PSYCHIATRISTVolume 66, Number 5 January 2018 Newsletter of the Southern California Psychiatric Society

The year just ended was notable for the number of immensely destructive natural disastersthat befell the United States and several neighboring countries. Hurricane Harvey struck Hous-ton and surrounding areas, causing devastating flooding. Soon after, another huge storm, Hur-ricane Irma, devastated Puerto Rico, the Virgin Islands and several Caribbean nations andcaused significant damage in Florida. October saw massive wildfires strike Northern Califor-nia. You can read about our CPA colleague and current Northern California Psychiatric Soci-ety President Dr. Firdouse Huq’s experiences with those fires in the November 17th edition ofPsychiatric News. Finally, in December, a series of huge fires struck in several southern Cal-

ifornia counties, including the Thomas fire in the Ventura area, which ultimately became the largest fire in Cali-fornia history. It is very hard to believe that all of these catastrophic events occurred over the course of just afew months.

For anyone wanting to contribute to disaster relief efforts, it is a fairly simple matter in our technologically con-nected age. You can donate money when you are checking out at some grocery stores. A quick Internet searchwill show that local chapters of a number of major national charities are currently working in the affected areas,including the Red Cross, the Salvation Army, and the United Way, as well as chapters of the Humane Societyand other animal welfare organizations; all are welcoming donations currently. If you want to volunteer yourtime, some of these same organizations are accepting volunteers – although it may take more searching onlineto find out when and where to go than is the case for sending monetary donations. But people are figuring it outand doing what people so often do in times of crisis: one news article I read reported that the Central Coastchapter of the Red Cross has had so many volunteers that in mid-December they were holding orientationstwice a week in Ventura and Santa Barbara.

Many of us will meet patients whohave been affected by one of thenatural disasters of 2017. As men-tal health professionals we under-stand the deleterious effects thattraumatic events of all kinds canhave on mental health. But thisyear is different because in additionto patients, some of you readingthis Newsletter have friends andfamily members who have been af-

(Continued on page 2)

Best Wishes for a Happy and Healthy 2018

P r e s i d e n t ’ s C o l u m n

Joseph Simpson, M.D.

January 2018

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

Considerations for Psychiatry and

Electronic Health Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Child Psychiatry: An update regarding youth involved

with child welfare and probation . . . . . . . . . . . . . . . . . . . . . . .7

World Wonders and

the Mental Health Benefits of Awe . . . . . . . . . . . . . . . . . . . . .10

Christmas at the Movies: I, Tonya . . . . . . . . . . . . . . . . . . . . . .12

Council Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Southern California

2

fected by the fires, or have been impacted yourself. If that is the case, please try to make time for your own heal-ing, and try to avoid diving in to helping others to such a degree that you neglect to care for yourself.

For anyone affected by the recent calamities, our thoughts are with you. Here’s hoping Nature will not be sobusy in 2018.

Advertisement

SCPS Member, Michael Blumenfield will be the recipient of the 2018 American Psychiatric

Association (APA)

Bruno Lima Award in Disaster Psychiatry.

The APA Bruno Lima Award recognizes the outstanding contributions of APA members in the care and understand-

ing of the victims of disaster. Upon recommendation by the APA Committee on Psychiatric Dimensions of Disaster

and the Council on Research, the APA feels strongly that your demonstrated leadership and your exceptional

achievements make you an outstanding recipient of this award. As a disaster mental health educator, researcher,

leader, and responder, your contributions to the psychiatric care of victims of disasters throughout the world has

served to strengthen mental health systems and the communities they serve.

3

Happy New Year

By: Matthew Goldenberg D.O.

SCPS Newsletter Editor

As 2017 comes to a close, I am grateful to all of the authors who have contributed high qual-ity articles each month this past year. If you missed any of our monthly newsletters you canview them here. The Newsletter readership has grown significantly and this has truly been agroup effort.

We all have incredibly busy schedules and much on our plates. However, the SCPS Newslet-ter is our little spot in the great big psychiatry world where we can communicate our perspec-tive and leave our mark on the field.

I want to encourage anyone who has been thinking about putting pen to paper (or keys to wordprocessor) to make 2018 the year you take the leap. Your article can be anything from an in-

teresting case, to a book or film review, to a psychopharmacology update to anything else of your choosing.

You can send your articles directly to me at DocGoldenberg@gmail.com, but please cc’ scps2999@earthlink.net.

Thank you again to everyone who contributed in 2017. Let’s make the 2018 SCPS Newsletter even greater!

The ABPN released details to its diplomates about the optional MOC Part III Pilot Project which is scheduled to begin in 2019. Thispilot program is a journal article-based assessment activity designed as an optional alternative to the current secure, proctored 10-year MOC examination. Diplomates who do not wish to participate in the pilot program may continue to take the 10-year MOC exami-nation.

