News

The Health and Incarceration Connection (HIC) student group at the University of Rochester School of Medicine was recently awarded an AΩA 2021 Medical Student Service Leadership Project Grant for their grant application titled "Health and Incarceration Connection: A Community-Centered Leadership Collaborative." The Health and Incarceration Connection (HIC) student group was formed in 2019 to educate medical students about the specific health needs of people who are currently or formerly incarcerated. The grant has been awarded to allow HIC to grow and expand its mission and community impact. HIC aspires to build a coalition between individuals who are currently and formerly incarcerated and community allies that is co-led by medical students and people with lived experience in Rochester, NY.

In fulfillment of the grant, HIC aims to accomplish the following:

1. Create a pilot program that matches individuals who are currently incarcerated in Monroe County Jail to the aforementioned coalition of people with lived experience and allies
2. Develop an effort to make a sustainable addition to the medical school curriculum, in partnership with community members who are formerly incarcerated, to strengthen education on the connections between health, incarceration, and race, and
3. Build a sustainable community alliance partnership that works against individual and structural biases in healthcare and centers advocates for the needs and ideas of community members in decision-making processes.

Faculty mentors of the grant include Dr. Diane Morse (primary faculty mentor), Dr. Natalie Whaley, Dr. Michael Mendoza, and Dr. Kristin Doughty. Community mentors of the grant include Matthew Petitte.

After taking a break last year due to the pandemic, we're excited to share that the Mental Health and Wellness Family Room sponsored by Ronald McDonald House Charities of Rochester, NY Inc. has officially reopened on the ground floor of our Strong Memorial Hospital location!

In Phase I of reopening, the room will be open Tuesday, Wednesday, and Thursday from 8 AM -- 5 PM. Families and guardians of pediatric patients can stop by for respite and laundry services.

Social distancing protocols will still be in place and families will need to sign a COVID waiver when they enter.

Last week, we were excited to celebrate our graduates and their families in our hybrid virtual and in-person ACGME Residency and Fellowship Graduation Ceremony.

Tziporah Rosenberg, PhD, Director for Training and Education, says, " The evening was such a breath of fresh air for those of us who have longed for connecting and the "normal" highlights of our year, with end-of-year and graduation events being a true highlight. The program was chock full of rich stories about our graduates, their growth and evolution over the course of their time with us, and the promise of what's next for each of them. . . . I can say with confidence that it was an evening replete with funny stories, touching reflections of appreciation, and heartwarming goodbyes."

In addition, we celebrated our faculty and education team who were selected by the graduates themselves along with our educational leadership.

Congratulations to all our graduates! We're excited to see your next steps in your journey as healthcare professionals!

The Clergy Mental Health Collaborative, a collective of pastors facilitated by John S. Walker, MDiv, PhD working together to address issues critical to the community, will be holding a virtual event on May 1st from 9 AM to noon titled A Discussion of the Needs and Concerns for Suicide Prevention in the Black, Latino, and Wider Communities. The event will feature our very own Eric Caine, MD, alongside April Aycock, EdD, Director of the Monroe County Office of Mental Health, Minister Earl Greene, MA of the Children's Institute, Rudy Rivera, Executive Director of the Fr. Laurence Tracy Advocacy Center, and Melanie Funchess, President of Ubuntu Village Works, LLC. ASL and Spanish translation available.

Psychiatry's Education Committee recently supported an educational collaboration between the Department's nursing educators and the School of Nursing for suicide prevention skill training for the Psychiatric Mental Health Nurse Practitioners students. Throughout the fall, 2020 and winter of 2021 twelve students engaged in two individual simulations in the Skills Lab with standardized patients who provided feedback on suicide specific skills. Joanne Bartlett and Julia Mitchell were project co-leads along with Dr. Susan Blaakman (URSON PMHNP Program Specialty Director) and additional faculty, including Dr. Kate Tredwell, who provided didactics and clinical mentorship. In addition to enhanced observed skills, students' knowledge, attitudes and satisfaction were assessed. The ability for the Skills Lab to provide a telehealth platform was particularly valuable during COVID but also because the PMHNP program is comprised of non-traditional distance learners. Dr. Blaakman emphasized that "it is vital to provide learners meaningful ways to develop essential competencies during their clinical education, and the Skills Lab telehealth experiences were ideal for addressing our distance students' diverse learning needs."

