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FPS Fall 2000 Meeting Honors 
Late Thomas Kay Buchanan, M.D.

This issue of Transference was a special issue for the FPS Fall Meeting October 5 - 8, 2000 at the Hyatt Regency Pier 66 in Fort Lauderdale. 

The meeting focused on community psychiatry and public health and prevention and was in honor of Thomas Kay Buchanan, MD. The following is a biography of Dr. Buchanan. 

Thomas Kay Buchanan was born July 9, 1923, in Imlay City, Michigan, a small town of 1500 inhabitants, affectionately called "The Garden Spot of Eastern Michigan" and "The Gateway to the Thumb." His father, Ernest, owned a restaurant and his mother, Mary Edith, was a nurse. It was her desire from the day he was born that he would become a doctor.

They lived next door to an Italian family with four children, one of whom was Gene Coscarelli, his best buddy who became his dearest lifelong friend. Gene's father would come home early for dinner, then go back to his store for evening hours. His mother would invite "the little blond bambino," who was usually at her house to eat with them, which he did. When his own father came home for dinner, Kay (as he was called by everyone) was not hungry, leaving his mother to worry that he must be sick - even though he was the chubbiest little boy on the block. It took a while for Mrs. Buchanan to figure out that her only child was not starving, but eating that good Italian food next door.

Growing up he had a newspaper route, which he walked in the winter and early spring. One fateful day, he made the mistake of not noticing that one of his customers had just seeded a new lawn on his very large corner lot. Kay started at one corner, went diagonally across the yard to the porch, then across the other way to the street, sinking in several inches with each big step. The lady of the house looked out her kitchen window and exclaimed in a very LOUD voice, "Larry, will you just LOOK at that big lummox of a Kay Buchanan 'kerplunking' across my new lawn!" Little did she realize  that he would grow into a handsome 6'3" athlete who would become her son-in-law, eleven years later.

Kay became a very loved young man in his community and his school, playing three sports - basketball, football and baseball - lettering in all three. He was captain of the basketball team, president of his class and valedictorian. He played first chair baritone in the band. He loved to dance.

He enrolled as a freshman at the University, of Michigan in the Pre-Med program in 1941, just a few months before Pearl Harbor. He pledged the Acacia Fraternity, went out for Freshman basketball and won his Freshman numerals. He always regretted that he did not go out for  the Michigan basketball team, but thought he should concentrate on his studies in order to get into medical school. His high school coach had assured him that he would have made the team.

Near the end of his Sophomore year, he began trying to enlist in a branch of the armed services, but kept failing the physical because of his eyesight. He was finally accepted by the Seabeas and was sent to the Marshall Islands for fifteen months where he served in a M.A.S.H. unit. Returning from overseas, he was sent to Philadelphia Naval Hospital where he served as a Medical Technologist Corpsman for the remainder of the war. While there he played basketball for the Naval Hospital.

Kay was discharged from the Navy in July, 1946, returned to the University of Michigan in the fall of that year, helped re-open the fraternity house, and was elected president of the Acacia Fraternity, helping to rebuild the group after the war.

One evening, he and his buddy 'Bearcat' noticed a young woman with her eight-year old sister  at the Lapeer County Fair, eating at the Rotary stand. It turned out to be someone he had known most of his life, named Donna Marie Thatcher .  They stopped to say "hello".    "That nice little Thatcher girl" had gone to the same church, played in the band since seventh grade, was a high school cheerleader and had been on the same team buses with him all those years, but something was different. SHE HAD GROWN UP DURING THE PAST THREE YEARS.

Since Donna and her little sister needed a ride home, Bearcat and Buck (as Kay was now called from his days on the football team) offered to borrow Bearcat's father's car and give them a lift. After putting her sister to bed, Donna and the boys began  talking in the living room. At midnight, Bearcat realized the fairgrounds had closed, and his Dad (with a true Irish temper) must have had to walk home!!!! They rushed to the door, Buck pushed Bearcat out on the porch, shut the door behind him, turned around and gave Donna a great BIG kiss and whispered in her ear, "I'll see you in Ann Arbor."

