University of Iowa Health Care – Page 5

U.S. News & World Report Ranks Iowa City Hospital in 9 Specialties

The University of Iowa Stead Family Childrens Hospital in Iowa City has ranked in 9 pediatric specialties, including pediatric behavioral health by U.S. News & World Report!

Thoughts on the Big Mo Pod Show “Funkin’ Down the Highway”

This is a post about the Big Mo Pod Show we heard last night on the KCCK FM radio dial 106.9. Incidentally, the KCCK fund drive was enormously successful this year, earning $100,000 in donations, according to Big Mo (aka John Heim) himself.

One item is the cover by Buddy Miles of the song “Tobacco Road.” This rendition was different from performances by other artists. Big Mo liked it and so did I. I did a little web search on it because I couldn’t catch all the lyrics. It was originally done by John D. Loudermilk in 1960. Miles’ version is essentially the same.

What interested me even more about “Tobacco Road” are the associations I have about it with specific literary works. I’ll admit I’ve never read nor seen the film adaptations of Erskine Caldwell’s books, “Tobacco Road” and “God’s Little Acre.” But one of my favorite short stories by James Thurber is “Bateman Comes Home,” which was published in a collection entitled “The Thurber Carnival,” in a hardcover edition in 1945. You’ve got to read it to get a sense of how comical the parody is of the regional dialect used in Caldwell’s novels. In fact, Thurber himself gives the game away about his intent in writing “Bateman Comes Home” by adding a wry comment as a subtitle:

Written after reading several recent novels about the deep south and confusing them a little—as the novelists themselves do—with “Tobacco Road” and “God’s Little Acre.”

He also adds another comment at the end of the short story: “If you keep on long enough it turns into a novel.”

The other thing I noticed about the podcast last night is that one of the songs which was not included in the list, “Joliet Bound,” was performed by an artist I haven’t heard of, the Reverend Shawn Amos, who is no relation to me, of course. But my background as a psychiatrist made me take special notice of details about his family, one of which is that his mother, Shirl-ee Ellis, a singer herself, had been diagnosed with schizoaffective disorder. Sadly, she eventually died by suicide. Shawn Amos is also the youngest son of the Famous Amos chocolate chip cookie founder, Wally Amos (again, no relation), although I’ve gotten a lot of friendly ribbing about that.

The song “Joliet Bound” is about a guy who expresses that he’s wrongly accused of killing a man over a woman and is on his way to Joliet prison in Joliet, Illinois. The Joliet Prison is a tourist destination nowadays and has other distinctions attached to it. It was featured in the 1980 film, the Blues Brothers. There were some famous inmates there, among them John Wayne Gacy, who was once evaluated and diagnosed with antisocial personality disorder by psychiatrists at The University of Iowa in 1968 as described in Dr. Donald Black’s book, “Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy).”

Congratulations KCCK Radio!

Can Artificial Intelligence Learn from My Book?

Recently the publisher of a book co-edited by me and my former psychiatry chair Dr. Robert G. Robinson asked me to sign off on a proposal to involve Artificial Intelligence (AI) in using the work.

The book, “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry,” is 14 years old now, but is still a practical tool for learners, at least in my opinion.

Interestingly, it looks like the publisher is also trying to contact Dr. Robinson about the proposal through me. I wonder if that means they’re having as much trouble finding him as I have.

I’ve made it clear that I have misgivings about AI, as I’ve indicated in at least one blog post about Google’s AI, which used to be called, Bard which I think has been renamed Gemini. I think AI is prone to spreading misinformation, which has been called “hallucinations” by some writers.

The publisher makes it clear that this proposal regarding AI involvement in our book is an “opt in” choice. I gather that means if I don’t opt in, they’ll continue to bug me about it until I do.

That’s unlikely to happen.

Thoughts on the Homeless Mentally Ill

The homeless man who lives on the sidewalk outside our hotel reminds me of a couple of things. One is Dr. Gerard Clancy, MD who is University of Iowa Health Care Professor of Psychiatry, Professor of Emergency Medicine, and Senior Associate Dean of External Affairs.