Student participants provided feedback on the experience. Erica Boccia, pictured left below during an encounter with a Standardized Patient (with permission) stated:

"As a soon-to-be new graduate, I can honestly say I have only encountered one person who was actively suicidal in the 3 years I had been working in mental health. These types of practice opportunities and immediate feedback are important to the reduction of harm for our patients. Being able to have a no-risk trial with prompt constructive feedback, may be the thing that saves a life later. I appreciate this being included in our program and really believe this to be incredibly useful to PMHNP students!"

Princewill Fonta, pictured right above during an encounter with a Standardized Patient (with permission) provided this reflection:

"…she made the session look so real. Her feedback regarding my performance was a good educational session, which is a step moving forward regarding my interview skills. I have never had the opportunity for patients assessing and giving me feedback regarding my performance. So the standardized patient experience was a good tool to help assess my rapport with patients, my skills, my engagement during the assessment process and if I`m asking the questions correctly."

With the success of this project, the URSON faculty are eager to pursue ongoing options to collaborate and to explore inter-professional learning opportunities through the Skills Lab.

Please join us in welcoming Serina Tetenov, PhD, LCSW-R to her new role as Director of Adult Ambulatory Services.

Dr. Tetenov comes to us with a great deal of clinical, teaching, and administrative experience. Prior to joining the University of Rochester Medical Center Department of Psychiatry, Dr. Tetenov served in the role of Director, Finger Lakes Area Counseling and Recovery Agency Outpatient Mental Health Clinic for Monroe and Yates counties. Within this role, she has provided group and clinical supervision, overseen the onboarding of new hires, developed and implemented policies and procedures, assisted the clinicians in meeting productivity targets, and built strong clinical teams.

In addition to her administrative role, Serina has taught courses at the University of Rochester -- Margaret Warner School of Education. Courses taught include Counseling Practicum, Counseling Theory and Practice, and Counseling Communication Skills. She also taught Social and Cultural Diversity at Medaille College -- Rochester campus. She has also spent a significant number of years providing care management and clinical care to varied patient populations. She has worked within Strong system- in the Comprehensive Psychiatric Emergency Program, Adult Partial Hospitalization Program, and Highland Hospital. She has also worked in the Rochester Regional Health mental health service areas.

On April 15th, we will celebrate our third annual Psychology Day here at URMC. Coinciding with the 14th Annual Psychology Day at the United Nations, this day honors the work of our psychologists and trainees across the UR system -- in primary care, pediatric specialties, inpatient units, surgery, women's health, outpatient mental health settings, and more. Thank you psychologists and psychologists-in-training for all you do for our patients, their families, our community, and our healthcare system at large! As part of our celebration, we'll be highlighting pictures of our psychologists on social media. Please check out our platforms and join us by using the hashtags #PsychologyDay2021 and #PsychDayUN2021. Thank you for your support and enthusiasm!

The Bridge Art Gallery and Pediatric Behavioral Health and Wellness Outpatient Services' Racial Justice Initiatives Group invited youth from the Rochester area to respond to calls for action for racial justice across the nation and in our own community for their current art show, Youth for Racial Justice: Not a Moment, but a Movement. This show was held with support from the William and Mildred Levine Foundation and Golisano Children's Hospital. A virtual reception celebrating the artists was held on March 18th.

Watch a recording of the reception below!

• Anthony Pisani, PhD, Wendi Cross, PhD, Jennifer West, PhD, Hugh Crean, PhD, and Eric Caine, MD published an article analyzing video-based suicide prevention training in primary care, focusing on the effectiveness and implementation in the workspace, and how training may be improved.
• Ian Rockett, PhD and Eric Caine, MD were among the authors on this study examining national trends of suicide rates and self-injury mortality (SIM) rates, which include suicides and accidental fatalities from drug self-intoxication.
• Catherine Cerulli, PhD led this paper published with University of Rochester Department of Psychology and University of Minnesota faculty members discussing the creation of the Translational Research that Adapts New Science FOR Maltreatment Prevention Center for research and intervention. Sheree Toth, PhD was also a coauthor on this paper.
• COVID-19 has had a profound effect on mental health- amplifying feelings of fear, anger, and sadness. In this Mayo Clinic Proceedings publication, Mark Oldham, MD, Andrianna Hitchins, MD, and Mark Nickels, MD discuss strategies for clinicians to mitigate the effects of trauma.