The rest is history. The next weekend, back on campus, Kay invited Donna to a dance in the ballroom of the Men's Student Union and Kay never dated another girl again. Donna became the "Sweetheart of Acacia", Kay gave her his Fraternity pin, and the fraternity brothers serenaded Donna under her window. This Fraternity tradition meant they were "engaged to be engaged". Kay & Donna became "officially" engaged the day Kay was accepted to the U. of M. Medical School, and were married at the end of Kay's first year on June 26,1948. As Kay always said - "We had a true storybook college romance."

Their wedding was a BIG social event in their little hometown. Both were children of prominent businessmen and the guest list was carefully made out to make certain that all 300 guests would have a seat in the little church. However, no one expected twenty-two Acacia Fraternity brothers and their dates would turn up (after receiving one courtesy invitation) and fill almost one quarter of the church. The remainder of the guests sat in the choir loft.  Even then, Donna's favorite uncle had to stand up!

Dr. Tom became a member of the First Baptist Church of Imlay City when he was twelve years old. He always held to high moral standards and was a role model for those around him. His faith brought him through some very difficult times and also brought him much joy, peace and strength throughout his life. He was always proud to be called and known as a "Christian Psychiatrist".  People who knew and loved him, always recognized his love of God, which shone through his dealings with others.

Dr. Tom received his B.S. degree in 1948 and graduated from the University of Michigan Medical School in June, 1951. He served his internship at St. Mary's Hospital in Grand Rapids, Michigan, and then moved back to his hometown of Imlay City to practice Family Medicine, which he did for eight years. During that time, he delivered over 1200 babies, was Chief of Pediatrics at the Lapeer County General Hospital, made house calls and farm calls throughout the large rural area, and assisted Dr. Clare Bishop of Almont, Michigan in surgery several mornings a week.

His patients loved him because he treated them as family. One day he went out to see a little old couple to let them know that he would be gone for a month to Florida on vacation- He assured them that his partner would take good care of them while he was gone. The little old lady patted him on the hand and said, "that's all right Dr. Kay, don't you worry about us. We will be just fine 'till you get back."

In August 1960 he left general practice and returned to Ann Arbor for a three-year residency in Psychiatry at Ypsilanti State Hospital and the U. of M. He remained on staff for two more years, having received two grants from NIMH for starting the first Alcohol Treatment Program for Women in a state hospital in Michigan. He graduated from the Yale University Graduate School of Alcohol Studies in 1961.

Dr. Buchanan always loved the month each winter when he would take his family to Florida for vacation. He and Donna were never ready to return home to Michigan, so in 1965 he applied for and was hired to be Executive Director of the Henderson Clinic, a small facility on Riverland Road in Ft. Lauderdale. He had a staff of ten and was the only psychiatrist.

He applied for and received the first Federal grants for community mental health in Broward County. Over the years he built the clinic into a full service Community Mental Health Center, with seven facilities throughout the county and over 250 mental health professionals on staff.

His accomplishments  in Broward County and the State of Floridainclude:

Starting the first Alcoholism Treatment Program in Broward.

Serving as a charter member of the Broward County Commission on Alcoholism, which started one of the first DUI schools in the area.

Developing a program for teens in distress, so that pregnant teens could finish high school.

Teaching alcohol and drug abuse treatment classes for nursing students at BCC.

Helping to organize advocacy groups for the mentally Ill.

Serving as a member and first chairman of the Florida State Indigent Drug Program.

Serving as President of the Broward County Psychiatric Society.

Serving as the first Community Psychiatrist to be elected President of the Florida Psychiatric Society.

Being elected as a Fellow and Life Fellow of the American Psychiatric Association.

Tom Buchanan served in many ways at First Baptist Church of Pompano including, being ordained as a Deacon in 1967, teaching a men's Bible class, singing in the choir for many years, serving as a Youth Choir Sponsor and traveled as the group's physician on Concert Tours, serving as a member of the Finance Committee and advisor to the Pastor for programs involving counseling.

