The Covid-19 pandemic and the resulting social and environmental changes exacerbated an already existing crisis of children’s mental health. Reports by researchers, clinicians, families, and youth have documented increasing rates of depression, anxiety, and suicidal behaviors among youth. The national declaration the children’s mental health emergency by AACAP, AAP and CHA called attention to worsening access to care that had existed prior to the pandemic. The pandemic also highlighted disparities in health care access and treatment, especially for minoritized populations and girls, and the impact of social determinants of health as major drivers for health outcomes, including mental health. Unprecedented national focus on children’s mental health, highlighted by the surgeon general’s report, provides opportunities for psychiatrists along with other mental health professionals to create mental health systems that will better serve our nation’s youth and families.

Mental disorders arise from brain circuit dysfunctions, but most of our treatments target the whole brain rather than defined circuits. Deep brain stimulation (DBS) is a more circuit-directed approach that has done well in movement disorders but has very mixed results in randomized clinical trials for mental illness. Part of the difficulty is that psychiatric DBS is delivered in a trial-and-error fashion, without clear evidence that it engages the target circuits. I will discuss new strategies for developing biomarkers to guide that target engagement, centered around the idea of understanding how brain stimulation changes cognition and decision-making. We have identified ways in which DBS can augment top-down executive function and have linked those changes to cortical electrophysiology. In animals, we have developed new approaches to understand how those changes occur and how we can leverage them for clinical benefit. Taken together, these offer the prospect of a new generation of rationally designed brain stimulation therapies.

This presentation was originally reviewed on July 26, 2023, and broadcast live online on July 26, 2023, from 12:00 PM – 1:00 PM ET. 

There is a great deal of interest in the relationship between the immune system and in particular inflammation and psychiatric syndromes. This presentation focuses on the relationship between inflammation and mood disorders. The goals of the talk are; (1) to distinguish between acute and chronic inflammatory states, (2) discuss the impact of peripheral inflammation on dopamine and glutamate systems of some people with inflammation and major depressive disorder, (3) review a series of studies we have performed exploring inflammation, depression and the resolution of both inflammation and depression with a high dose omega-3 fatty acids.

In his new theory of suicidal behavior, Thomas Joiner proposes three factors that mark those most at risk of death: the feeling of being a burden on loved ones; the sense of isolation; and, perhaps chillingly, the learned ability to hurt oneself. He tests the theory against diverse facts taken from clinical anecdotes, history, literature, popular culture, anthropology, epidemiology, genetics, and neurobiology--facts about suicide rates among men and women; white and African-American men; anorexics, athletes, prostitutes, and physicians; members of cults, sports fans, and citizens of nations in crisis.

This presentation was originally reviewed on July 3, 2023, and broadcast live online on July 12, 2023, from 12:00 PM- 1:00 PM ET.

Climate change presents the mental health professions with profound challenges in responding to and preparing for acute and chronic, multifaceted, mental health needs in individual patients, families, communities and our larger society. Mental health professionals can be as disoriented as others in integrating the evolving realities of climate change and our multiple social crises. However, we do have understandings and skills that are pathways out of disorientation. This presentation will assist the clinician in being more comfortable and capable in responding to and working with climate change realities and climate change material in treatment. Particular attention will be paid to issues for adolescents, young adults, and parents and what is required for “containment” of climate-related experience. There will be emphasis on the public health aspects of our work and the requirement that we deeply understand our predicament, as we must now “skate to where the puck is going to be”.

This lecture will discuss the concepts of trauma-informed care (TIC), why it matters, and that TIC is not simply a mandate to reduce seclusion and restraint rates. The speaker will review several models of care designed for acute care settings, from theoretical background to more practical implementation strategies. Attendees will learn specifics about seclusion and restraint data at Nationwide Children’s Hospital and learn about the challenges in gathering national data to benchmark. This lecture will describe how the pandemic and other confounders may have changed clinical practice of treating traumatized hospitalized youth, and potential ways to improve staff retention and family satisfaction.

This presentation was originally reviewed on June 19, 2023, and broadcast live online on June 21, 2023, from 12:00 PM- 1:00 PM ET.

This presentation was originally reviewed on May 12, 2023, and broadcast live online on May 18, 2023, from 12:00 PM- 1:00 PM ET.