• Yezhe Lin, MD and Paul Geha, MD were coauthors on this preliminary study in Molecular Pain looking at the effects of long-term opioid analgesic treatment on brain structure and function in patients with chronic back pain.

• Several Department of Psychiatry faculty members, alongside Martha Bruce, PhD of the Geisel School of Medicine, published a paper in the American Journal of Geriatric Psychiatry synthesizing research discussed during a workshop hosted by the National Institute of Mental Health on social disconnection and late-life suicide.

• Kenneth Conner, PsyD, MPH, Benjamin Chapman, PhD, MPH and Yeates Conwell, MD published this paper developing a checklist to assess the quality of psychological autopsy studies, which assess risk factors for suicide. The checklist combined items from a previously validated checklist with new items and displayed high inter-rater reliability.

• Wilfred Pigeon, PhD was a coauthor on a publication in Life Sciences assessing strategies used by veterans to manage Gulf War Illness, and their perceptions of how successful they are. Many of the self-management strategies that were effective were also consistent with clinical practice guidelines.

• In the past 15 years, there has been an increased focus on oculomics in schizophrenia research. Steven Silverstein, PhD, and Brian Keane, PhD join Philip Corlett, PhD of Yale University in a discussion of the reasons for this increase and its implications on schizophrenia research.

Coordinated by Laura Inclema, MS, RN-BC and Telva Olivares, MD, our ambulatory psychiatry nursing team and the ambulatory provider group held two Mobile Vaccine Clinic days in order to provide COVID-19 vaccinations for at-risk patients enrolled in Office of Mental Health or Office of Addiction Services and Supports programs.

This mobile vaccination clinic was held in partnership with the Finger Lakes Vaccine Hub and East House. In just two days between two vaccine sites, the Mobile Vaccine Clinic was able to provide vaccines to almost 400 individuals in the Rochester community. Thank you to everyone that helped with this effort including, but not limited to, identifying and scheduling eligible patients and assisting with paperwork! Pictured are Laura Inclema, Kerry Uebelacker, Courtney Blackwood, Stephany McClure, Margaret Marcello, Telva Olivares.

• Robert Weisman, DO, Gretchen Foley, URMC and Joseph Richard Ciccone, MD published a book chapter in The Wiley International Handbook on Psychopathic Disorders and the Law, 2nd Edition discussing competence to stand trial and psychopathic disorders.

• This study from several members of Psychiatry examined the effects of a brief version of cognitive behavioral therapy for insomnia. Decreases in both insomnia and co-occurring depression were observed over the first two sessions.

• Adam Simning, MD, PhD and Yeates Conwell, PhD were coauthors on this paper published in the Journal of the American Geriatrics Society looking at care-partner support and its effects on hospitalization in individuals in assisted living.

• Todd Bishop, PhD, Hugh Crean, PhD, Jennifer Funderburk, PhD and Wilfred Pigeon, PhD published this article examining the effects of a brief, four-session version of cognitive-behavioral therapy for insomnia.

• Wilfred Pigeon, PhD was a coauthor on a Journal of Allergy and Clinical Immunology: In Practicearticle looking at relationships between atopic dermatitis and sleep disorders, methods for assessment and therapies.

• Erinn Duprey, PhD led a study in Child Abuse and Neglect examining the relationship between child maltreatment, recent stressful life events, and suicide ideation through a stress sensitivity hypothesis.

• Thomas Gift, MD led a study in Journal of Psychiatric Research on the psychometrics, clinical utility and implications of the Wender Utah Rating Scale for ADHD.

• Jennifer Funderburk, PhD and Wilfred Pigeon, PhD published a paper in the Journal of Affective Disorders examining the effectiveness of a brief version of behavioral activation designed for primary care at reducing symptoms of depression in veterans. BA-PC was associated with reduced depressive symptoms and improved mental health and quality of life.