His wife remained his Sweetheart.

His family was his first priority -  his pride and joy.

His children loved him dearly.

He cherished his wonderful friends. He found time for whomever needed him, and his beautiful smile and infectious laugh warmed the hearts of all who knew him.

Thomas K. Buchanan, M.D. is survived by his wife, Donna; his children Julie Kay Drewry, Thomas K. Buchanan, Jr., Mary Anne Cooley; five grandchildren, Bradley Thomas Drewry, Thomas Kay Buchanan, III, Elizabeth Anne Buchanan, Lauren Alexandra Cooley, and David Thomas Cooley.

Psychiatrists at North Florida Evaluation and Treatment Center have been locked in battle with their administrator, Denny Gies, and institution psychologists, led by Monte Bein, Ph.D., Director of the NFETC Psychology Department, over what has been termed the "Matrix"-the "Shared Responsibility Treatment Team Model."  Historically, this forensic hospital located in Gainesville, FL, has treated  persons identified as incompetent to stand trial or not guilty by reason of insanity using a Multidisciplinary Treatment Team (MDT) led by a psychiatrist.  I personally had the opportunity to work under this traditional model for one year in the late 80's while in my forensic psychiatry fellowship and recall this approach having worked smoothly and effectively, with good team morale and an orderly chain of command. 

The Matrix, developed and spearheaded by Mr. Gies, is a document which explicitly requires agreement by non-medical personnel in the medical decision-making process.  The attempt to implement this plan has led to chaos in team functioning, with conflicts over responsibilities and leadership, arguments among MDT members, decreased morale, and a tense work atmosphere.  All of these factors impair communication among team members, ultimately affecting the ability of the MDT to administer quality medical care.  One is reminded of the nefarious vying for power and leadership in the novel "Lord of the Flies."   Relatedly, of great concern and adding to the chaos, is the appointment of a non-medical individual, Mr. Don Walsh, to the medical directorship following the resignation of their psychiatrist Medical Director about two years ago.  Thus, the psychiatrists have lost an administrative voice to protect the dispensation of quality medical care.

The NFETC psychiatrists sought relief by requesting a Declaratory Statement by the Florida Board of Medicine.  Reportedly, Mr. Walsh and a member of the Department of Children and Families (DCAF) program office attempted to have the Board of Medicine delay their ruling on this matter.  Notwithstanding, the Board recently ruled (June 2000) in favor of these beleaguered physicians', stating that if they practiced under the Matrix's shared responsibility model, it would constitute substandard care.  And the Board of Medicine does have the authority to interpret "standard of care" requirements for physicians.  Of note, in the Declaratory Statement, the Board of Medicine noted that Mr. Gies had "...announced that the petitioning physicians would no longer have final clinical decision-making authority regarding the treatment of patients at the facility [NFETC]."   Moreover, the Matrix would "...shift final decision-making authority to a team of physicians, psychologists, and administrators."

Did this ruling actually bring relief for these physicians?  No.  Mr. Gies and his supporters are pushing ahead with the Matrix.  Dr. Bein has told the psychiatrists that his department will continue to practice under the Matrix.  Treating psychologists under his auspices have parroted his position to the psychiatrists.   Social workers are experiencing confusion over what model to follow.  An investigative group from Department of Children and Families came to NFETC to investigate this situation, but did not support the position of the physicians.   DCAF reportedly did support the reestablishment of a physician to serve as the medical director but we have not seen the report.

Currently, the psychiatrists are faced with practicing under the Matrix, putting them at risk of loss of licensure, malpractice suits, and violations of the AMA Code of Medical Ethics, or not practicing at NFETC.  Neither alternative serves the health care needs of the chronically mentally ill patients at NFETC, who have become sacrificial lambs in this thinly veiled scope of practice issue.  Mr. Gies responded to the psychiatrists' proclamation of their inability to practice in this setting by noting, "If you feel you can no longer work here, I will assist you in relocating."  Presumably, he hopes the next batch of physicians will not be so attentive to the standard of care.