The pilot project is self-assessment based, open-book, and allows diplomates to select articles which align with his or her practicefrom an approved library of articles. Diplomates will be required to read and answer questions on at least 30 but not more than 40 ap-proved journal articles. Diplomates will have discretion in selecting articles from a library of approved journal articles which have beenselected by the Pilot Project Test Writing Committees. These committees include nominated members from the ABPN and from pro-fessional societies including the APA. Five article-based questions (mini-tests) will be delivered in an online, open book format via theinternet to home or office computer. Mini-tests related to articles can be completed one at a time over multiple sittings. If a diplomatecorrectly answers 4 out of 5 questions on the first attempt via the online mini-test, he or she will have successfully completed one arti-cle. Diplomates who have successfully completed 30 mini-tests will have met the requirements of the pilot program and will not be re-quired to complete the traditional 10-year Part III MOC examination

The Pilot Project will begin for eligible ABPN diplomates in January 2019. Diplomates are currently receiving invitations to enroll andmust enroll by March of 2018. Diplomates who are eligible to participate in this Pilot Project are those who are currently listed as ‘Cer-tified-Meeting MOC Requirements’ and have:

Passed an ABPN certification or MOC examination in the years 2012, 2013, or 2014 in Psychiatry or Child andAdolescent Psychiatry; or

A certificate expiring in 2019, 2020 or 2021 in Psychiatry, Child and Adolescent Psychiatry, Neurology, or ChildNeurology.

Pilot Project participants must continue to meet all MOC program requirements (CME, Self-Assessment and PIP). The usual ABPNMOC fee structure will be in place for Pilot Project participants. Those transitioning from 10-year MOC into Continuous-MOC will berequired to pay a fee equal to the amount for the 10-year examination. Those currently in Continuous-MOC will not be required to payany additional fees to participate in the Pilot Project.

The pilot is scheduled to run 3 years, after which tie ABPN will expand the program to include additional diplomates (including thoselast decertified in 2015-2018), and develop a plan for expanding this approach to subspecialties beyond child and adolescent psychia-try.

This pilot project comes as a result of APA’s advocacy from the APA’s leadership, Board of Trustees, and Assembly which has soughta self-assessment and journal-based alternative to the traditional 10-year exam. We continue to advocate for additional MOC reform.More information about APA’s MOC reform efforts can be found at http://psychiatry.org/mocreform.

From Saul Levin, M.D., APA

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Considerations for Psychiatry and Electronic Health RecordsAriel Seroussi, M.D.

For this month’s issue of the SCPS Newsletter, I am reviewing considerations for using elec-

tronic health record (EHR) systems in clinical psychiatric practice. With technological advances

emerging at a rapid pace, psychiatrists are increasingly using computer-based systems for their

clinical work. These systems can help providers and support staff in a number of areas, in-

cluding scheduling, clinical evaluation, documentation, orders and prescribing, patient instruc-

tions and education, and billing.

The choices for providers looking to implement an EHR are vast, and vary based on the clini-

cal setting. They range from systems specifically designed for mental health practitioners, to broader EHR sys-

tems that may or may not have embedded components for psychiatry or mental health. Many providers currently

use electronic systems that may address some but not all of the functions associated with their practice. For in-

stance, products such as SureScripts or AllScripts support electronic prescribing as their main function. Some sys-

tems may support telepsychiatry, which is emerging as an increasingly used method of providing psychiatric care.

Specific programs exist for billing, or for scheduling.

Health systems or hospitals may utilize extensive software packages with broad functionality, with the two most

popular being Epic or Cerner. UCLA, Kaiser Permanente Southern California, and Providence Southern Califor-

nia, for instance, utilize Epic. The Veterans Administration (VA) utilizes a proprietary software called the Com-

puterized Patient Record System (CPRS), but announced this summer that they plan to switch to Cerner. This is

in part to use the same system as the Department of Defense (DoD).

The landscape of EHR options can be overwhelming, but the APA provides extensive resources for psychiatrists

seeking to learn more about health information technology (HIT): https://www.psychiatry.org/psychiatrists/prac-

tice/practice-management/health-information-technology. They provide answers to frequently asked questions

about EHRs for psychiatry. Furthermore, they provide guidelines for the specific requirements of psychiatric EHRs,

as well as guidelines for the implementation of these EHRs. The APA website also links to an independent rank-

ing of mental health-specific EHRs, by Capterra: https://www.capterra.com/mental-health-software/#infographic.

Their ranking is a composite score incorporating the number of customers, total number of users, and reviews

for different software packages. This is helpful for providers shopping for EHR software, to familiarize themselves

with the packages available on the market.

Of note, successfully using an EHR in any clinical setting requires attention to implementation and maintenance.