• Mark Nickels, MD was a coauthor on this study with colleagues from the University of Rochester Medical Center Departments of Internal Medicine & Cardiology as well as Eastman School of Music on the potential of musical improvisation to decrease negative thoughts and distress of labile hypertension.

• Thomas O'Connor, PhD was a coauthor on this paper examining the association between breastfeeding and children's neurodevelopment while accounting for the effects of prenatal depression.

• Elizabeth Karras, PhD led a study examining factors that contribute to failed suicide prevention messaging among veterans. During interviews with veterans, participants identified barriers to effective suicide prevention messaging such as language, images, and communication strategies.

• Wilfred Pigeon, PhD was a coauthor on this study examining the association between sleep disturbances and radiation therapy induced pain in breast cancer patients. Results showed that patients who experienced sleep disturbances before radiation treatment experienced more pain after radiation treatment.

• Elizabeth Karras, PhD was a coauthor on this paper evaluating veterans' opinions about discussing firearms storage safety (FSS) during primary care visits. Participants in this study supported the discussion of FSS during primary care visits but advised primary care staff to provide rationale for FSS discussions.

A new injury mortality study, published by Lancet's EClinicalMedicine, exposes a mental health crisis that has unfolded across the United States over the past two decades, with study data having direct implications for suicide prevention efforts.

Suicides by drug self-intoxication are more difficult to determine for medical examiners and coroners in the U.S. than suicides that result from behaviorally and forensically obvious methods, such as death by firearm. Measuring self-injury mortality (SIM)—suicides plus estimated "nonsuicide" drug self-intoxication deaths—circumvents misclassification and more accurately accounts for fatal self-injuries.

Using this broader definition of suicide paints a drastically different picture. Counting suicides alone as the measure of fatal self-injury in the U.S. emphasizes only a high rate in western states. Yet measuring self-injury mortality, this new study describes a burgeoning national mental health crisis that actually encompasses all four major geographic regions (Northeast, Midwest, South and West).

Leading the study is Ian Rockett, Ph.D., of West Virginia University and the University of Rochester Medical Center. Co-investigators include URMC's Eric D. Caine, M.D., and Hilary Connery, M.D., Ph.D., of McLean Hospital and Harvard Medical School.

"Despite victims sharing many common risk factors, suicide and drug overdose deaths tend to be treated separately in the scientific literature, media, health care system, and by funding agencies and prevention programs," Rockett said. "Among these risk factors are unemployment, family discord, unmanaged and mismanaged physical pain, and various psychiatric disorders that include alcohol and other substance use disorders."

Rockett emphasized that, "While most people dying by overdose may not have intended to die, they were engaging in repetitive, intentional, self-injurious behaviors that they understood markedly increased their chances of dying prematurely. Calling these deaths 'accidents' (the forensic classification most often used in the U.S.) or 'unintentional' (the term used by the Centers for Disease Control and Prevention) mischaracterizes what occurred, even if it is consistent with the classifications used by medical examiners and coroners."

The research team tapped into cause-of-death data for all 50 states and Washington, D.C. from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research. After broadening the SIM definition, they found the national annual average percentage change in the SIM rate was 4.3% versus 1.8% for the suicide rate.

Early data indicate the Covid-19 pandemic is exacerbating the situation.

"Opioid and other drug-overdose deaths continue to rise in spite of medical efforts to make life-saving medications for opioid use disorder available to patients and communities," Connery said. "Many persons suffering drug use disorders become hopeless—they relapse frequently, continue to experience relationship losses, health consequences, and economic instability, and they frequently suffer other mental disorders, such as depression, post-traumatic stress disorder, and other anxiety disorders. We know that people with addiction have 10 times the rate of suicide compared to those without addiction."

Caine underscored that this work has major implications for future suicide prevention efforts. It is especially important to deploy programs "upstream" when groups and individuals can be helped with fundamentally distressing problems long before they ever become suicidal, he said. Recognizing a patient's full story -- risk factors, long-term health history, socioeconomic experiences -- is key to providing lifesaving, comprehensive care.

"The ultimate goal must be to prevent premature death," Caine said, "whether by suicide or fatal overdoses, or from the many systemic medical conditions that arise from the same group of risky, damaging behaviors."