Heraclitus once said,  "Nothing endures but change."   After 29 years as separate district branches the reintegration of the Florida Psychiatric Society and the South Florida Psychiatric Society has been successfully completed.  The time for the change was right.  We now must focus on our mission as a collective organization.  Our goals are, and have been, the same for many years.  Gone are the sports and military analogies in which we are competing with each other.   Much of this year will focus on continuing the process of integration.

We will continue to focus on three main areas:

1)      Membership

2)      Advocacy

3)      Finances

Each member of the society is truly an asset.  Among other things, we exist for the benefit of our members.   We will continue to look to increase recruitment of new members and decrease attrition of our current members.  I and other FPS leadership will attempt to attend as many as possible of the Chapter meetings around the state.  We will demonstrate that the FPS leadership is serving its members.  We will use these opportunities to understand what the problems each psychiatrist is encountering in their part of the state.  We will share with each of you what we are trying to accomplish and what we are actively trying to do about it.    Understanding the process is important.  Participation is a must! 

Advocacy comes in many forms.  We are definitely continuing our work on scope of practice issues.  Non-physicians from all fields are trying to expand the scope of their practices, affecting quality of care and potentially endangering the lives the patients.  We expect to continue to address the plight of the mentally ill throughout the state.  Parity or nondiscrimination of mental illness remains a priority.  Advocacy for patients, the public and psychiatrists across the state will remain a priority. 

Finances and fiscal responsibility are important issues as old as time.  With the reintegration of the Societies we find ourselves in a unique situation where we can take a step back and look at our financial situation (as if we hadn't done it before).  We hope to be opportunistic and utilize the situation to examine if the grouping of the memberships will allow for different opportunities in the use of our precious financial resources. 

As many of you know, Dodi Shellow is retiring as Executive Director of the SFPS.  We hope that she will remain as consultant to FPS.  Her dedication, energy and expertise will be missed.

Our FPS staff remains tireless in their efforts.  Emily Grimm has returned as Associate Director and will work on meeting planning and continuing medical education, marketing and fundraising for the FPS PAC and Foundation.  Jan Starnes will serve as the Director of Member Services and will manage both the process and experience of membership as well as office accountability and database management.  Cam Fentriss will continue her adept work as government relations consultant.   And last but not least, Margo Adams enters her 75th year as Executive Director of the Society.  She is the driving force behind the daily operations.  Her leadership is invaluable.   

Success revolves around member involvement - in FPS committees, attendance at the fall meeting and increased interaction with members from around the state.  You may have heard all of this before but IT'S NOT CORNY,  IT'S TRUE.  I look forward to this exciting year.  Please feel free to contact me at:

e-mail:      dcastell@med.miami.edu

PH:         305.355.7077 (mornings)

            305.446.0085 (afternoons)

And then there was one...  The visible aspects of the merger of Florida's district branches have been accomplished or are well underway.  Much has been written, much has been discussed, and much remains to be done.

Adding three hundred members at one time from a well-managed but differently structured database is a challenge that can be met.  Adding to and managing that information in a database that is already fraying at the edges is a challenge not so easily met.  Our database use is multipurpose and complicated.

Meeting the challenges of a membership organization today requires more information on member preferences and expectations, member interests and needs, and member contacts with the organization, its programs and services.  Our information system needs work and we are researching solutions. 

We have already done some work on our communications systems.  The office has reasonably up-to-date computer and fax communication capability.  We have recently purchased a new telephone system that has added a line, and improved the use of the existing lines.  Members will be able to call toll free.  Busy signals should decline significantly and if we are unable to answer a call, there is an auto-attendant to direct calls to a limited number of voice mailboxes.  We hope this makes it easier to get the person or information you need.