First, the process of implementing an EHR effectively is not an immediate one, far from plug-and-play. EHRs re-

quire a process of clinical optimization, whereby the content and organization of information and actions in the

software is adapted to meet the specific workflow needs of a particular organization or clinical setting. Second,

as with most software, the EHR will likely require updates to keep pace with changes in hardware, operating sys-

tems, and other programs. This process is beneficial as new features may be introduced and efficiency enhanced,

though it risks frustrating providers by altering workflows and interfaces they had previously been accustomed to.

Several aspects of EHRs require unique consideration for psychiatry. Given that our field often utilizes prose and

free text to capture clinical information, this can be at odds with the use of automated or pre-made selections in

electronic documentation. In fact, these features can increase provider efficiency, but capturing the individuality

of each unique patient’s care can be compromised by over-reliance on “click-boxes.” It is important to strike a bal-

ance between efficiency and appropriate, patient-centered documentation.

Furthermore, a patient’s access to health records can be enhanced in some EHR systems. Many systems have

6both a provider and patient-facing interface, and some patient “portals” allow the patient to access upcoming ap-

pointments, communications with physicians, recent diagnostic test results, or even documentation itself. In fact,

UCLA has recently implemented an “Open Note” system by which providers can share their notes directly with

patients on their health portal. This means particular attention must be directed to how one documents – while

medical records can be accessed by any patient whether electronic or on paper, EHRs may facilitate this ac-

cess. Though some psychiatrists may cringe at this increased access, recent experience suggests that risks may

be overblown and there may be benefits to transparency in documentation. The OpenNotes initiative has a help-

ful resource on this topic for mental health providers: https://www.opennotes.org/tools-resources/for-health-care-

providers/mental-health/.

Lastly, many EHR systems have a messaging feature incorporated as part of their software, intended to facilitate

patient-provider communication. This presents similar considerations to the use of email or text messaging, par-

ticularly delicate forms of communication in mental health. While they can be efficient, electronic messaging sys-

tems can also be misused. For instance, providers must be careful to establish rules regarding communication

of suicidal ideation or other emergent concerns, as many EHR messaging systems rely on the provider to log in

to the software program to see messages. Subtleties of intonation and rhythm of speech can be lost in electronic

messaging, which may be particularly relevant when communicating with the patient in psychiatry. Electronic

messaging represents a new platform for communication in psychiatry which must be treated with caution despite

its potential benefits, and further research may guide training in its use.

The role of EHRs will likely continue to grow as a part of modern psychiatric practice. With research and thought-

ful consideration, providers can harness the power of such systems while preempting potential pitfalls, and in par-

ticular those unique to psychiatry.

7

Child Psychiatry: An update regarding youth involved with child welfare and probationby: George Fouras, M.D.

This article is reprinted with permission and was originally published in the San Francisco Marin Medical Society

newsletter.

Over the last ten years, greater attention has been paid to the condition of those youth who areinvolved with child welfare (foster care) and/or probation. Not only have the number and quan-tity of psychotropic medications caused concern, but also ther is concern for the youth whowere not reunited with family, spending their childhoods in foster homes or congregate care.

In June of 2016, it was reported that as of September 30, 2015, 427,910 American youth werein out of home care (foster care).(1) Based on data from California compiled by U.C, Berkeley, as of July 1, 2017the state had 53,382 youth in care, with Los Angeles having 18,755 and San Francisco 638.(2) Not included inthis statistic, but just as important, were the number of youth who were booked into juvenile hall in San Francisco,743, representing a 19.6% drop from 2012.(5)

Prior to 2010, a few studies were conducted by Bonnie Zima, MD and Julie Zito, MD indicating that foster youthwere being prescribed medications at high rates, based on Medicaid claims data.(8) However, this was greatlyclarified in the summer of 2010 with two reports being published. The first was by Laurel Leslie from Tufts look-ing at psychotropic medication oversight programs of forty-seven states.(4) In general, state programs were notas robust in providing oversight of psychotropic medications for youth in foster care. In comparison, San Fran-cisco County began a psychotropic medication oversight program in 1996, well ahead of the state and the coun-try. As a result of SB 543 in 1999, the State of California passed the first rules for medication oversight, referredto as the JV-220. This was a significant change in that the courts were given jurisdiction of consent for medica-tion over parents or legal guardians. At first, it applied only to youth in foster care, with youth in probation beingoptional. This was changed in 2012 with the oversight of psychotropic medication authorization for probationyouth now falling under the JV-220 process. The second, was a study from Rutgers looking at atypical antipsy-chotic use in sixteen states.(6) They noted that this class of medication was used up to nine times more often inyouth in foster care versus the general Medicaid population. In addition, they noted that youth under the age offive were also being prescribed these medications, along with evidence of poly-pharmacy in the primary study pop-ulation of five to seventeen (inclusive).