The University of Rochester Medical Center is launching a new center to study the relationship between emotional well-being and dementia-related diseases, such as Alzheimer's.

Ample research has uncovered links between emotional well-being in older adults and Alzheimer's disease and related dementias. But little is known about the direction of the relationship.

The Network for Emotional Well-Being (NEW) and Brain Aging is a collaboration between researchers from the UR School of Nursing, the Del Monte Institute for Neuroscience, the Department of Psychiatry, the UR Aging Institute and their colleagues at other universities across the country. It is one of five networks funded by the National Institutes of Health (NIH) to examine the topic from different angles.

The NEW Brain Aging Center at URMC, established with a four-year, $2.5 million grant from the NIH's National Institute on Aging, will focus on clarifying two separate mechanistic relationships: the impact of an aging brain on emotional well-being in older adults, and the influence of emotional well-being on brain function and cognitive aging.

"People have been studying aspects of emotional well-being, such as how to be happy or finding a purpose in life, for hundreds of years. But in terms of understanding how emotional well-being is linked to aging and dementia pathologies, this is really new. Nobody has studied it in this way," said Feng Vankee Lin, PhD, RN, Marie C. Wilson and Joseph C. Wilson Professor in Nursing and associate professor of nursing, neuroscience, psychiatry, neurology, and brain and cognitive sciences, who is the principal investigator on the grant.

"Fully 30% of the patients we see in our system, in inpatient and ambulatory settings, are older adults. They are the fastest growing segment of the population and the most frequent consumers of health care," said Yeates Conwell, MD, professor of psychiatry, who is a lead investigator on the grant. "The UR Aging Institute, now with the addition of NEW Brain Aging, will help meet the challenge of assuring not only the health care needs of our older patients are met, but that the quality of life is optimized, as well."

The NEW Brain Aging Center will be guided by an eight-member executive committee made up of researchers from four universities (University of Rochester, Duke University, Johns Hopkins University, and the University of California Santa Cruz), headed by Lin, Conwell, and Kuan Hong Wang, PhD, professor of neuroscience, who is also a lead investigator. "We knew we needed to know more about the link between emotional well-being and aging, but the COVID-19 pandemic has put a particular urgency into understanding this relationship," Wang said. "The pandemic is a stressor particularly threatening to older adults. Some people are already having either mild cognitive impairment or are having Alzheimer's disease progression. This center will hopefully lead us to a better understanding of the interplay between emotional well-being and aging brain diseases."

Other URMC co-investigators on the committee include Benjamin Chapman, PhD, MPH, an associate professor of psychiatry, and Jianhui Zhong, PhD, a professor of imaging sciences. Together, the group will organize activities around five core areas: investigator engagement, strategic priority workshops, a resource repository, evaluation, and pilot project grants. All of the core functions will serve to disseminate the products of the network.

Building an inter-university and transdisciplinary network of investigators with complementary areas of expertise is crucial, said Lin, noting that the network will take a cross-species approach and conduct research on both human and animal subjects in order to broaden understanding of brain mechanisms and develop therapeutic targets for addressing aging-associated concerns of emotional well-being.

Using behavioral and brain imaging measures in animal models and comparing those findings to humans, researchers will look to match the observable biomarkers in both, ultimately linking those back to the emotional states. "There are technical challenges to this, we must consider the constraints of the evolutionary distance between the different brain systems, and there must be constant dialogue between the human and animal researchers," Wang said. "But if we do this, it will allow us access to a more subjective aspect of emotional well-being, something that has not been achieved before."

Alzheimer's disease and other related dementias affects more than 5 million people in the U.S. and more than 47 million people worldwide, according to the NIH. There are no known treatments to prevent or stop the progression of dementia, and the toll on individuals, caregivers, and society will continue to increase as the population ages unless effective interventions can be developed.

Previous research has established an association between emotional well-being and select aspects of Alzheimer's and other forms of dementia, but it's unclear whether dementia pathologies are a cause, byproduct, or consequence of declines in mental and emotional health.

"Many people don't realize that older adults on average are more satisfied with their lives than younger people, in spite of the inevitable stressors that aging brings," said Conwell. "NEW Brain Aging will help us understand the neural mechanisms underlying that resilience and yield insights into how best to help those who are in distress."