We have added staff and assigned responsibilities as follows.  Emily Grimm has returned as Associate Director, with primary responsibility for meeting planning and marketing, continuing medical education, and fundraising for the PAC and the foundations.  She will also serve as Managing Editor of Transference and manage our electronic communications. 

Jan Starnes is now Director of Member Services, and is responsible for the process and experience of membership, chapter relations, office accounting and management.  She also handles most of the referrals requested at the office. 

I continue to oversee legislative and regulatory activities, manage staff and volunteer resources, manage liaison and outreach activities, provide budgetary and financial oversight, ride herd on the APA and FMA, and we all focus on communication and information.

We continue to be assisted by Cam Fentriss, our talented and ferocious government relations consultant.  Cam implements our legislative program and is always willing to lend her considerable expertise to legal and business matters as well as advising our PAC.  Though not staff, she is family.

Upward and Onward  The adoption of reunification bylaws has provided a viable organizational structure.  The successful transition of officers from both district branches into a single slate has provided diversity, experience and new ideas.  We are financially sound for the present, and planning for the future.  Moving to a statewide organization was the right thing to do.

President Dan Castellanos has asked FPS leadership to prioritize membership, with the goal of increasing both numbers and participation.  FPS will evaluate our finances - making sure there are adequate resources to meet member needs and organizational goals and objectives.  FPS will evaluate our administrative structure - making sure we are lean and mean.  FPS will evaluate our programs and services - making sure we provide value and quality in everything we present to members and the various publics we also serve.

It is not possible to be all things to all people, but we can take the time to learn what matters most to FPS members, and set about meeting those needs.  Cost and value must receive equal consideration.

And in other news  We have also been busy with substantive psychiatric issues as well as organizational ones.  FPS member Ray Pomm serves on the Florida Mental Health and Substance Abuse Commission.  Dr. Pomm has been thoughtful and provocative as a member of the Commission.  He has brought good ideas and enthusiasm to his task.   And has been a pleasure to watch.  A draft of the commission report should be ready for review by early fall.  This year's legislative session added several items to the commission's charge.

Drs. Yelton, Hernandez, Infante and Gabb, psychiatrists at the North Florida Evaluation and Treatment Center, continue to battle for appropriate medical responsibility and authority in the multidisciplinary treatment teams used at the facility.  The administrator continues to try to portray this concern about patient care as physician arrogance and desire for control.  The Department of Children and Families has yet to respond in support physicians in spite of a declaratory statement from the Board of Medicine which establishes that the administrator's Shared Responsibility Matrix does not meet the standard of care expected of physicians.

FPS continues to monitor plans to close GPW and shift patients to other facilities or community based care.  We have expressed concern to the Secretary of DCF and received a letter assuring us that there was a plan to place and care for patients displaced by the hospital closure.  Community and advocacy concerns have not been quieted by what information DCF has released or made public through the media.

FPS has also responded to two members who asked for help in challenging 1) a psychologist's attempt to get prescribing privileges at a VA facility in Florida and 2) a psychology inspired assertion that current law requires that hospitals give psychologists medical staff membership.  It doesn't.  We welcome those calls!!

Greetings from FPS Headquarters!  I am excited to return to the Florida Psychiatric Society as your Associate Director. 

One of my responsibilities is to ensure that FPS has successful CME meetings each year and I am so excited about the meeting we have in store for you this fall, so Save The Date - the Fall 2000 Meeting will be October 5 - 8, 2000 in Fort Lauderdale, Florida.

This fall meeting will be the first meeting that South Florida Psychiatric and Florida Psychiatric are officially one District Branch.  The reintegration of these two District Branches brings our membership to over 1,100 members.  Make plans to attend the 2000 Fall Meeting - October 5 - 8, at the Hyatt Regency Pier 66 in Fort Lauderdale.  What a great opportunity to see old friends and make new ones.   The Florida Psychiatric Society CME Committee has planned over 7 hours of CME for you that include speakers from all over the country.  There will also be many wonderful opportunities for networking with psychiatrists from around the state. 

