA Cynthia N. Wilson, MD ............................................. Manassas, VA Kimberly A. Woodyard, MD, MSW .......................... Richmond, VA

MEMBERS IN TRAINING

Amara Chudhary, MD, MBBS ......................................Roanoke, VAAaron C. Clark, MD.........................................................Salem, VA Joseph M. Otonichar, DO...................................Charlottesville, VA Bhuvaneshwao Pagadala, MD, MBBS..........................Roanoke, VA Anuradha Sekhri, MD, MPH, MBBS ............................Roanoke, VAJagdeep S. Wander, MD, MBBS .......................................Salem, VA

PAge 13Psychiatric society of Virginia | Virginia news | sPring 2013

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Spring 2013 | Virginia news | pSychiatric Society of Virginia PAge 14

Keisha McFarlane, MD, LT MC USN

Unfortunately, as with the civilian population, substance abuse issues are a problem in the military. Secondary to the need to provide for service members and their dependents who sacrifice so much for their country on a daily basis, an outpatient program that focuses on sub-stance abuse issues, as well as any other mental disorders contributing to sub-stance abuse, was born. The Substance Abuse Rehabilitation Program, or SARP, at the Naval Medical Center Portsmouth is one of only two programs in the Department of Defense that offers resi-dential programs for substance abuse. According to LCDR Michael J. Franks, Department Head of SARP since July 2012, a licensed independent provider will first screen an individual for any substance abuse disorders along with any other psychiatric illness. Then, treatment recommendations are guided by the American Society of Addiction Medicine Patient Placement Criteria.

treatMent Of substance Misuse in tHe MilitarY

There are four levels of treatment provided at SARP. Level 0.5, also known as Early Intervention (IMPACT) focuses on early prevention. These are for in-dividuals who are at risk for substance misuse, but do not currently meet cri-teria for a substance use disorder. This is a twenty hour course. The next level of care would be Level I, also known as Outpatient. This is an eight day course that focuses on different aspects of an individual’s life that might contribute to his or her belief that he or she can only function with the use of a substance. Level II, also known as the Intensive Outpatient program, is a three-week program in which patients are educat-ed, offered treatment, and are able to apply the skills that they have learned to their normal environment. Level III is the highest level of outpatient care and unlike Level II does provide housing to its participants. It offers the same treat-ment as Level II, but it is a five-week program for individuals who have

problems related to family and home environments, and transportation.

Secondary to recovery being an on-going process, there are services offered to the individual once they complete the various levels of SARP. There is the Continuing Care and Aftercare Program in which the individual is encouraged to attend recovery groups. There is also the Navy My Ongoing Recovery Experience (MORE). It is an exclusive, secure, confi-dential online program of recovery.

How effective has SARP been throughout the years? Just look at the numbers. Over ninety-five percent of patients who begin in the various levels of SARP treatment complete the initial phase of the program. Local statistics show a recidivism rate for an individual who has had at least some level of Navy SARP treatment to be approximately 16% across the board. Individuals that have completed the program find it very helpful on the road to recovery. Therefore, as it has been an asset to the military in years past, its record in-dicates its effectiveness in the years to come.

PAge 15Psychiatric society of Virginia | Virginia news | sPring 2013

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Spring 2013 | Virginia news | pSychiatric Society of Virginia

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