"The objective of the network is to engage a wide range of investigators in collaborative thinking and research in order to build the field," said Lin. "We want to be the leaders in the study of the neuromechanisms of emotional well-being and accumulate resources, data, and expertise that can then be provided to networks or other individuals interested in further developing this area of research."

This past August, April Aycock, Ed.D, MS, LMHC, CASAC achieved the educational milestone of completing her doctoral degree in executive leadership from St. John Fisher College. Dr. Aycock has now decided to take the next big step in her career and accepted the position of Office of Mental Health Director for Monroe County. Although we are saddened she has been recruited away from Strong Recovery and the Department of Psychiatry, we are extremely proud to have one of our own fulfill this vital role in our field for the entire county. April has 13½ years of experience in various mental health and substance use disorder (SUD) treatment settings. Her experience across the behavioral health spectrum will be of great benefit to our field and the community.

For the past year and a half, April has led the development and operations of our newest Strong Recovery clinic to provide specialized services for adolescents and young adults (AYA). Prior to the implementation of AYA, she led the integration of SUD services within our Department's Child & Adolescent Outpatient clinic (at the time at Science Parkway) for about 2 years. In her role as Clinical Coordinator of the AYA clinic, she continued to provide supervision and consult for integrated adolescent SUD services in our department. April joined Strong Recovery and the University of Rochester almost 5 years ago and her passion for adolescent co-occurring disorder services was the driving force behind the development of our AYA clinic. Although she is moving on to the next stage of her career, her legacy remains in the clinic as we continue to grow adolescent services. April's contributions to the Department of Psychiatry also expands to her advocacy for improving diversity in our system as a member of the DICE Board. Although we will surely miss her numerous contributions to Strong Recovery and Psychiatry as a whole, we are very happy for her advancement to this new leadership appointment with Monroe County.

April's last day with us will be 2/19/21. After that date, Julie Achtyl will manage interim coverage for AYA clinic and can be reached for clinical operations issues until a permanent replacement is announced. Please join me in congratulating Dr. April Aycock on this momentous appointment and wish her the best for the significant work ahead as we continue to transform behavioral health services in our community!

Peter A. Wyman, PhD and colleagues have been funded by the Department of Defense for 15 months to prepare their Wingman-Connect Program (W-C)-- a universal suicide and depression prevention program--for expansion into operational Air Force bases.

The W-C Program is a new military suicide prevention program focused on strengthening unit cohesion, shared purpose, and healthy relationships through a six-hour group training. In comparison to current military suicide prevention programming which focuses on high-risk groups, the W-C Program targets the full population of Air Force trainees across the continuum of risk.

A recently completed cluster randomized controlled trial with 1,485 Airmen in 215 technical training classes found W-C reduced suicidal ideation, depression symptoms, and occupational fitness problems for Airmen during training (1-month follow-up); reduced depression extended into 1st base assignment.

• Steve Silverstein, PhD was a coauthor on this paper in The Journal of Nervous and Mental Disease investigating the effect of reinforcement learning on attention shaping in people with schizophrenia.

• Anton Porsteinsson, MD was a coauthor on a paper published in the American Journal for Geriatric Psychiatry examining the neurobiologic mechanisms for treating apathy in Alzheimer's disease with Methylphenidate.

• Elizabeth Karras, PhD was a coauthor on a paper published in Drug and Alcohol Dependence looking at mortality risk in veterans that have experienced a prior nonfatal opioid overdose.

• Anton Porsteinsson, MD was a coauthor on this study published in the American Journal for Geriatric Psychiatry comparing two instruments used to measure the diagnostic criteria for apathy in Alzheimer's Disease.

• Steve Silverstein, PhD was a coauthor on a paper published in Clinical Ophthalmology discussing unmet mental health needs and treatment options for individuals with vision loss.

Catatonia can be challenging to assess for a variety of reasons, but perhaps the most pressing reason of all is that comprehensive educational materials on catatonia assessment simply have not existed. Our Collaborative Care and Wellness Division recently partnered with Andrew Francis, PhD, MD, senior author of the Bush-Francis Catatonia Rating Scale (BFCRS), to create free online training resources for trainees and psychiatrists on using the BFCRS to assess for catatonia.