Auction at the Fall Meeting!!!!  
As you have requested, FPS will have a silent auction at the meeting in Fort Lauderdale.  This auction will have vacation getaways and other prizes that you won't want to miss.  The auction will open for bidding on Saturday October 7 and will close at the end of the Reception Saturday Evening!  Ask around, last year we had some incredible auction items available.  I know you won't want to miss this one.

You should receive your Fall Meeting mailing shortly.  This will provide you with the information necessary to register for the Fall Meeting, to reserve your hotel room and to find out about the interesting and exciting topics your CME Committee has provided for you!  This fall meeting will provide you the opportunity to earn your much-needed CME as well as pay tribute to a very special psychiatrist, Tom Buchanan.  Tom Buchanan, M.D., who passed away in 1997, helped to shape mental health care in Florida.  At the fall meeting we will pay tribute to Dr. Buchanan for all that he did to promote the practice of psychiatry in Florida.  (For more information about Dr. Buchanan, please see article on page 13.) This will be a meeting you do not want to miss. So, mark your calendars for a fun filled weekend in Fort Lauderdale, FL. 

Pharmaceutical Representatives?
All members come in contact with pharmaceutical representatives and FPS would like your help in finding out who they are.  If you would please forward their business cards to me I would greatly appreciate it.  The financial success of our meetings depends largely on financial support from outside sources including pharmaceutical companies.   Please send me their business cards or email me their mailing information at Emily@floridapsych.org so that we may provide them information about how they can help FPS by participating at our fall meeting. This meeting will be one of our biggest and most important yet and we need financial support from the pharmaceutical industry - so please, get them involved!

Don't forget our web site: http://www.floridapsych.org  Phillip Cushman, MD, spends an enormous amount of time and energy maintaining the site and is constantly finding new and innovative ways to improve the site and make it more user friendly.

FPS Classifieds!  
We have a classifieds page for members and non-members.  This is a great way for you to advertise at a minimal cost! For more information contact the FPS Office.

Email
Do we have your email address? We have had much success using email to ask members about job openings and opportunities for Psychiatrists moving into Florida.  This is very beneficial as it will increase our membership and fill job vacancies you may have.  Email is an efficient and inexpensive method of communication, which I love to use.  Please call me at 800-521-7465 or email me at Emily@floridapsych.org you would like to provide us with your email address.

I hope you have a wonderful summer and we look forward to seeing you in October in Fort Lauderdale!

The first auxiliary formed by spouses of any state psychiatric society, Florida's Psychiatric Society Auxiliary has a long history of member assistance and community education.  But more than anything, its members value the bonds formed among one another as they planned and executed social and assisting projects.

While this organization has provided some of the extras that make the Society's meetings memorable, such as staffing, greeting teams and selecting and paying for live dance bands for its semi-annual dinner dances, it has also taken on siginifcant challenges.

For example, in recent years the auxiliary has provided tasteful decorations and furnishings for the Society's offices in Tallahassee and has helped pay for the reproduction of a series of videotapes explaining the value and effects of psychotherapy.  These tapes are disseminated upon request from the Tallahassee office to schools of nursing and medical schools, to civic groups and to local chapters for use in their community relations efforts.

The Auxiliary also arranges outings and activities for spouses and children during each semi-annual and leadership meeting, promoting good will and fellowship among members.  During the recent semi-annual meeting in St. Petersburg, Auxiliary members went to the nationally touring John F. Kennedy Exhibity after a brief business breakfast.

Although the South Florida Psychiatric Society has  not had an active auxiliary in recent years, the FPS Auxiliary is hopeful to gain new friends from South Florida and encourage spouses to come to the FPS Fall Meeting at the Hyatt Pier 66 in Fort Lauderdale Florida.  The FPS meeting is October 5 - 8, 2000 and the Auxiliary will meet on Saturday, October 7.

At that time, Sharon Merritt, President, will open a discussion of "Welcoming New Members, Determining New Directions" for the statewide auxiliary.  "We want members to enjoy and look forward to these meetings, knowing that friendships made will continue over the years and that they will have an opportunity to participate in meaningful, fun activities."