I remember Gerry, who was in the department of psychiatry when I was a resident. I saw his picture in the newspaper and hearing about him riding a bicycle around Iowa City doing a sort of outreach to the homeless mentally ill.

I found an archived article mentioning him published in 1995 in the Daily Iowan. The story starts on the bottom of the front page, entitled “I.C. opens new doors for area’s mentally ill.” It continues on page 9A.

The story mentions Dr. Clancy and what was called then the Clinical Outreach Services and the Emergency Housing Program (EHP). The challenges then sound a lot like what they are now: long waiting lists for psychiatric evaluation and treatment, a lack of funding for the treatment of mental illness, and a lack of preventive care. The most common mental illnesses in the homeless mentally ill are chronic schizophrenia, schizoaffective disorder, and bipolar disorder. The idea of reaching out to them “on their own turf” as Clancy was quoted, was to help them feel more comfortable talking about their mental illness.

The housing situation for this population of those struggling with mental illness was dismal then and it’s still dismal.

The homeless guy I’ve been calling Bob lives on the sidewalk next to a busy street. It’s just my opinion that he’s mentally ill based on my observations of his behavior. I’ve never tried to talk to him. However, Bob gets visits from people who obviously have differing views about the way he lives.

Some of them do talk to him and, although I can’t hear their conversations, the actions tell me important things. Some bring him what I call “care packages,” often food, water, and other items. They may start by acting kind, although may get impatient with him. Others try to clean up his sidewalk, and may criticize him. The police occasionally visit and have so far not taken him into custody.

It looks like things have not changed much since 1995 regarding the homeless mentally ill based on what I write here about my observations. In fact, it’s easy to find current news stories that say things are getting worse.

At the beginning of this post, I said I found a couple of things. The other thing was a very thorough teaching presentation about the current state of formal outreach to this population. It’s available on the web as a power point presentation by another University of Iowa faculty, Dr. Victoria Tann, MD, entitled “Assertive Community Treatment 101.”

Dr. Tann is currently an IMPACT Team psychiatrist. It’s an excellent source of background on the history of this effort at outreach to the homeless mentally ill. It also summarizes what’s happening with the program now.

Thoughts About Psychedelic Assisted Psychotherapy

I read the Psychiatric Times article “FDA Issues CRL to Lykos for MDMA-Assisted Therapy.” The short story is that the FDA essentially told the drug company Lykos that their study of the efficacy of MDMA-assisted treatment of PTSD needs more work.

I tried to wade through the on-line documents of the FDA’s meeting on June 4, 2024. There are hundreds of pages and I didn’t go through every page of the transcript. The minutes were succinct and much easier to digest.

I’m going to simply admit that I’m biased against using psychedelics in psychiatry for personal and professional reasons. I’m not a research scientist. I’m a retired consultation-liaison psychiatrist. I saw many patients with a variety of psychiatric diagnoses including PTSD and substance use disorders. I’m not opposed to clinical research in this area, but I’m aware of the difficulty of conducting it.

In that regard, I want to also admit that I’m very susceptible to being influenced by a former colleague’s remarks about the quality of the research in question in the Lykos study. Dr. Jess G. Fiedorowicz, MD, PhD formerly was formerly on staff at University of Iowa Health Care. He’s now the Chief of Mental Health at The Ottawa Hospital where he’s also Professor and Senior Research Chair in Adult Psychiatry, Department of Psychiatry, University of Ottawa, Ontario. His remarks in the transcript are typical for his erudition and expertise as a clinician scientist.

It’s difficult to wade through the pages of the FDA transcript and I couldn’t digest all of it, by any means. But if you’re interested in reading both sides of this issue, it’s a good place to get the best idea of the committee members’ thinking about it. The minutes are much easier to read and provide a succinct summary.

I realize the Psychiatric Times article editor doesn’t agree with the FDA recommendations for further study of psychedelic-assisted psychotherapy for PTSD. It may or may not influence the University of Iowa’s study of psilocybin. In my opinion, the FDA did the right thing.