These studies then prompted the Government Accountability Office (GAO) to conduct a report, which was pre-sented as testimony to Congress in December of 2011.(7) Five states were selected for audit and review using2008 data. One of the key findings was that of the five states selected for review, California not included, the psy-chotropic medication oversight programs fell short of the American Academy of Child and Adolescent Psychiatry(AACAP) “Position Statement on Oversight of Psychotropic Medication Use for Children in State Custody.” Othersignificant findings were that foster youth were prescribed medication 2.7 to 4.5 times more often than non-fos-ter youth. In addition, a significant number of children were prescribed five or more psychotropic medications ata time, while others were prescribed doses in excess of Food and Drug Administration (FDA) guidelines. Finally,there were several cases of children less than one year of age being prescribed medication.

Concurrent with these investigations, in a project that took over ten years, in June 2015, AACAP published thefirst, ever, “Practice Parameter for the Assessment and Management of Youth Involved with the Child Welfare Sys-tem.” Part of the challenge of this paper was the esoteric nature of foster care, which varies greatly from state tostate, versus a disease process or illness.

Shortly after the publication of the GAO report, the California Department of Social Services (CDSS) and the De-partment of Health Care Services (DHCS) entered into a joint quality improvement project with three workgroups(Clinical, Data, and Youth/Family) tasked with creating deliverables that were reviewed by an expert panel priorto release or publication. The clinical workgroup drafted “California Guidelines for the use of Psychotropic Med-ication with Children and Youth in Foster Care”, which is accompanied by five appendices.(3) Unlike most pub-

8

lic documents of this kind, it is the intention of these two state agencies to review and update these guidelinesyearly. While not mandatory, it is hoped that counties will voluntarily utilize these guidelines as best practices foryouth in foster care (or probation) in California.

Since the publication of these reports, several pieces of legislation have been enacted related to the care pro-vided to youth in foster care and probation. Ostensibly, youth are being removed from the care of their parentsand family, because of concerns about safety, abuse, or neglect or the commission of offenses against the lawsof society. However, there was a growing realization that having social services as the “parent” for a child oftenresulted in worse outcomes with almost no support available once the youth reached the age of majority, or “agedout,” of the system. Many youth, especially teenagers, would end up being placed in group homes, in many casesuntil reaching the age of eighteen. Placement in a group home was based on a Residential Care Level (RCL)model with the average group home a “10”, while “residential treatment” was considered levels 12-14. The levelwas not strictly defined, and was based on the services provided by the home. While the youth was to receivetreatment and then be stepped down to a less restrictive setting, in reality, many stayed in these homes for years.Adoption of AB 403 “Foster Youth: Continuum of Care Reform” completely changed this system. Gone were RCLlevels and group homes, replaced by Short Term Residential Therapeutic Placements (STRTP), which were de-signed to be a short term (six months or less) placement, and where intensive assessments and treatment wouldoccur. This would also include medical care and psychiatric treatment and therapy. While it is possible for a youthto stay longer than six months, the goal would be for the youth to be stepped down to placement at home or witha “resource family” (i.e. foster home). The overall treatment plan would be guided by the Child Family Team meet-ing (CFT) which included the youth and family in treatment and placement decisions.

Another concept that began to be discussed by child psychiatrists in 2015 was the concept of “deprescribing,” firstidentified in the adult literature based on the degree of poly-pharmacy for geriatric patients (not just psychiatricmedication). A literature search for deprescribing in children yielded no published papers. As a result, a proposalwas put forth for the AACAP to develop a “clinical guideline” (formerly called a practice parameter) on despre-scribing to be developed by the Adoption and Foster Care committee of the AACAP.

Deprescribing is not synonymous with the discontinuation of medication, but is rather the evaluation and identi-fication of medications to be optimized as part of a treatment regimen with a structured approach to minimizingor discontinuing identified medications for which the risk outweighs the benefit. In addition, reliance on evidencebased practices, including prescribing, is to be emphasized.

In the last legislative session, a bill was passed that allowed the Medical Board of California to investigate physi-cians for “repeated acts of clearly excessive prescribing” to youth involved with the child welfare system. This isbeing accomplished by DHCS forwarding records to the Medical Board of California (MBC) based on Medi-Calbillings and/or the atypical antipsychotic Treatment Authorization Request (TAR) process that is supervised bythem. In addition, there is language that the MBC may act if a youth is prescribed three or more medications forninety or more days. However, the criteria that the MBC employs for making this determination is unknown. Forexample, if a physician writes a prescription for Benadryl or melatonin so that the foster parent does not have topay out of pocket, it is unclear whether that counts toward the three medications.

The overall practice of child psychiatry is changing dramatically as new research and discoveries are made. Thestandard of care is being shaped not only by current research and best practices, but also by legislation, oftenby well meaning groups and agencies, but for which there are often unintended consequences. As a result, it isimportant that we as medical providers of care focus not only on the hard science of biological processes, but alsoon the more esoteric nature of public health that occurs in our State and Federal legislative bodies.