Drugs differ from dietary supplements in vital ways according to Paul Doering, Professor of Pharmacy Practice at the University of Florida College of Pharmacy. Drugs must pass scrutiny of the FDA clinical trials whereas vitamins, mineral, herbs, and dietary substances add to the diet in some way and the burden of safety is shifted to the FDA to prove they are unsafe. A number of alternative medicines are known to be effective and safe.

Among the most widely used and considered to be safe is Ginkgo (ginkgo biloba) which has mild posited effects when used to enhance memory. It is used for cerebrovascular insufficiency or mild dementia. It is safe and comes from the leaf of the plant and the active ingredient is flavinoids, which interact with anticoagulants due to effects on platelet function and monoaminoxidase inhibitors. It is usually well tolerated, although it takes several weeks to take effect. Consumers are advised to look for a standard extract and select a name brand. 

Kava Kava (piper myristicum) is a pharmacologically active depressant used to treat insomnia, anxiety and seizures. It is safe for short-term use and comes from the root. It interacts with alcohol and is often used recreationally, consequently it can be abused. 

St Johns Wart is used for depression. In Germany, sales outnumber those for Prozac by 7 to 1. No one knows the active principle. It has an effect on spontaneous behavior. It has drug interactions with Indinavir used to treat HIV, and other antiretroviral agents, oral contraceptives, cyclosporine, digoxin, quinidine, SSRI's, MAOI's and has an effect on the P450 pathway.  It is photosensitizing. Consumers should use a sunscreen if they are to be exposed to sunlight. 

Valerian root (blaerana officianalis) is used to treat insomnia and anxiety. It is felt to be safe for short-term use. The root contains the active part of valerinic acid. Adverse effects include morning drowsiness and headaches. 

Ephedra ma hu or ephedrines and guarana concentrate consists of naturally occurring caffeine plus 16 other ingredients. It is a potent source of caffeine and causes tachycardia. The FDA is concerned about its use in consumers with cardiac disease. 

Other supplements such as DHEA and phito estrogens including soy supplements are considered risky for a variety of reasons and consumers are advised to read about them and seek authoratative advice before using them. 

Jorge L. Armenteros, M. D., assistant professor of pediatrics and psychiatry at the University of Miami, describes schizophrenia in children as a deterioration in functioning, i.e. a failure to achieve the expected level of interpersonal, academic or social achievement. Normal mental processes such as sensation, perception, language, emotion, interpersonal relationships appear to go completely awry. Children with the disorder lose touch with the real world. It is likely more than one disease entity. Whereas one percent of all adults have schizophrenia, it occurs in only 0.5% of adolescents and only 0.19% of children below the age of 12. Schizophrenia in chilgren is rare, happening less frequently than autism. The modal age of onset is between 21 and 22 years of age. Females develop it later than males. It is thought that perhaps estrogen, especially estradiol, may serve as a protective agent. Prevalence is higher in poor urban areas giving rise to the "social drift" theory of mental illness. 

In children, auditory hallucinations are the most frequently reported symptoms, but visual hallucinations appear to be quite common as well. The onset is usually gradual and can often initially present as a mood disorder. Treatment of the family is critical issue. The prognosis is generally poor, but is better if there are affective symptoms and a paranoid subtype. The earlier the onset, the worse the prognosis. 

The most effective treatment includes educational and family interventions, hospitalization to stabilize the situation using medications and psychotherapy, which consist primarily of promoting ego boundaries and strengthening reality testing. The neurotransmitters implicated include dopamine, acetylcholine, seratonin and norepiniphrine. The newer antipsychotics offer great potential benefits due to the fact that they treat both positive and negative symptoms, thus improving functionality. 

Clozapine has been available since the early 60s. It is associated with a 4% weight gain and a 1% risk of agranulocytosis at one year. The optimal dose 300-600mg. Side effects include sedation, seizures, syncope, dizziness, and tachycardia. 

