Faculty Bibliography

Objectives: CBT for insomnia (CBT-I) in adolescents and young adults is a brief intervention that includes both behavioral and psychological procedures. At the end of this presentation, participants will be able to 1) describe when and for whom CBT-I is an appropriate form of treatment intervention; 2) provide practical guidelines for conducting CBT-I, including stimulus control, sleep restriction, cognitive restructuring, and sleep hygiene; and 3) practice arousal reduction and biofeedback for the treatment of insomnia. Methods: This session will provide a comprehensive literature review, lecture, and discussion. Results: Medications for the treatment of insomnia are sometimes necessary but most often are insufficient to fully address the problem. CBT-I, by contrast, represents an easily taught series of skills that are portable and time and cost effective. The utility of CBT-I has been repeatedly demonstrated for adults and adolescents. The goal of CBT-I is to alter the factors that perpetuate insomnia and include the following: 1) behavioral factors, such as poor sleep habits, and irregular sleep schedules; 2) psychological factors, such as unrealistic expectations, and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. CBT-I is indicated for primary and secondary insomnia in adolescents and adults and can be delivered on a one on one basis; in groups; and via telephone, telemedicine, and video. This presentation will describe the use of CBT-I and necessary adjustments when applying these techniques with children. Participants will practice arousal reduction and biofeedback techniques. Conclusions: The use of cognitive-behavior therapy for insomnia will be described, and participants will engage in a series of applied exercises to enhance their therapeutic skills

Objectives: The goal of this session is to bring Clinical Perspectives and the eponymous JAACAP column "into life" by casting content from recent and forthcoming installments of the series into the popular "TED Talk" (Technology, Education, and Design Talk) format. Methods: Following the format first established at the 2014 Annual Meeting, this will be a 180-minute session co-moderated by JAACAP Editor-in-Chief Andres Martin and Assistant Editor for Clinical Perspectives Laura Prager. The session will start with a brief introduction providing the background, context, and "ground rules" for an effective TED Talk, including adherence to tight time limits and minimal use of audiovisual supports. The authors of five published or forthcoming Clinical Perspectives will then each present a 15-minute TED Talk of their respective articles. Each presentation will be followed by five minutes of interactive and moderated discussion. There will be a short break between speakers, allowing for a brief introduction. The session will end with overarching concluding remarks, time for discussion, and an invitation for new submissions. Results: All five presentations will discuss child psychiatric takes on topics of acute public health relevance and social concern that have been featured prominently in the lay media. Conclusions: Child and adolescent psychiatry is grounded in solid clinical practice, and it is from this clinical substrate that important research questions and hypotheses first arise. Clinical Perspectives provides a forum to consider and revisit clinical phenomena anew, a platform from which to reclaim the excitement that first drew us into our chosen field. The TED Talk format, which has been so successful in the global dissemination of Technology, Education, and Design ideas, can be successfully borrowed to reveal that child and adolescent psychiatry does indeed have (clinical) "ideas worth spreading."

Objectives: The five presenters and discussant in this Clinical Perspectives highlight the challenges associated with pediatric psychiatric crises in standard emergency care settings. Each presenter will focus on a crisis care model that can address urgent patient needs, improve access to mental health care, and decrease unnecessary time or treatments in hospitals Methods: A literature review of pediatric mental health emergencies and crisis care systems will be provided. Each presenter will share her experience in creating, implementing, and/or practicing a particular crisis care model, including phone triage systems, mobile crisis clinics, and crisis stabilization and residential units. Presenters will discuss funding and community resources that have made such projects feasible and highlight key components of program development. Results: Communities and agencies are responding to increased emergent pediatric mental health needs by shifting treatment from standard emergency department settings to a continuum of team-based and nonhospital services. Each of the crisis care models included here has improved community access to behavioral health providers and helped triage children to more appropriate locations/programs of care. Data collected from individual sites indicate improved quality of care and interagency relationships, decreased length of stay or need for emergency department visits, increased outpatient follow-up, and decreased need for inpatient hospitalizations. Conclusions: Providing quality care to youth in mental health crises has become a challenge in our current health care system, with the decline of inpatient beds, lack of providers with mental health training, and limited access to community mental health services. A continuum of psychiatric crisis care services can better meet community and patient needs, thereby relieving burden on emergency departments and linking children and families to the services they need. More research on additional outcomes, as well as establishment of national standards of pediatric psychiatric crisis care, is needed