Dr. Fouras is a child psychiatrist with the Los Angeles County Department of Mental Health. He was formerly a child psy-

chiatric consultant to the San Francisco Human Services Agency, and was a past President of the SFMMS. He currently co-

chairs the Adoption and Foster Care committee for the AACAP.

9

References1. Adoption and Foster Care Reporting System (AFCARS), U.S. Dept. of Health and Human Services, Children’sBureau, Report #23 June 2016 FY 2015.

2. California Child Welfare Indicator Project, U.C. Berkeley School of Social Welfare. Website accessed 6 Oct2017.

3. California Dept. of Social Services, Dept. of Health Care Services, Quality Improvement Project. “Clinical Guide-lines for the Use of Psychotropic Medication with Children and Youth in Foster Care.” May 2015.

4. Leslie, et al. “Multi-State Study on Psychotropic Medication Oversight in Foster Care.” Tufts Clinical and Trans-lational Science Institute (Boston, Mass.: 2010).

5. “Francisco Juvenile Probation Department 2016 Statistical Report.” Allen Nance (Chief Probation Officer), Jan2017, p 1.

6. Medicaid Medical Directors Learning Network and Rutgers Center for Education and Research on MentalHealth Therapeutics. “Antipsychotic Medication Use in Medicaid Children and Adolescents: Report and ResourceGuide from a 16-State Study.” MMDLN/Rutgers CERTsPublication #1. July 2010. Distributed by Rutgers CERTs at http://rci.rutgers.edu/~cseap/MMDLNAPKIDS.html

7. GAO Report: “FOSTER CHILDREN HHS Guidance Could Help States Improve Oversight of Psychotropic Pre-scriptions.” DEC 2011.

8. Zima BT, Bussing R, Crecelius GM, Kaufman A, Belin TR. “Psychotropic medication treatment patterns amongschool-aged children in foster care.” Journal of Child and Adolescent Psychopharmacology 1999;9(3):135- 147.

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World Wonders & the Mental Health Benefits of Awe-by Kavita Khajuria, M.D.

A recent trip to Asia included a visit to the amazing Angkor Wat in Cambodia, perhaps one ofthe greatest tributes to Hindu culture and heritage.

This architectural wonder served as the Khmer Empire’s great state temple in the early 12th cen-tury and as a mausoleum for its builder, King Suryavarman II. It is the largest religious structureever built, and is cited as one of the greatest human achievements of all time. A moat surroundsthe five grand lotus bud shaped towers to create an earthly incarnation of the celestial oceanwhich surrounded the mythological home of the ancient Hindu gods. Innumerable scenes fromthe Hindu epics and depictions of epic battles are evident in almost a mile of finely carved bas-

reliefs. It has been said that Angkor Wat is one of the most richly carved buildings in the world. The experiencewas exhilarating and captivating.

Another awe inspired visit was to the spectacular Schwedagon Pagoda in Yangon, Myanmar. This gold gildedstupa and sacred Buddhist site is believed to contain sacred relics, including 8 strands of hair from the Buddha,and according to legend, constructed over 2600 years ago. Made of bricks covered with gold plates, the crownis tipped with 5,448 diamonds and 2,317 rubies. The images, candles, gold leaf, incense sticks, umbrellas, flow-ers and atmosphere - all invoked an indescribable sense of fascination, gratitude and humility. Truly awesome.

The concept of awe is not new.

Ancient philosophy and religious discussions are rich in descriptions of awe and wonder. Many memorable per-sonalities throughout history found inspiration in the transcendent power of awe.

What is awe?According to one definition, awe is an emotion or feeling that tends to occur when people encounter a vast andunexpected stimulus, something that makes them feel small and forces them to revise their mental models of whatis possible in the world (1).

More recent research suggests that awe is an emotion we shouldn’t take for granted, as it may have significantconsequences for everyday behavior and wellbeing. Awe prompts us to think in more self-transcendent ways,shifting our focus from inward concern to an outward sense of universality and connectedness (2). Two pro-posed essential aspects of awe include 1) a sense of vastness and 2) an adjustment of our cognitive schema toaccommodate awe-inducing stimuli (2). Awe encourages us to step out of the confines of ego, and reconsiderfixed ways of knowing (3). Studies demonstrate a consequent promotion of patience, greater life satisfaction (2),enhanced critical and creative thinking, improved health, and a greater sense of connection (3). Altruism, loving-kindness, prosocial behaviors (4), benevolence and openness are other awe inspired benefits (1). Biologically,dispositional awe has been found to be one the strongest predictors of lower IL-6 levels (2).

How do we seek awe-evoking opportunities during these fast paced times?