Rounding at Iowa: New Treatments for Alzheimer’s Disease

This is one of the latest Rounding@Iowa podcasts and it’s about new treatments for Azheimer’s Disease, with one specific agent called Lecanemab.

I’m an old psychiatrist, and I remember my clinical impresson of the previous medications for Alzheimer’s Disease, one of which was Donepezil. The scientific literature seemed to suggest that patients and families were more impressed with Donepezil than clinicians were.

According to Dr. Shim, one of the participants in the podcast, it’s been 20 years since there has been a new treatment for Alzheimer’s Disease-and the long term effectiveness of Lecanemab is uncertain.

In addition, there are significant risks associated with the agent as well. As you can guess, it’s very expensive, and while Medicare pays for some of the cost, the podcast participants mentioned that it was difficult to get some treatment monitoring imaging studies covered.

Patients and their physicians need to have a full discussion of the risks and benefits of treatments for Alzheimer’s Disease. It’s just as important to avoid the use of certain drugs that are known to worsen cognitive function, such as benzodiazepines and anticholinergics.

87: New Treatment Options for Menopause – Rounding@IOWA

Join Dr. Clancy and his guests, Drs. Evelyn Ross-Shapiro, Sarah Shaffer, and Emily Walsh, as they discuss the complex set of symptoms and treatment options for those with significant symptoms from menopause. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=81895 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Evelyn RossShapiro, MD, MPH Clinical Assistant Professor of Internal Medicine Clinic Director, LGBTQ Clinic University of Iowa Carver College of Medicine Sarah Shaffer, DO Clinical Associate Professor of Obstetrics and Gynecology Vice Chair for Education, Department of Obstetrics and Gynecology University of Iowa Carver College of Medicine Emily Walsh, PharmD, BCACP Clinical Pharmacy Specialist Iowa Health Care Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.00 ANCC contact hour. Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.) References/Resources:

Great Rounding@Iowa Podcast on Preventing & Managing Heat-Related Illness

The Rounding@Iowa podcast has many fascinating and helpful episodes, not the least of which is this one on heat-related illness. The days are getting hotter and we need to pay close attention to what happens in our bodies when exposed to excessive heat.

87: New Treatment Options for Menopause – Rounding@IOWA

In Memory of L. Jay Stein

I was thinking of one of the Johnson County judicial mental health referees I often worked with years ago. L. Jay Stein died in 2014. I looked up his obituary the other day and was a little surprised to find I had written a remembrance for him. I’d forgotten it.

“I will always remember my first encounters with Judge Stein. I was a first-year resident in psychiatry at The University of Iowa Hospitals & Clinics. He often presided at mental health commitment hearings at which I was often the nervous trainee providing “expert testimony” as the treating physician. Jay taught me and countless other psychiatry residents about the importance of procedure. His knowledge was prodigious. But it was his compassion, his fairness, and his inimitable sense of humor I will always treasure.”

Judge Stein’s vocabulary was impressive. Even his recorded telephone automatic replies sounded amusingly erudite. Occasionally, when I had a question about legal procedures in mental health I would call him but get his answering machine. These out of office replies were entertaining and sounded very much like the way he did during commitment hearings. I can’t remember all of it, but it began with something like, “Once again, your request has been denied…” It made me think of what I might hear at a parole hearing—not mine of course.

L. Jay Stein was wise and funny.

Rounding At Iowa: Smoking and Vaping

I just want to give a shout out to University of Iowa Health Care and the Rounding@Iowa podcast for an outstanding presentation on the hazards of smoking tobacco, vaping, and dabbing.

The program originally aired on May 14, 2024 and the guests included two ICU doctors who are pulmonologists I’ve worked with as a psychiatric consultant. They are very dedicated.

There was a third guest and he is a patient who vaped and suffered disastrous consequences leading to lung transplant surgery. His insights are invaluable.

Breathing is good; not breathing is bad.