Objectives: Participants who attend this workshop will learn how to identify their current skills and how to advance and get their papers published. Relatively few students, trainees, and clinicians publish scientific or other educational manuscripts because of limitations in time, experience, and access to mentorship. Improving access to publishing opportunities is important because the process of authoring and publishing scientific manuscripts can increase competency in research literacy, engagement in evidence-based practices, and other skills needed to increase mastery in child and adolescent psychiatry. Methods: We aim to overcome these limitations by providing a "back stage pass" experience, combining hands-on training with practical instruction to build the early foundation for getting published. Topics include choosing a publishable topic of interest, practical steps toward publication, searching the literature and harnessing electronic library resources, writing using organizing principles, preparing an effective abstract, optimizing cover and revision letters, thinking like an editor, dealing with revisions, and the inevitability of rejection and constructively moving forward. Results: Attendees will learn practical steps toward getting published in scholarly journals and strategies to overcome current limitations and obstacles. Interested participants will also have the opportunity to get started with mentored-publishing experiences available through JAACAP and JAACAP Connect. Conclusions: Participating in this workshop will provide the preliminary knowledge and skills necessary for getting published

Objectives: The application of mindfulness-based practices in psychiatry is indeed real and patient-level outcomes include symptom reduction and enhanced sense of well-being. Perhaps as importantly, the provider also experiences gains such as enhanced attention, empathy, compassion, and resilience. Methods: This hands-on workshop led by experienced mindfulness-based researchers, practitioners, and authors will consider the evidence for mindfulness in clinical psychiatry and teach the audience several simple mindfulness exercises for themselves and their patients. Results: Upon workshop completion, participants will have considered the application of mindfulness in several common practice-based cases in child psychiatry. Conclusions: The clinician will be able to define mindfulness, understand its applications, refine mindfulness techniques as part of their toolkit, and access mindfulness resources for themselves and their child and adolescent patients

This paper is the third in a series of investigations into (1) the nature and development of unconscious fantasy, (2) its place in a contemporary model of mind that, parenthetically, suggests a possible solution to the problem of theoretical pluralism, and (3) its mode of operation in the mind. The aim of these investigations is to update the notion of unconscious fantasy, an indispensable construct in psychoanalytic theories that assume out-of-awareness mentation, and to situate that construct within contemporary views of mental functioning in disciplines such as philosophy of mind, cognitive science, and developmental psychology. At the same time, data accessible only through psychoanalytic work challenge these fields with findings that indicate the need for further investigation. This paper argues that experimental evidence on the phenomenon of "priming" lends support to one of the seminal claims in our field, one frequently attacked as an outmoded shibboleth: that is, that the past matters, whether encoded in declarative or in procedural memory. In common parlance, we are "primed" to respond to some situations in predetermined ways; the past primes us to experience the present in often unique and personal ways. There is evidence too that the priming mechanism and the encoding of subjective experience in declarative and procedural memory operate from very early in life.

Zinc participation is essential for all physiological systems, including neural functioning, where it participates in a myriad of cellular processes. Converging clinical, molecular, and genetic discoveries illuminate key roles for zinc homeostasis in association with clinical depression and psychosis which are not yet well appreciated at the clinical interface. Intracellular deficiency may arise from low circulating zinc levels due to dietary insufficiency, or impaired absorption from aging or medical conditions, including alcoholism. A host of medications commonly administered to psychiatric patients, including anticonvulsants, oral medications for diabetes, hormones, antacids, anti-inflammatories and others also impact zinc absorption. Furthermore, inefficient genetic variants in zinc transporter molecules that transport the ion across cellular membranes impede its action even when circulating zinc concentrations is in the normal range. Well powered clinical studies have shown beneficial effects of supplemental zinc in depression and it important to pursue research using zinc as a potential therapeutic option for psychosis as well. Meta-analyses support the adjunctive use of zinc in major depression and a single study now supports zinc for psychotic symptoms. This manuscript reviews the biochemistry and bench top evidence on putative molecular mechanisms of zinc as a psychiatric treatment.