Research indicates that awe can occur in a variety of ways in our daily contexts i.e live music, art galleries, the-ater, museums, in moments of individuals standing up to injustice, and in unstructured time for inviting awe (3).Many of the experiences people cherish most are triggers of awe (4), i.e amazement at the birth of a child. Mostof the time (75%), triggers arise from nature (1) i.e the atmosphere of mountains, trees, flowers, sunrise, sun-set, dramatically bad weather, water, and the spring season (4). Anyone can tap into the power of nature and beawestruck, if given the opportunity, which can impact one’s life in profound ways. Gazing at the night sky or acrossthe blue ocean, and immersing oneself in a scenic hike are all low cost, accessible tools to invoke awe, and im-portantly, boost well-being.

So, as amazing as the Angkor Wat, Schwedagon Pagoda, or other wonders of the world may be, one need nottravel across the world to seek awe. Our environment and experiences may serve as prime opportunities, if weare alert and aware for the sense of wonder and awe that is everywhere.

“ While still in the cage of your beingBehold the spirit bird before it flies away”

-Rumi-

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References/Bibliography:Abrahamson, J. The Science of Awe. University of California, Berkeley, Psychology Department. http://psy-chology.berkely.edu/news/science-awe. Accessed 11/30/17.Mikulak A. All about Awe. Association for Psychological Science. 2015. https://www.psychologi-calscience.org/observer/all-about-awe. Accessed 11/30/17.Stone, Emma, PhD. The Emerging Science of Awe and Its Benefits. Psychology Today. April, 2017.https://www.psychologytoday.com/blog/understanding-awe/201704/the-emerging-science. Accessed11/30/17.Bergland, C. The Power of Awe. Psychology Today. 2015. https://psychologytoday.com/blog/the-athletes-way/201505/the-power-awe-sense. Accessed 11/30/17.Schwedagon Pagoda. Wikipedia. https://en.wikipedia.org/wiki/Scwedagon_Pagoda. Accessed 11/30/2017‘Angkor Wat’. Wikipedia. https://en.wikipedia.org/wiki/Anglor_Wat. Accessed 11/30/2017‘Angkor’. United Nations Educational Scientific and Cultural Organization.http://whc.unesco.org/en/list/668. Accessed 11/30/2017Jarvis, O. Angkor Wat: History of Ancient Temple. 2014. https://www.livescience.com/23841-angkor-wat.html. Accessed 11/30/2017Angkor Wat -7th Wonder of the World. www.tourismcambodia.com. Accessed 11/30/2017Schwedagon Pagoda Great Wonder. Global New Light of Myanmar. http:www.globalnewlightofmyan-mar.com/schwedagon-pagoda-great-wonder.Accessed 11/30/2017Rumi’s Little Book of Life: The Garden of the Soul, the Heart, and the Spirit. Translated by Mafi and Kolin.Hampton Roads Publishing Company, Inc.2012.

Kavita Khajuria, M.D. is a Forensic psychiatrist practicing at Twin Towers Correction Facility; Adjunct Faculty, the Wright

Institute, Berkeley, California; Adjunct Faculty, Fuller Graduate School of Psychology, Pasadena, California.

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Christmas at the Movies

‘I, Tonya’Film Review by Tim Thelen

At this time of year the market is flooded with high profile films and Oscar contenders. Insearching for suitable content for review in a psychiatric newsletter there are certainly a fewchoices, including James Franco’s comedic portrait of a narcissistic filmmaker in The Disaster

Artist and Daniel Day Lewis’ dress maker in Phantom Thread - a character who takes per-fectionism to new heights. The obsessive drive for success is also at the heart of I, Tonya, atrue story of jealousy and revenge that played out against the backdrop of the 1994 Olympics.

The winter games in Lillehammer had the world glued to the figure skating competition featur-ing the 2 top skaters from the United States. Nancy Kerrigan was the talented skater with an attractive all-Amer-ican image, while the tough girl, Tonya Harding wore punky make up and often skated to heavy metalaccompaniment. When Kerrigan was attacked and her knee broken prior to the final competition the focus quicklyshifted to Harding and her personal bodyguard.

Played by Margot Robbie, Tonya is a likeable girl who has handled her violent upbringing amazingly well. Fauxdocumentary-style interviews and flashbacks from Tonya’s life reveal a horrific domestic scenario. Her mother(Allison Janney) is an abusive, foul-mouthed, chain smoking nightmare of a parent who resorts to physical vio-lence on a regular basis. Lacing her methods with anger and humiliation, she oversees young Tonya’s extremetraining to become a skater. Tonya’s only support system is boyfriend Jeff Gillooly (Sebastian Stan) another trou-bled soul who encourages her career but inflicts constant threats and severe physical abuse. Relying on figureskating to define herself as a human being, Robbie’s Tonya is the only likeable character in the film.

If the portraits of Tonya’s mother and boyfriend are infuriating, at least the sequences on ice are fairly exciting andwell-executed, with Robbie’s face CGI’d onto a professional figure skater. Unfortunately, director Craig Gillespieoften resorts to a cliché replica of Martin Scorcese’s trademark fast-paced flashback-with-voice-over. Originallypioneered by Scorcese for 1992’s Goodfellas, this overused stylistic device continually resurfaces - most re-cently in Aaron Sorkin’s Molly’s Game (also just released for Christmas.)

