Psychiatry Resident Researchers Have Their Eyes on the Prize

Competitive psychiatry got a boost in April when three young researchers stepped into the arena and presented their results before throngs (well, dozens) of fellow residents and other members of the Brooklyn Psychiatric Association.

In the town that gave the world the Dodgers, a famous bridge, Nathan's hot dogs, and the transgressive poetry of Walt Whitman, residents from the borough's three psychiatry programs squared off at Brookdale University Hospital Medical Center for the 19th annual contest sponsored by the Brooklyn district branch.

“It's the Super Bowl of Brooklyn,” said Ramaswamy Viswanathan, M.D., D.Sc., an associate professor of clinical psychiatry and director of the consultation-liaison service at the State University of New York Downstate Medical Center. He founded the competition in 1991.

Sports were more than a metaphor, as a member of the audience was appointed to ring a bell for the two-minute warning near the end of each 15-minute presentation.

Watching the proceedings were partisans from all programs and three judges who had reviewed their share of papers in their careers: Deborah Cross, M.D., president of the New York State Psychiatric Association and director of the adult outpatient psychiatric clinic at Westchester Medical Center in Valhalla, N.Y., and an associate professor of clinical psychiatry at New York Medical College; Fryderyka Shabry, M.D., director of psychiatry at Coney Island Hospital; and Alan Schatzberg, M.D., a professor of psychiatry and behavior sciences at Stanford University and APA's president-elect. Contestants were judged on both the content and style of their presentations.

Peng Pang, M.D., representing Maimonides Medical Center in Brooklyn, got the evening off to a smooth start with a talk on the utility of tai chi chuan in improving the quality of life and reducing depression and anxiety for cancer survivors. Tai chi evolved from Chinese martial arts 700 years ago. It emphasizes controlled, fluid movements and includes both physical and meditative elements.

Her review of prior literature found 13 randomized, controlled studies with 730 subjects on the topic. Most patients had some sort of physical limitations restricting their participation in conventional exercise.

Some studies used sham exercise as a control and found there was no difference physiologically, but sham exercise produced different outcomes compared with tai chi, said Pang. The theoretical basis of any effect was unknown, despite comparisons with physical exercise, reading, and meditation.

A meta-analysis of the studies found positive outcomes for quality of life in cancer patients. However, studies of anxiety and depression were so varied that it was impossible to draw significant conclusions of tai chi's efficacy.

Pang also presented the design of a study intended to answer many of the questions raised by her meta-analysis, including intragroup differences and longer-term follow-up.

Next, Brookdale's own Marina Smirnov, M.D., stepped into the ring, accompanied by raucous cheers from her disproportionately numerous fellow residents in the hall.

Smirnov discussed the role of clinicians' religious and spiritual beliefs in clinical practice.

“Psychiatry and religion provide alternative ways of looking at life,” she said. The two have not always played together nicely, reminding the crowd of Freud's view that religion was an obsessional system bordering on mental illness.

While religion and spirituality are often used interchangeably, the former should be seen as organized systems of beliefs and practices, while the latter is more of a subjective, internal appreciation of the divine, she said.

In a survey of fellow Brookdale clinicians, Smirnov found few significant differences in their spiritual beliefs when viewed through the lenses of gender, religious attitudes, and prescribing status. The only significant variable was how much patients talk about these issues.

“Clinicians didn't let their own beliefs influence discussions with patients on religious or spiritual issues,” she said. “If patients talk more about these concerns, the clinician became more willing to include them in the discussion.”

Regardless of their own religious or spiritual beliefs, clinicians should be sensitive to patients' beliefs, she concluded before leaving the stage to loud cheers from her fans.

After those two presentations, Carolina Klein, M.D., carrying the flag for SUNY Downstate Medical Center, had her work cut out for her. She rocked the audience immediately with a sudden shift in strategy to biological psychiatry.

Klein reported on a study examining the interaction of early life stress and Substance P in bonnet macaques. Substance P is a neuropeptide associated with psychopathology. The monkeys were stressed with variable foraging demands (VFD), in which they always received enough food but sometimes it was hidden within their cages, forcing them to search for it more intensively. Klein and her fellow researchers found that presented with these alternating high and low foraging demands, the macaques tended to cling more to their mothers after weaning but also showed less “huddling,” a measure of social interaction. However, there were no significant differences in Substance P levels between VFD and non-VFD cohorts.

Upon closer examination of the VFD group, they found that infant macaques that had clung more closely to their mothers had higher levels of Substance P as adolescents, while those that were more independent as infants had lower Substance P levels as adolescents.

“The lesson is not that Substance P causes elevated dysregulation of neurochemicals, but that it shows the vulnerabilities of the individual.”

Klein, too, left the stage to cheers from her visiting fans.

The three judges did some huddling of their own outside the hall as Pang retook the stage for a brief demonstration of the stately art of tai chi.

Cross, Shabry, and Schatzberg returned with a unanimous decision in Klein's favor, a decision that garnered her bragging rights in Brooklyn for the next year and a check for $250. The runners up each received $125 for their efforts.

Klein is not on a research track in residency, but getting involved in research adds scientific rigor to residents' training, she said, as she took congratulations from fellow Downstaters.

“We gain a skill in doing research instead of just learning the outcomes,” she said. “I think it also allows us to read the literature more critically.”

“All the presentations were excellent, but Klein's won the consensus vote of the judges,” commented Schatzberg afterward.

But there was more to the competition than intraborough glory and the winner's check, he added. “It promotes the intellectual and professional development of the residents and it gets them involved with their district branch and APA.”

Inspired by the Brooklyn DB contest, a similar contest has been started by the Queens DB, and a written-paper contest has been started by the New York State Psychiatric Association, said Viswanathan.

Schatzberg would like to see a similar program with nationwide scope. In any case, while he was the first APA president-elect to judge the proceedings, he will not be the last. The incoming president-elect, Carol Bernstein, M.D., has agreed to be a judge of next year's contest, and Viswanathan hopes that creates another new tradition. ▪