Faculty Bibliography

People with substance use disorders (SUD) who are hospitalized often have worse medical outcomes and face treatment inequity. Individuals from racially and ethnically minoritized groups face structural racism in addition to the general stigma against people with substance use disorders. Outpatient racial disparities in SUD treatment, such as rates of buprenorphine prescription, may be perpetuated if unaddressed during medical hospitalizations. Thus, psychiatric consultation or addiction treatment services have the potential to reduce systemic inequities in access and initiation of evidence-based SUD treatments. We describe best practices that addiction treatment services can follow to move towards equity in treating hospital ized patients with SUDs, particularly for minoritized groups. Areas of improvement include access to addiction consultation services, minimization of patient-directed discharges, buprenorphine initiation, access to harm-reduction resources, incorporation of lived experience, referrals to post-discharge treatment, and education.

As psychedelic-assisted therapy research and clinical trials continue to grow, there is a positive outlook on the future, but also concerns about who will benefit. Most research shows that there is an obvious deficit of racial and ethnically minoritized populations, defined within the article, enrolling in studies. The objectives of this paper are (1) to provide a history of psychedelics and its resurgence over the last two decades; (2) to present an understanding of the racialization of psychedelics in the treatment of psychiatric disorders; (3) to showcase the current inequity of psychedelic medicine; and (4) to operationalize an antiracism framework for racial equity to decolonize psychedelic research, or remove the historically pervasive White power dynamic in hopes of shifting power back to the originating indigenous cultures. The psychedelic movement is in a rare place to optimize inclusion and this article aims to demonstrate how. [Psychiatr Ann. 2022;52(12):494-499.].

Burnout and moral injury within medicine have steadily increased over the last decades, especially among those providing care during the COVID-19 pandemic. The term burnout has been used to describe clinician distress and a syndrome of emotional exhaustion, a diminished sense of personal accomplishment, and depersonalization. Burnout has a significant impact on both job performance and patient care. Moral injury occurs when external circumstances interact with a person's cherished beliefs and standards. When the tension between them cannot be reconciled, the felt integrity of the individual is disrupted and the person experiences distress. The consultative aspect in consultation-liaison psychiatry (CLP) presents challenges that may predispose the young clinician to burnout and moral injury, especially during fellowship training. CLP psychiatrists also have a liaison role that could catalyze systemlevel change to enhance the mental well-being of their colleagues. This article reviews clinically relevant psychodynamic aspects of burnout and moral injury during CLP training. In addition, the authors propose strategies to enhance career growth and prevent and address moral injury during training to generate fulfilling professional development.

Increasing attention to systemic racism in the United States in all aspects of life has sharpened focus on its effects on the health outcomes of Black, Latinx, and Indigenous populations. Racial disparities in substance use disorders remain a significant public health problem in mental health, and psychiatrists require sufficient knowledge and awareness to help address these disparities. First, this article reviews evidence of racial disparities in substance use disorders. We then discuss the historical and legal foundations of systemic racism and substance use disorder disparities and explore research examining the role of systemic racism in substance use disorder outcomes on structural and individual levels. Finally, we discuss recommendations for providing substance use disorder care in a more racially equitable manner.

OBJECTIVE:The primary purpose of the study was to develop and implement a psychiatry mnemonic PSYCH-PASS for transitions of care in residency training programs. METHODS:The authors examined areas of improvement in the handoff system with residency training administration, service directors, and psychiatry residents to create PSYCH-PASS, a novel mnemonic that could be integrated in the electronic medical record (EMR). The components of PSYCH-PASS are Patient summary, Situational awareness, "whY" is the patient here, Comorbidities, Hemodynamics, Pharmacology/PRNs, Action list, Specifics, and Synthesis. The authors developed a 14 question pre- and post-survey with a 4-point Likert scale measuring five categories. RESULTS:Pre-survey and post-surveys completed by post-graduate year 2 and 3 residents at Montefiore Medical Center (n = 24) noted increased satisfaction, handoff efficiency, handoff efficiency, accessibility, accuracy, communication, awareness, and adherence to PSYCH-PASS, along with a decrease in frequency of errors. CONCLUSIONS:With promising results across a range of metrics indicating resident-reported positive impacts on patient care, further research on the implementation of PSYCH-PASS and its integration into EMR systems is merited. Future directions include gathering objective data from Epic and expansion of the initiative to other psychiatric services and institutions.

The intrinsic properties of tonically firing neurons in the cochlear nucleus contribute to representing average sound intensity by favoring synaptic integration across auditory nerve inputs, reducing phase locking to fine temporal acoustic structure and enhancing envelope locking. To determine whether tonically firing neurons of the avian cochlear nucleus angularis (NA) resemble ideal integrators, we investigated their firing responses to noisy current injections during whole cell patch-clamp recordings in brain slices. One subclass of neurons (36% of tonically firing neurons, mainly subtype tonic III) showed no significant changes in firing rate with noise fluctuations, acting like pure integrators. In contrast, many tonically firing neurons (>60%, mainly subtype tonic I or II) showed a robust sensitivity to noisy current fluctuations, increasing their firing rates with increased fluctuation amplitudes. For noise-sensitive tonic neurons, the firing rate vs. average current curves with noise had larger maximal firing rates, lower gains, and wider dynamic ranges compared with FI curves for current steps without noise. All NA neurons showed fluctuation-driven patterning of spikes with a high degree of temporal reliability and millisecond spike time precision. Single-spiking neurons in NA also responded to noisy currents with higher firing rates and reliable spike trains, although less precisely than nucleus magnocellularis neurons. Thus some NA neurons function as integrators by encoding average input levels over wide dynamic ranges regardless of current fluctuations, others detect the degree of coherence in the inputs, and most encode the temporal patterns contained in their inputs with a high degree of precision.