Entertaining as a drama, I Tonya, often tries a bit too hard as a comedy. The attack on Kerrigan (“the incident”)as depicted in the film is so ridiculous that it barely makes for an interesting plot development. In one of her faux-interview sequences, Tonya reveals that she and Nancy were actually friends who often roomed together on theroad. Too bad the filmmakers missed this opportunity to develop an on-screen relationship between the two ri-vals and add a needed dimension to the drama.

Score: 3/5

MINUTES Dr. Woods

Motion to approve minutes by Dr. Red, 2nd by Dr. Wiita. November 9, 2017 meeting minutesapproved unanimously, no opposed, no abstentions.

PRESIDENT’S REPORT Dr. Simpson

Public Affairs Chair:

Nadia Haddad is interested in being the public affairs chair. Public affairs chair is responsi-ble for the face of SCPS and psychiatry to the public. She would interface with the public. This is a president ap-pointed position.

95 Rule: See CPA council report section below.

Dinner Location: Dr. Folgelson recommends Il-Moro (see website www.ilmoro.com)$43 per meal. Estimated to be an extra $200 per meeting or about $1700-$2100 per year. Will need to verify if there is a room fee. Motion by Dr. Red, 2nd by Dr. Wiita To investigate other options for monthly meeting including but not limited to IlMoro. Motion passes unanimously, no opposed, no abstentions.

Newsletter Update: Mindi provides newsletter update on behalf of Dr. Goldenberg who was not able to be pres-ent. Thanked contributors for November newsletter. One of the most dense newsletter this year. Recommendmembers share on social media and with colleagues. Think about what articles members would like to contributenext year, 2018. Contact Dr. Goldenberg if you would like to contribute.

Executive Director Review: Dr. Simpson has the evaluation sheets and averaged 4s, which is the highest scorepossible. Excellent evaluations in all categories.

RFM Movie Night:

“Captain Fantastic” will be the movie played at movie night with Dr. Wiita facilitating the discussion. Attendanceestimated for about 20 people and Dr. Silverman has volunteered her home for the venu. Will utilize resident li-aisons to disseminate information regarding the vent. Will be on first come first serve basis for members and non-members. Date to be determined.

Dr. Schaepper would volunteer her house in Redlands (Inland Empire) for potential second event in the fu-ture. Her house can accommodate 40 people Dr. Wagreich could volunteer his apartment for the future as well.

PRESIDENT-ELECT’S REPORT Dr. Red

Nominating Committee:

Final nominating list 2018-2019 President Elect: ErickCheungTreasure Elect: Michelle Furuta Secretary: Ijeoma IjeakuAssembly Rep: Samuel Miles, Heather SilvermanInland Empire Councilor: David SieglerSan Gabriel/East LA Councilor: Zaheib IdressWLA Councilor: Brooke Spanos, Zeb Little

Council HighlightsDecember 14, 2017Amy Woods, M.D., Secretary

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ECP Rep: PK Fonsworth, Michelle MeshmanSouth Bay Councilor- Linda Do has been appointedRFM: Katie Unverferth, Eric Wagreich, Amy Woods, Danielle ChangLiaisons: George Fouras- CAP, Rod Shaner- Public PsychiatryRFM possible Liaisons Danielle Chang, Torri montgomeryNominating list Passes unanimously, no opposed, no abstentions.

CPA Council Report: 12/3/17 CPA meeting - Dr. McCarron- training more PMD prescribe psychiatric medications- CPA president elect are Drs. Schaepper and Nelson- Decided against giving out emails particularly for CPA election.

APA office of CEO- Psych registry- Medicare Access and Chip Reauthorization act: Created the Quality Payment program admin-istered by the Centers for Medicare and Medicaid Services.

- MIPS- Practices that collect more then $90,000 in Part B allowed charges or 200 Part B benefi-ciaries enroll by 12/16/17 for reporting 2018. -MOC Par IV registry can help meet these requirements.

Learning management systems: Courses for members, next quarter new courses in military and veteran mentalhealth.

95 rule: Active years plus age greater than 95= life members=gradual dues reduction then 10 years past that, duesare zero. APA will lose $250,000 year, which is not sustainable. SCPS is against changing the 95 rule.

MOC 10 year exam- ABPN- pilot program starts Jan 2019, $1400 is the regular MOC exam fee. Pilot programwill include completing 300 CMEs, 24 self assessments, 1 PIP activity, Journal reading assignments 4/5 on firstattempt on 30 articles. Or take the traditional MOC exam.