Risperdol was introduced in 1992. Its optimal dose is 4-6 mg per day. Side effects include extra pyramidal symptoms, which are dose-dependent and weight gain, which is significant. The satiety is blocked; since you don't know you are full, you keep on eating. Weight gain usually occurs within about two months. Patients' families must be educated. Time to maximum weight gain is 6-15 weeks and can represent a serious threat to longevity due to a risk of hepatotoxicity due to the rapid weight gain. It can cause fatty liver due to rapid gain. Liver enzymes should be checked. If they are abnormal, they should be investigated. The drug might have to be discontinued. As the dose is increased, the blockade of D2 increases so the incidence of parkinsonian symptoms increases. 

Zyprexa is effective in improving positive and negative symptoms. It has a low incidence of extra pyramidal symptoms. It does produce weight gain which is about 7% above optimal. Somnolence is usually transient.  

Seroquel is less effective, but the weight gain is slightly less. Its optimal dose is above 300mg.  

Ziprasidone is not yet on the market. It is not clear that it will have a true advantage over Risperdone.

Senator George McGovern's first contact with mental illness came immediately following his nomination for the Presidency in 1972.  His selection of Thomas Eagleton as his running mate led him to defeat.  Senator Eagleton was a dynamic, well-respected man who also had a well-controlled manic depressive illness.  A firestorm of stigma against mental illness brought down his campaign.  Senator McGovern called a trusted psychiatrist friend for advice and was told to drop Eagleton from the ticket.  Dismayed by that suggestion, he called Carl Menninger, who expressed his condolences to McGovern and told him he had already lost the election due to our nation's inability to deal comfortably with mental illness.  As a result, other issues would no longer be a focus of the campaign.  Dr. Menninger's assessment was dead-on.

Senator McGovern was summoned to the door late one night to learn his daughter had been found dead in a snowdrift in Madison, Wisconsin, thus bringing her battle with alcoholism to an end.  She had a long history of mental illness and had the benefit of innumerable inpatient stays and psychotherapy.  He commented,  "I feel sad when I think of her and always will." His talk was the most poignant one given at the Annual Meeting.  Hopefully the sharing of his experiences will help lessen stigma against mental illness and substance abuse in this country. 

The Texas Society of Psychiatric Physicians has developed a Utilization Review Complaint Service providing a benefit for members who experience difficulties with managed care.  It is now possible to address those issues within the state rather than through the APA.  We plan to begin organizing a similar service in Florida over the next few months and it will be discussed at the leadership retreat in June.

The manufacturers of a Transcranial Neuromagnetic Resonance machine told me that approval by the FDA is eminent.  The machine will be available for use within the next few months.  Billing codes will not be in use until January, so it will not be able to be used by insured patients until then.  Studies show equal efficacy with ECT for depressed, non-psychotic patients.  Reboxitine, a new norepiniphrine reuptake inhibitor will not be on the market until around the first of the yeas due to the FDA decision that clinical trails on American citizens are required.

In an effort to enhance the analysis and interpretation of quantitative data already collected from the Practice Research Network (PRN), Substance Abuse Treatment Focus Groups were held during the Annual Meeting. Being a participant in a focus group was an invigorating experience.  Any APA member is eligible to join the PRN and be a participant in gathering data to improve the scientific basis of our field.

Every practice, whether private or in a mental health clinic where Medicare or Medicaid patients are seen, should have a Medicare Compliance plan, according to Michael Murphy, M.D.  We heard horror stories of large fines being levied against doctors in private practice and medical directors of community medical centers due to coding errors.  In a four-hour CME course, the reasons were presented for having a Compliance Plan and evidence of ongoing activity to support it should be available in case either the carrier or Medicare officials chose to investigate your practice.  Members are encouraged to attend a meeting concerning Medicare Compliance and develop a plan of action to protect themselves against possible dire consequences.  A copy of a model plan will be provided for those who are interested.