- Psychiatry burnout- 80% changes are systemic and institutions would help 80% of the problem. - The APA and APA foundation they have fellowships every year and applications are now open and due Jan 31for residents. Dr. Arroyo is encouraging people to apply. Benefits include attending 2 APA meetings and othermeetings, workshops, APA board of trustees non-voting member. - Fellowships include; Leadership, Child and Adolescent Psychiatry, Diversity Leadership, Jeanne Spurlock Con-gressional, Public Psychiatry, Psychiatric Research, SAMHSA Minority, SAMHSA Substance abuse minority.

- Tobacco tax- revenue was suppose to improve Medical rates CMA supports governor candidates to help physi-cians

- Dr. Arroyo is requesting any resolutions to present to the California Medical Association.

- Supporting e-consult: A way for PMD to ask psychiatrist questions for better understanding of medications andtreatment. This would be included in the written record and there was a motion made to explore how to get re-imbursed for e-consults.

CPA supported legislation

- Sponsorship of legislation expanding psychiatric inpatient and subacute bed capacity. - Policy actions that will expand access to psychiatric services. - Amendment to increase training of PMD in the essentials of primary care psychiatry. - Early loan repayment for those in public/community psychiatric training tracks or fellowship. - Fellow or MITs in public psychiatry training tracks or fellowships may bill Medi-Cal for services rendered in thecounty based public mental health system during their training.

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- LPS GD adding the inability to provide for an individual’s health and safety. - Legislation clarifying that information protected by the current psychotherapist-patient privilege may not be di-vulged to licensing boards conducting investigations of licensees without patient consent. - Support legislations clarifying that physician assistant or nurse practitioners training programs are qualifyingeducational programs under existing programs for mental health workforce loan repayment. - Encouraging members to contribute to PAC. They are vital to making changes within the government.

ART OF PSYCHIATRIC MEDICINE Mindi on behalf of Dr. FurutaFrancis Liu- National Academy Collaborative of Physician For clinician burnout, considered submitting film but thiswould also be giving up rights to the film. Alternatively there was past project of a collective collage created andcould be appropriate for submission. Minidi will confirm the content of release forms. Members can view the filmmade of the collage on the website. Motion to submit the film by Dr. Wiita second by Dr. Cheung, passed unan-imously.

TREASURER’S REPORT Dr. Cheung

SCPS is financially stable for November 2017. Motion to accept treasurer’s’ report by Dr. Red seconded by Dr. Folgelson. Passes unanimously, no opposed,no abstentions.

MEMBERSHIP REPORT Mindi, on behalf of Dr. IjeakuCurrent Membership —968 (November - 966)

9 new residents and 2 general members that are Reinstating Motion to approve members by Dr. Schaepper andsecond by Dr. Wiita passes unanimously.

PROGRAM COMMITTEE REPORT Dr. Gales

Psychopharmacology Update will be held January 27, 201860 registered participants. This is on track for full registration. Encourage council members to attend the meeting.

NEW BUSINESS Dr. Simpson

Dr. Schaepper- Thanked members for her nomination for the CPA presidency.

Dr. Seroussi asks if there has been any information related to SCPS members affected by the fires. Mindi didsend email out to Ventura members. She will follow up on any affected members.

OLD BUSINESS Dr. Simpson

None

ADJOURNMENT Dr. Simpson

Meeting adjourned at 9:16 pm

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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.

SCPS OfficersPresident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Joseph Simpson, M.D.President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anita Red, M.D.Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amy Woods, M.D.Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Erick H. Cheung, M.D.Treasurer-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Galya Rees, M.D.

Councillors by Region (Terms Expiring)Inland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ijeoma Ijeaku,M.D. (2018). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . John Luo, M.D. (2020)

San Fernando Valley . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Marc Cohen, M.D. (2020). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Matthew Goldenberg, D.O. (2019)San Gabriel Valley/Los Angeles-East. . . . . . . . . . . . . . . . . Steve Khachi, M.D. (2019)

Roderick Shaner, M.D. (2018)Santa Barbara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vacantSouth Bay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Michelle Furuta, M.D. (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. (2018). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ariel Seroussi, M.D.(2019)ECP Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Daniel Bonnici, M.D. (2018)ECP Deputy Representative . . . . . . . . . . . . . . . . . . . . . . . . Patrick Wiita, M.D. (2019)RFM Representative . . . . . . . . . . . . . . . . . . . . . . . . . Michelle Meshman, M.D. (2018). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Katherine Unverferth, M.D. (2018)

Past Presidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . David Fogelson, M.D.Heather Silverman, M.D.

Curley Bonds, M.D.Federal Legislative Representative . . . . . . . . . . . . . . . . . . . . . . Steve Soldinger, M.D.State Legislative Representative. . . . . . . . . . . . . . . . . . . . . . . . Davin Agustines, D.O.Public Affairs Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vacant

Assembly Representatives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . David Fogelson, M.D. (20120) Mary Ann Schaepper, M.D. (2020)Larry Lawrence, M.D. (2018) Steve Soldinger, M.D. (2021)

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

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

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

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

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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